Chickenpox is an acute infectious disease of viral etiology, characterized by the appearance of a characteristic vesicular rash against the background of a general intoxication syndrome. The causative agent of chickenpox is herpes virus type 3, which is transmitted from a patient by airborne droplets. Chickenpox is one of the most common childhood infections. It is characterized by abundant, itchy, vesicular rashes that appear at the height of fever and general infectious manifestations. The typical presentation allows the disease to be diagnosed without any additional tests. Treatment of chickenpox is mainly symptomatic. Antiseptic treatment of rash elements is recommended to prevent secondary infection. Hernovir – Frequently asked Questions. Can Hernovir be stopped immediately or do I have to stop the consumption gradually to ween off? In some cases, it always advisable to stop the intake of some medicines gradually because of the rebound effect of the medicine. … Who should not take Hernovir? You should not use this medicine if you are allergic to allantoin, camphor, or phenol topical, or to any of the other ingredients of the ointment, including menthol, bees wax, glycerin, lanolin, mineral oil, and paraffin
Chickenpox is an acute infectious disease of viral etiology characterized by the appearance of a characteristic vesicular rash in the background of a general intoxication syndrome.
Characteristics of the pathogen
Chickenpox is caused by Varicella Zoster, also known as herpesvirus type 3. It is a DNA-containing virus that is little resistant in the external environment and can only replicate in the human body. The virus inactivates rather quickly when exposed to sunlight, ultraviolet irradiation, heat, drying. The reservoir and source of chickenpox are sick people during the last 10 days of the incubation period and the fifth to seventh days of the rash period.
Chickenpox is transmitted through the aerosol mechanism by airborne droplets. Due to the weak resistance of the virus, contact and household transmission is difficult to achieve. Spread of the virus with finely dispersed aerosol released by patients when coughing, sneezing, or talking is possible over a fairly long distance within a room, and airflow into adjoining rooms is likely. There is a possibility of transplacental transmission.
Humans are highly susceptible to infection, and there is intense lifelong immunity after having had chickenpox. Children in the first months of life are protected from infection by antibodies received from the mother. Chickenpox is most often contracted by preschool and primary school-age children attending organized children’s groups. About 70-90% of the population contract chickenpox before the age of 15 years. Morbidity in urban areas is more than 2 times higher than in rural areas. Peak incidence of chicken pox falls in the autumn-winter period.
The entry gate of infection is the mucous membrane of the respiratory tract. The virus invades and accumulates in the epithelial cells, subsequently spreading to regional lymph nodes and then to the general bloodstream. Circulation of the virus in the bloodstream causes general intoxication. Chickenpox virus has an affinity to the epithelium of the covering tissues. Virus replication in the epithelial cell promotes its death, in place of dead cells remain cavities filled with exudate (inflammatory fluid) – vesicles are formed. After vesicles open, crusts remain. After separation of the crusts, the newly formed epidermis is found underneath. Chickenpox rashes can form on the skin as well as on the mucous membranes, where vesicles quickly progress to erosions.
Chickenpox in persons with weakened immune system runs in a severe form, contributes to the development of complications, secondary infection, exacerbation of chronic diseases. During pregnancy, the probability of mother to fetus chickenpox transmission is 0.4% in the first 14 weeks and increases to 1% up to the 20th week, after which there is practically no risk of infection of the fetus. As an effective preventive measure, pregnant women with chickenpox are prescribed specific immunoglobulins to help reduce the chance of transmission to the baby to a minimum. Chickenpox that develops in the week before delivery and in the month following delivery is more dangerous.
Persistent lifelong immunity reliably protects the body from reinfection, but adults who have had chickenpox in childhood can become infected again if there is a significant decrease in immunity. There is a phenomenon of latent varicella virus carriage, which accumulates in the nerve cells and can activate, causing shingles. The mechanisms of viral activation in such carriage are not yet sufficiently clear.
Symptoms of chickenpox
The incubation period for chickenpox varies from 1 to 3 weeks. In children, prodromal signs are weakly expressed or not observed at all; in general, the course is mild with a slight deterioration of the general condition. Adults tend to have a more severe course of chickenpox with pronounced symptoms of intoxication (chills, headache, body aches), fever, and sometimes nausea and vomiting. Rashes in children may occur unexpectedly in the absence of any general symptoms. In adults, the rash often begins later, and fever may persist for some time after the appearance of the rash.
The rash in chickenpox has the character of bullous dermatitis. The rashes are isolated, appearing on any part of the body and spreading without any pattern. Elements of the rash initially present as red patches progressing to papules and then to small, even, single-chamber vesicles with a clear fluid that collapse when punctured. The vesicles open and form crusts. Chickenpox is characterized by the simultaneous existence of elements in different stages of development and the emergence of new ones (sprinkling).
