VARICELLA INFECTION

primary

infection

varicella

/chickenpox results in establishment of a lifelong latent infection of sensory ganglion neurons

of the latent infection herpes zoster/shingles begins 14-16 days after exposure
Reactivation

ETIOLOGY
Varicella

Zoster Virus

neurotropic human herpesvirus -herpesvirus enveloped with double-stranded DNA genomes encode more than 70 proteins

PATHOGENESIS
Transmitted
respiratory

secretions fluid of skin lesions

airborne

spread direct contact

Primary

infection
inoculation of virus

respiratory

Incubation

Period: 10-12 days

virus replicates in the respiratory tract brief subclinical viremia second viremic phase - Widespread cutaneous lesions Peripheral blood mononuclear cells carry infectious virus, generating new crops of vesicles for 3-7 days transported back to respiratory mucosal

late

incubation period permitting spread to susceptible contacts before the appearance of rash

 latent

infection

ganglia cells primary infection. herpes zoster

sensory
vesicular

rash dermatomal in distribution necrotic changes may be produced in the associated ganglia

CLINICAL MANIFESTATIONS
acute febrile rash illness common in children, not been immunized self-limited occur 24-48 hr before the rash appears

Fever
Malaise Anorexia

Headache
mild

abdominal pain

 initial

lesions are crusting new crops form on the trunk central or centripetal The average number of varicella lesions is about 300 Hypopigmentation or hyperpigmentation of lesion sites persists for days to weeks in some children

VACCINE
95% prevent typical varicella 70-90% prevent all disease Live attenuated virus second dose may be administered before age 4 years
>
provided

at least 3 months have elapsed since the first dose.

 children

aged 12 months through 12

years
recommended

minimum interval between doses is 3 months

second

dose can be administered at least 4 weeks after the first dose

TREATMENT

Choice: Acyclovir
20

mg/kg/dose maximum: 800 mg/dose Given as 4 doses per day for 5 days

initiated as early as possible

within

24 hr of the onset of the exanthem

does not interfere with the induction of VZV immunity. Intravenous therapy is indicated for severe disease and for varicella in immunocompromised patients.