Chickenpox is a highly contagious disease caused by primary infection with varicella zoster

virus (VZV).[1] It usually starts with avesicular skin rash mainly on the body and head rather than on
the limbs. The rash develops into itchy, raw pockmarks, which mostly heal without scarring. On
examination, the observer typically finds skin lesions at various stages of healing, and ulcers in the
oral cavity and tonsil areas. The disease is most commonly observed in children.
Chickenpox is an airborne disease which spreads easily through coughing or sneezing by ill
individuals or through direct contact with secretions from the rash. A person with chickenpox is
infectious one to two days before the rash appears.[2] They remain contagious until all lesions have
crusted over (this takes approximately six days).[3] Immunocompromised patients
are contagious during the entire period as new lesions keep appearing. Crusted lesions are not
contagious.[4]
Chickenpox has been observed in other primates, including chimpanzees[5] and gorillas.[6]
The origin of the term chicken pox, which is recorded as being used since 1684,[7] is not reliably
known. It has been said to be derived from chickpeas, based on resemblance of the vesicles to
chickpeas,[7][8][9] or to come from the rash resembling chicken pecks.[7][9] Other suggestions include the
designation chicken for a child (i.e., literally 'child pox'), a corruption of itching-pox,[8][10] or the idea
that the disease may have originated in chickens.[7] Samuel Johnson explained the designation as
"from its being of no very great danger."[11]
Contents
[hide]

1 Signs and symptoms

2 Diagnosis
3 Pathophysiology
o 3.1 Pregnancy and neonates
o 3.2 Shingles
4 Prevention
o 4.1 Hygiene measures
o 4.2 Vaccine
5 Treatment
o 5.1 Children
o 5.2 Adults
6 Prognosis
7 Epidemiology
8 See also
9 References
10 External links

Signs and symptoms[edit]

A single blister, typical during the early stages of the rash

Male with varicella disease

The back of a 30-year-old male after five days of the rash

The early (prodromal) symptoms in adolescents and adults are nausea, loss of appetite, aching
muscles, and headache. This is followed by the characteristic rash or oral sores, malaise, and a lowgrade fever that signal the presence of the disease. Oral manifestations of the disease (enanthem)
not uncommonly may precede the external rash (exanthem). In children the illness is not usually
preceded by prodromal symptoms, and the first sign is the rash or the spots in the oral cavity. The
rash begins as small red dots on the face, scalp, torso, upper arms and legs; progressing over 10
12 hours to small bumps, blisters and pustules; followed by umbilication and the formation of
scabs.[12][13]
At the blister stage, intense itching is usually present. Blisters may also occur on the palms, soles,
and genital area. Commonly, visible evidence of the disease develops in the oral cavity & tonsil
areas in the form of small ulcers which can be painful or itchy or both; this enanthem (internal rash)
can precede the exanthem (external rash) by 1 to 3 days or can be concurrent. These symptoms of
chickenpox appear 10 to 21 days after exposure to a contagious person. Adults may have a more
widespread rash and longer fever, and they are more likely to experience complications, such as
varicella pneumonia.[12]
Because watery nasal discharge containing live virus usually precedes both exanthem (external
rash) and enanthem (oral ulcers) by 1 to 2 days, the infected person actually becomes contagious
one to two days prior to recognition of the disease. Contagiousness persists until all vesicular lesions
have become dry crusts (scabs), which usually entails four or five days, by which time nasal
shedding of live virus also ceases.
Chickenpox is rarely fatal, although it is generally more severe in adult men than in women or
children. Non-immune pregnant women and those with a suppressed immune system are at highest
risk of serious complications. Arterial ischemic stroke (AIS) associated with chickenpox in the
previous year accounts for nearly one third of childhood AIS.[14] The most common late complication
of chickenpox isshingles (herpes zoster), caused by reactivation of the varicella zoster virus decades
after the initial, often childhood, chickenpox infection.

Diagnosis[edit]
The diagnosis of varicella is primarily clinical, with typical early "prodromal" symptoms, and then the
characteristic rash and oral-cavity sores. Confirmation of the diagnosis can be sought through either

examination of the fluid within the vesicles of the rash, or by testing blood for evidence of an acute
immunologic response.
Vesicular fluid can be examined with a Tzanck smear, or better by testing for direct fluorescent
antibody. The fluid can also be "cultured", whereby attempts are made to grow the virus from a fluid
sample. Blood tests can be used to identify a response to acute infection (IgM) or previous infection
and subsequent immunity (IgG).[15]
Prenatal diagnosis of fetal varicella infection can be performed using ultrasound, though a delay of 5
weeks following primary maternal infection is advised. A PCR (DNA) test of the mother's amniotic
fluid can also be performed, though the risk of spontaneous abortion due to
the amniocentesis procedure is higher than the risk of the baby developing fetal varicella
syndrome.[16]

Pathophysiology[edit]
Main article: Varicella zoster virus
Exposure to VZV in a healthy child initiates the production of host immunoglobulin
G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA) antibodies; IgG antibodies persist for
life and confer immunity. Cell-mediated immune responses are also important in limiting the scope
and the duration of primary varicella infection. After primary infection, VZV is hypothesized to spread
from mucosal and epidermallesions to local sensory nerves. VZV then remains latent in the dorsal
ganglion cells of the sensory nerves. Reactivation of VZV results in the clinically distinct syndrome
of herpes zoster (i.e., shingles), postherpetic neuralgia,[17] and sometimes Ramsay Hunt syndrome
type II.[18] Varicella zoster can affect the arteries in the neck and head, producing stroke, either during
childhood, or after a latency period of many years.[19]

Chickenpox (varicella) is a contagious illness that causes an itchy rashand red spots
or blisters (pox) all over the body. Chickenpox can cause problems for pregnant women,
newborns, teens and adults, and people who have immune system problems that make
it hard for the body to fight infection.
Chickenpox usually isn't a serious health problem in healthy children. But a child with
chickenpox needs to stay home from school. And you may need to miss work in order to
care for your child.
After you have had chickenpox, you aren't likely to get it again. But the virus stays in
your body long after you get over the illness. If the virus becomes active again, it can
cause a painful viral infection calledshingles.

Chickenpox is caused by the varicella-zoster virus. It can spread easily. You can get it
from an infected person who sneezes, coughs, or shares food or drinks. You can also
get it if you touch the fluid from a chickenpox blister.
A person who has chickenpox can spread the virus even before he or she has any
symptoms. Chickenpox is most easily spread from 2 to 3 days before the rash appears
until all the blisters have crusted over.
You are at risk for chickenpox if you have never had the illness and haven't had
the chickenpox vaccine. If someone you live with gets chickenpox, your risk is even
higher because of the close contact.
The first symptoms of chickenpox usually develop about 14 to 16 days after contact with
a person infected with the virus. Most people feel sick and have a fever, a decreased
appetite, a headache, a cough, and asore throat. The itchy chickenpox rash
usually
appears about 1 or 2 days after the first symptoms start.
After a chickenpox red spot appears, it usually takes about 1 or 2 days for the spot to go
through all its stages. This includes blistering, bursting, drying, and crusting over. New
red spots will appear every day for up to 5 to 7 days.
It usually takes about 10 days after the first symptoms before all blisters have crusted
over. This is when the person with chickenpox can return to day care, school, or work.