Chickenpox

General Illness Information

Common Name:

CHICKENPOX

Medical Term: Varicella

Description:

Chickenpox is a very contagious disease caused by the varicella-zoster virus. It presents with a very characteristic itchy rash, consisting of clusters of small raised or flat spots, fluid filled blisters, and crusting. It can affect all ages, but most common in children.

Causes:

Chickenpox can be caused through an infection with the herpes zoster virus. It is spread from person to person by airborne droplets or contact with a skin eruption on an infected person. Incubation after exposure is 10 to 21 days. A newborn is protected for several months from chickenpox if the mother had the disease prior to or during pregnancy. The immunity diminishes in 4 to 10 months.

Prevention:

  • An immune globulin is available for high-risk persons, such as non-immune pregnant women and for those who take anti-cancer or immuno-suppressive drugs.
  • Live attenuated varicella vaccine is currently available in the United States and Canada.

Signs & Symptoms

The following are usually mild in children, severe in adults:

  • May have fever.
  • Malaise for 1-2 days.
  • Skin eruptions that appear almost anywhere on the body, including the scalp, penis, and inside the mouth, nose, throat or vagina. They may be scattered over large areas, mainly the trunk, and on the arms and legs.
  • Rash starts as small, flat, red areas, which then become raised and form a bleb (blister) against a red background. Blisters collapse within 6 to 8 hours and form scabs. New crops of blisters erupt for up to 5-7 days. New spots usually stop appearing by the fifth day and a majority of the lesions are scabbed by the sixth day. Person with chickenpox is not contagious once all the lesions are scabbed.
  • Adults have additional symptoms that resemble influenza.

Risk Factors

  • Use of immunosuppressive drugs, or HIV.
  • Diagnosis & Treatment
  • General Measures:
  • Diagnosis is usually determined by the appearance of the skin eruptions and laboratory tests are not necessary.
  • Treatment is directed toward relieving symptoms.
  • Use cool-water soaks or cool-water compresses to reduce itching.
  • Keep the patient as cool as possible as heat and sweat trigger itching.
  • Keep the nails short to discourage scratching, which can lead to secondary infection.
  • Bathe often with soap and water.

Medications:

The following non-prescription medicines may decrease itching:

  • Topical anesthetics and topical antihistamines, which provide quick, short-term relief. Preparations containing lidocaine and pramoxine are least likely to cause allergic skin reactions. Lotions that contain phenol, menthol and camphor (such as calamine lotion). Follow package instructions.
  • For fever, use acetaminophen. Never use aspirin as it may contribute to the development of Reye’s syndrome (a form of encephalitis), especially in children.
  • Acyclovir (brand name Zovirax), or other anti-viral medications may be prescribed in the first 24-48 hours, especially in adults to reduce severity of symptoms and the rash.
  • Atarax may help if itching is severe. Benadryl should not used in a patient with chickenpox because of risk of developing toxic encephalitis.

Activity:

  • Bed rest is not necessary. Allow quiet activity in a cool environment. A child may play outdoors in the shade during nice weather.
  • Isolate child from others, until all blisters have crusted and there are no new ones. Usually 6 days after onset of rash.

Diet:

No special diet.

Possible Complications:

  • Secondary bacterial infection of chickenpox blisters.
  • Pneumonia.
  • Viral eye infection.
  • Encephalitis (rare).
  • Reye’s syndrome usually occurs in patients using aspirin or salicylates.
  • Shingles many years later in adulthood (possibly).
  • Myocarditis.
  • Arthritis (transient).

Prognosis

Spontaneous recovery. Children usually recover in 7 to 10 days. Adults take longer and are more likely to develop complications.

After recovery, a person has lifelong immunity against a recurrence of chickenpox. After chickenpox infection, the virus remains dormant in the body (possibly in the roots of nerves near the spinal cord). The same virus may later be reactivated in later life causing shingles, especially in immunocopromised and HIV patients.

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