Varicella (Chickenpox)

Chickenpox is a very contagious infection caused by the varicella-zoster virus, and it causes painful skin rashes called shingles (herpes zoster).

Transmission: Varicella is highly contagious, with a secondary attack rate of 60-100%. It is transmitted through droplets from the nasopharynx or direct contact with the vesicular fluid. The patient is infectious 2 days before and 5 days after the onset of lesions.

Clinical Features:

Fever, Malaise, and Myalgia for 2-3 days precede skin lesions.

The lesions appear in multiple crops of itchy, red macules and papules and progress rapidly to vesicles (dewdrop on rose petal appearance), pustules, and crusts over 12-24 hours. The lesions are of different shapes and in various stages of development at any given point. They resolve in 7-10 days without sequelae, and sometimes depressed scars may form. The lesions are more profuse on the trunk and upper parts of the extremities and less profuse on the face, scalp, and limbs.

Children tend to have a benign and self-limiting disease. Adults have more severe cutaneous lesions that heal with scars. It can lead to significant morbidity and mortality in immunocompromised individuals with extensive and hemorrhagic lesions, indolent course, and systemic involvement.

Complications:

• Secondary bacterial infection and scarring

• Transient hepatitis

• Primary varicella pneumonia

• Meningoencephalitis

• Glomerulonephritis

• Optic neuritis

• Thrombocytopenia and DIC

Treatment:

• Treatment in both varicella and herpes zoster should be started as early as possible, preferably within 24-72 hours. V

• Varicella is generally benign and self-limited in children.

• General measures include isolation to prevent spread, hygiene maintenance, and symptomatic treatment with antihistamines, antipyretics, and calamine.

• Antivirals are required in adolescents and in adults and children with chronic or pulmonary disorders.