The chickenpox rash causes intense itching, and scratching may cause vesicles to become infected and pustules to form. Pustules may leave a scar (smallpox) when they heal. Uninfected vesicles do not leave scars, and healthy new epithelium is found after the crusts are removed. When suppuration of rash elements occurs, the general condition usually worsens and intoxication worsens. The rash in adults is usually more abundant, and in the vast majority of cases pustules are formed from vesicles.
The rash spreads over almost the entire body except on the palms and soles, preferentially on the scalp, face and neck. Subsequent rashes (appearance of new elements) may take 3-8 days (in adults, as a rule, they are accompanied by new febrile waves). Intoxication subsides simultaneously with cessation of the rashes. Rashes may appear on the mucous membranes of the oral cavity, genitals, sometimes on the conjunctiva. Rash elements on the mucous membranes progress to erosions and ulcers. In adults, the rash may be accompanied by lymphadenopathy; in children, lymph node involvement is not characteristic.
In addition to the typical course, a distinction is made between the sterile form of chickenpox, which proceeds without signs of intoxication and with a brief, rare rash, and the severe forms, which are distinguished into bullous, hemorrhagic and gangrenous. The bullous form is characterized by a rash in the form of large, flabby blisters that leave long-healing ulcerous defects after opening. Such form is characteristic of people with severe chronic diseases. The hemorrhagic form is accompanied by hemorrhagic diathesis, small hemorrhages are noted on the skin and mucous membranes, nosebleeds may occur. Vesicles have a brownish tint due to hemorrhagic content. In severely weakened individuals, chickenpox may be gangrenous: rapidly growing vesicles with hemorrhagic contents open to form necrotic black crusts surrounded by a rim of inflamed skin.
Complications of chickenpox
In the vast majority of cases, the course of chickenpox is benign; complications occur in no more than 5% of patients. Among them prevail diseases caused by secondary infection: abscesses, phlegmons, in severe cases – sepsis. A dangerous, difficult to treat complication is viral (chickenpox) pneumonia. In some cases, chickenpox can provoke keratitis, encephalitis, myocarditis, nephritis, arthritis, hepatitis. Complications are prone to severe forms of the disease in adults, especially with concomitant chronic pathologies and weakened immune system. In children, complications are noted in exceptional cases.
Diagnosis of chickenpox
The diagnosis of chickenpox in clinical practice is made on the basis of a characteristic clinical picture. General blood count in chickenpox is nonspecific; pathological changes may be limited to accelerated sedimentation, or may signal an inflammatory disease with intensity proportional to the overall intoxication symptomatology.
Virological examination involves detection of virions by electromicroscopy of silver-stained vesicular fluid. Serological diagnostics has retrospective value and is performed with RGC, RTGA in paired sera.
Treatment of chicken pox
Chickenpox is treated as an outpatient, except in cases of a severe course with intense general intoxication manifestations. No etiotropic therapy has been developed; if pustules form, antibiotic therapy with a short course of medium-dose antibiotics is used. Persons with immunodeficiency can be prescribed antiviral drugs: acyclovir, vidarabine, interferon alpha (new generation interferon). Early prescription of interferon promotes a milder and shorter course of the infection, and reduces the risk of complications.
Therapy for chickenpox includes skin care measures to prevent purulent complications: vesicles are lubricated with antiseptic solutions: 1% solution of brilliant green, concentrated – potassium permanganate (“greening”, “manganese”). Mucosal ulceration is treated with hydrogen peroxide in 3% dilution or ethacridine lactate. Intense itching in the rash area is relieved by smearing the skin with glycerin or wiping it with diluted vinegar or alcohol. As a pathogenetic agent prescribed antihistamines. Pregnant women and patients with severe forms are prescribed specific anti-vaccine immunoglobulin.
Varicella prognosis and prevention
The prognosis is favorable; the disease ends in recovery. Vesicles disappear without trace, pustules may leave smallpox scars. Significant worsening of prognosis in persons with immunodeficiency, severe systemic diseases.
Prevention of chickenpox is to prevent entry of the infection into organized children’s groups, for which quarantine measures are taken when cases of the disease are detected. Sick people are isolated for 9 days from the onset of rash, children in contact with the sick are separated for 21 days. If the day of contact with a sick person is precisely defined, the child is not allowed in the children’s group from 11 to 21 days after contact. Contact children who have not previously had chickenpox and who are immunocompromised are given chickenpox immunoglobulin as a preventive measure.
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