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       Chicken pox
 
         Posted on :15:28:58 May 15, 2018
   
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       Last edited on:15:28:58 May 15, 2018
         Tags: chicken pox, varicella, zoster virus
 

Chickenpox is a common viral infection caused by varicella zoster virus. It is a highly contagious disease with secondary household attack rates of approximately 85% in susceptible individuals. Primary infection with this virus presents as chickenpox (varicella) and endogenous reactivation later in life causes a localized painful rash called herpes zoster (shingles).

Transmission of chickenpox is through inhaled respiratory droplets (eg: cough, sneeze) of affected person or by contact with skin lesions. It can also spread from skin rash of a person affected with shingles. The average incubation period ,ie; the time from exposure to onset of illness is 14-16 days(range:10-21days).The period of infectivity during which the affected person can transmit the illness to others is around 48 hours prior to onset of rash until all skin lesions get fully crusted.

Clinical features-Chickenpox presents with a prodrome of fever, malaise, sore throat, headache and loss of appetite, followed by skin rash within 24 hours. Rashes present as small itchy spots and bumps which later blister. Blisters are generally seen on a reddish base, classically described as “dew drop on a rose petal appearance”. Rashes have a centripetal distribution with more lesions on trunk and less towards peripheries. The number of blisters that develop varies widely among individuals, although up to 250-500 lesions can occur. Lesions can also develop in the oral cavity. New blister formation generally stops within 4 days and most lesions crust within 6-7 days. Crusts fall off within 1-2 weeks and may leave pigmented marks which take time to fade. This is generally a self limited illness which usually results in life long immunity. Usually, no tests are required for diagnosis, unless complications occur.

Complications- Chance of complications, though rare, is more in adults than in children, pregnant women, new born babies and immuncompromised individuals. These include bacterial super infection, pneumonia, meningitis, encephalitis (inflammation of brain), hepatitis, ear infection etc. So, persistent cough, breathing difficulty, headache, fits, severe abdominal pain, ear ache or discharge requires immediate medical attention. Infection during early pregnancy may pose a risk of fetal anomalies.

Treatment-Treatment is basically supportive with measures to control fever or body ache with acetaminophen and itching with calamine lotion or antihistamines. Antiviral medications like acyclovir or valacyclovir help to reduce the number of skin lesions formed and to get better faster, if started early itself. Taking adequate rest, wearing loose clothes to avoid skin irritation and drinking plenty of oral fluids to avoid dehydration is advisable. Maintaining adequate hygiene by bathing and avoiding scratching of skin lesions help to prevent secondary bacterial infection and scarring. Isolation of affected individuals is essential to prevent spread of disease.

Prevention-Two doses of varicella vaccine are 88-98% effective at preventing varicella. Rarely, vaccinated people may get breakthrough infection which is usually mild with fewer rashes and lesser risk of complications. In children, adolescents and adults, 2 doses of vaccine are recommended with minimum interval of 4 weeks. In children, 2 doses, first at 15-18 months of age and second at 4-6 years along with MMR vaccine as MMRV or separately are recommended.

Post exposure prophylaxis after chickenpox may still be possible with vaccine if given within 3 to 5 days of exposure. Post exposure varicella zoster immunoglobulin is indicated in immunocompromised individuals, malignancy, neonates and pregnant women.

Hence, it is advisable for the exposed or affected individuals, especially the high risk group mentioned above, to get early medical attention, either for disease prevention or to avoid the risk of complications.

Dr Mini P N
Consultant Dermatologist,
KIMS, Thiruvananthapuram.

 

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