Chicken pox

Chicken pox
Introduction
Causative agent
Clinical feature
 Mode of Transmission
 Incubation Period
Risk factors
Pathology
Management
 Complication
 Prevention and control Measure
Prepared by Gaurab pandey health profesional

Introduction
• It is an acute highly contagious/ infectious diseases
caused by varicella zoster virus.
• Chicken pox is usually a mild self limiting illness and
most healthy children recover with no complication.
• Anyone who has had chickenpox in the past may
develop shingles ,you can only get shingles if you
have previously had chicken pox as it is a recurrence
or reactivation of the varicella zoster virus .
• It is not possible to develop shingles from exposure
to a person with chickenpox it is possible however
to develop chickenpox as a result of exposure to a
person with shingles second attacks of chickenpox
are rare but do occur.

Shingles
shingles are an acute viral inflammation of the sensory ganglia
of spinal and cranial nerve that is associated with a vesicular
eruption and neuralgic pain and caused by reactivation of the
herpes virus causing chicken virus is also called as herpes zoster
Red Rashes with small fluid filled Blister

Causative Agents
The varicella zoster virus VZV : causes two
distinct clinical infectious diseases
 chicken pox (varicella )
Shingles(zoster)

Clinical FeaturesSigns
A) Rashes:
 Rash is the classic symptoms of chiken pox that turns into itchy
fluid filled blisters that eventually turn into scabs.
 The rash may first show up on the chest back face and then spread
over the entire body including inside the mouth ,eyelids or genital
area.
 It usually takes about one week for all of the blister to become
scabs.
B) Non Rashes:
 Red spots first appear on the chest
 Intense itchy
 Vesicular fluid filled blister
 Fever
 Swallen glands
 Blisters weep , Abdominal Tenderness

Contd.
 Symptoms:
• Fever with red spots appearance on the trunk, face
scalp and other sites
• Blisters fluid filled ,scabs, crusts
• Headache
• Nausea vomiting, loss of appetite
• Abdominal pain
• Myalgia
• Intense itchy

Mode of Transmission
 It is a highly contagious disease infecting up to 90% of non
immune people who are exposed to the disease.
Chickenpox is transmitted by the following routes
 Airborne respiratory dropletes
 Direct contact with the vesicle fluid .
 Indirect contact through clothes /linen freshly soiled by
vesicle fluid.
 Chickenpox can also be spread from people with shingles.A
person with shingles can spread the VZV virus to others who
have never had chickenpox.

Incubation Period
(The time from becoming infected until symptoms appear)
• It ranges from 10 to 21 days although is usually from 14-16
days
• Susceptible individuals who have been in contact with a
person with chickenpox should be considered potentially
infectious from the 10th to the 21th day after exposure
• The most infectious period is 1-2 days before the rash
appears but infectivity continue until the vesicles have
crusted over at least 5 days onset of the rash.

Risk Factors
• Chicken pox is more common in children who are younger
than 10 years
• Person when they come in direct contact with infected one.
• Children less than 1 years of age(infants)
• Immune depressant
• Pregnancy a mother who is exposed to vzv during pregnancy
• Fetus exposed to vzv
• Previously infected with vzv
• Newborn, Not Immunized person

Pathology/pathophysiology
• Inhalation of contaminated respiratory droplets
• The virus infects the mucosa of respiratory tract
• Viral proliferation occurs in regional lymphnodes followed by primary viremia
• Again viral proliferation occurs in bodys internal organ mostly in liver and
spleen followed by secondary viremia
• Diffuse viral invasion of capillary endothelial cells and epidermis
• Infection may involve localized blood vessels of the skin resulting in necrosis,
epidemal haemorrhage or
Secretion of vesicular fluid and becomes cloudy followed by recruitment of
polymorphonuclear leukocytes and the presence of degenerated cells and
fibrin
• Ultimately the vesicles either ruptured or release their fluid

Early detection/diagnosis
• There is no screening guidelines for chickenpox
• Diagnosis is done by history and physical examination
followed by:
vesicular rashes which starts as small papules
develop into clear vesicles which becomes pustuls and then
becomes dry into crusts

Management
• Investigation:
Laboratory investigation/confirmation is rarely
required but if necessary is available by sending a
microscopic slide with vesicle fluid to serological
demonstration.
Baseline investigation can be done such as
. complete blood count
. erythrocyte sedimentation rate
. c Reactive protein, white blood cells
. chest x ray

Contd.
• Treatment:
A)Supportive Therapy:
• Manage pruritus in patients with varicella with cool compresses and regular
bathing.
• Discourage scratching to avoid scarring.
• Warm soaks and otameal or cornstarch baths.
• Administration of plenty fluid .
• General home remedies.
• Dietary measures.
B)Antiviral therapy :
• The routine use of acyclovir or valacyclovir in healthy children is
recommended
• Those with the chronic cutaneous or pulmonary disorder those on long term
salicyclate therapy and children receiving corticosteroid
• Intravenous acyclovir is recommended for immuno compromised

Contd.
• C) varicella zoster immune globulin therapy
(variZIG )
• It is indicated for high risk individuals within 10 days of
chickenpox exposure.
• This agents reduces complications and the mortality rate of
varicella not its incidence.
• Its route of administration is intravenous route.
• The dose is about 125u/kg body weight.
• The expected duration of protection is approximately 3
weeks

Contd.
• D) specific treatment:
• Oral antihistamine(diphenhydramine,hydroxyzine)
• Topical calamine lotion
• Aspirin or acetaminophen for fever
• Prophylaxis treatment with VZIG and acyclovir
• Treatment of secondary bacterial infections (antibiotic therapy)
• Varicella vaccination(live attenuated oka strain varicella virus
vaccine)
• Admission to intensive care unit(if altered
consciousness,seizurs,respiatory distress,cyanosis,low o2
saturation)
• Transfer to tertiary care facility.

Contd.
• Vaccination: for children adolescent and adults for examples
MMRV vaccine
varicella vaccine
• First dose at age 12 through 15 months
• Second dose at age 4 through 6 years
• Prevention and control measure
 Health education
 Maintainance of personal hygiene
 Vaccination
 Surveillence
 Early diagnosis and treatment
 Proper food supply
 Isoltion
 Health promotion

Complications
(facts:During chickenpox the virus infects the dorsal root ganglia where it
remains latent and establish lifelong residence until reactivated)
• Bacterial infection of the skin and soft tissues group A
streptococcal infection
• Infection of lungs (pneumonia)
• Infection or inflammation of brain (encephalitis,cerebral
ataxia)
• Bleeding problems (haemorrhage)
• Dehydration
• Joint inflammation

Chicken pox

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Chicken pox