varicella-zoster%20virus%20infection%20(pediatric)
VARICELLA-ZOSTER VIRUS INFECTION (PEDIATRIC)
Varicella, also known as chickenpox, is a self-limited, benign disease caused by primary varicella-zoster virus (VZV) infection characterized by fever, malaise, and generalized pruritic vesicular rash.
The average incubation period is 14-16 days. It is transmitted via direct contact with vesicular fluid or inhalation of aerosolized respiratory secretions or via droplet route during face to face contact.
Hallmark sign is pruritic rash that begins in the scalp and face which eventually spreads to the trunks and extremities.

Introduction

Varicella

  • Also known as chicken pox; is a self-limited benign disease caused by primary varicella-zoster virus (VZV) infection, characterized by fever, malaise & generalized pruritic vesicular rash

Herpes Zoster

  • Also known as shingles; results from recrudescence of latent VZV from dorsal root or cranial nerve ganglia that has been present since primary infection w/ varicella

Etiology

Varicella  

  • Varicella zoster virus (VZV) is a herpes virus that causes varicella & herpes zoster & belongs to the subfamily Alphaherpesvirinae along w/ herpes simplex virus (HSV) types 1 & 2
  • Double-stranded DNA virus that contains the smallest genome of the herpes viruses
  • Average incubation period: 14-16 days
  • Transmitted via direct contact w/ vesicular fluid or inhalation of aerosolized respiratory secretions or via droplet route during face to face contact

Herpes Zoster

  • VZV is a herpes virus that causes varicella & herpes zoster belongs to the subfamily Alphaherpesvirinae along w/ HSV types 1 & 2
  • Double-stranded DNA virus that contains the smallest genome of the herpes viruses
  • Transmitted via direct contact w/ vesicular fluid or inhalation of aerosolized respiratory secretions

Signs and Symptoms

Varicella 

  • Prodrome of fever (<38.9oC), headache, malaise, pharyngitis & abdominal pain may occur 1-2 days before development of rash in adolescents
    • In younger patients the rash & fever typically occur simultaneously w/o prodromal symptoms
  • Hallmark sign is pruritic rash that begins on the scalp & face which eventually spreads to the trunks & extremities
    • Initially, erythematous macules then to maculopapular phase to vesicular
    • Small fluid filled vesicles w/ an erythematous base that has “dewdrop-on-a-rose-petal” appearance
    • W/in 24-48 hours the vesicles transform into pustules that crust & scab w/in 6 days
    • New lesions may arise in successive crops
    • Lesions are in varying stages of development
  • Ulcerative & often painful lesions appear on mucous membranes including the oropharynx, conjunctivae & vagina

Herpes Zoster

  • Preceding the rash, the patient may complain of neuritis described as burning, deep aching, tingling, itching or stabbing pain that ranges from mild to severe in the involved dermatome
  • Prodromal symptoms of fever, headache, malaise, hyperesthesia, paresthesia or pruritus, in the affected dermatome & photophobia may occur 1-2 days before development of rash
  • Prodromal phase is followed by pruritic, vesicular rash that usually appears unilaterally
    • Initially it appears as maculopapular rash that follows a dermatomal distribution, commonly referred to as “belt-like pattern” develops into vesicles w/ an erythematous base
    • Vesicles are often painful & their development can be accompanied by anxiety & flu-like symptoms
    • Vesicles often coalesce into larger, fluid-filled lesions, become hemorrhagic or turbid & crust w/in 7-10 days & fall off; may leave scars or pigmentary changes
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