(CHICKEN POX)

An acute, highly contagious

exanthem.
Most often occurs in
childhood.
Result of primary infection
of a susceptible individual.
1.Worldwide in distribution,
whereas the proportion of
susceptible adults is even
higher in Asia, Africa, and the
Middle East.
2.No difference in racial or
sexual susceptibility.
3.Humans are the only known
reservoir.
4.Vectors play no role in
transmission.
5.The mean incubation period
is 14 or 15 days, with a rarge
of 10 to 23 days.
6.The major route by which
varicella is acquired and
transmitted is thought to be
the respiratory tract
7.Airborne droplets constitute
an important mechanism of
transmission, but can also be
spread by direct contact
1.VZV is a member of the
herpes virus family.
2.There is only one VZV
serotype.
3.A number of antigens are
present in the virion and
produced infected cells.
4.Studies of molecular biology
and its pathogenesis have
been hampered.
1.Entry of the virus is
through the mucosa of the
upper respiratory tract and
oropharynx.
2.Initial multiplication at this
portal dissemination small
amounts of virus blood and
lymphatics (primary viremia)
by cells of RES.
3.Incubating infection is
partially contaired by innate
host defenses and by
developing immune
responses.
4.Virus replication eventually
overwhelms these still
undeveloped defenses
secondary viremia occurs
(zweeks often infection)
fever and malaise and
disseminates throughout the
body especially skin and
mucous membranes.
5.Cyclic viremia is terminate
after about 3 days.
6.Host immune responses
terminate viremia and limit
the progression of varicella
lesions.
7.IgG, IgM, and IgA of VZV are
detectable 2 to 5 days after
onset of clinical varicella.
8.Reach maximum titers
during second or third week
decline slowly persist in
low levels for life
9.Cell mediated immunity is
more important than
humoral immunity in
recovery from varicella.
Prodrome of Varicella
1.Uncommon in young
children.
2.In older children and adults,
rash preceded by 2 to 3 day
of fever , chills, malaise,
headache, anorexia, severe
backache.
Rash of Varicella
1.Benigns on the face and
scalp.
2.Spreads rapidy to the trunk,
with relative sparing of the
extremities.
3.Central in distribution.
4.More profuse in lows and
protected parts of the body.
5.Rose colored macules
papule vesicles pustules
crusts.
6.Vesicle is superficial and
thin walled like a drop of
water
7.Vesicle can also develop in
the mucous membranes
8.Fever that persist is
proportional to the severity
of rash.
1.Secondary bacterial infection
of skin lesion (children).
2.Primary varicella pneumonia
(adult).
3.Congenital VZV infection :
asymptomatic infection
severe congenital
malformation.
4.Morbidity and mortality are
markedly increased in
immuno compromised
patients.
5.CNS complication :
Reyes syndrome.
Acute cerebellar atoxia.
Encephalitis or
meningoencephalitis.
Acute ascending or
transverse myelitis.
Guillain-barre syndrome.
6.Mild hepatitis.
1.Histologically, cant be
distinguished from herpes
zoster.
2.Ballooning degeneration
(characteristic changes).
1.The development papulo
vesikular eruption after a brief
and mild (or absent) prodrome
symptoms.
Characteristic diagnostic include:
2.Appearance of lesions in crops
with central distribution.
3.Rapid evolution of lesions.
4.Presence of lesions in all
stages of development in any
area throughout the acute
disease.
5.Presence of lesions in the
mucous membranes of the
mouth.
1.Routine blood test are not
helpful.
2.Asymptomatic elevation in
ALT and AST.
3.Punch biopsies more
rediable for histologig
examinations.
4.Defenitive diagnosis from
isolation of virus in cell
cultures.
5.Serologic tests.
Antiviral agents :
Acyclovir.
Famciclovir.
Laciclovir.
Vidarabine.
Foscarnet.
1.Generally benign and self-
limited.
2.Locally :
Cool compresses.
Calamine lotion.
Orally :
Antihistamines.
Antipyretics.
Antiviral agents.
1.Passive immunization.
2.Chemoprophylactic.