Chickenpox

From Wikipedia, the free encyclopedia

Jump to: navigation, search
For other uses, see Chickenpox (disambiguation).
The remainder of this article may require cleanup to meet
Wikipedia's quality standards.
Please improve this article if you can.

This article or section is in need of attention from an expert on the

subject.
WikiProject Medicine or the Medicine Portal may be able to help recruit one.
If a more appropriate WikiProject or portal exists, please adjust this template
accordingly.(March 2008)

Chickenpox
Classification and external
resources

Child with varicella disease

ICD-10 B01.
ICD-9 052
Diseases
29118
DB
Medline
001592
Plus
ped/2385
eMedicin
derm/74,
e
emerg/367
C02.256.466.1
MeSH
75
Chickenpox is a highly contagious illness caused by primary infection with varicella
zoster virus (VZV). It generally begins with conjunctival and catarrhal symptoms and
then characteristic spots appearing in two or three waves, mainly on the body and
head rather than the hands and becoming itchy raw pockmarks, small open sores
which heal mostly without scarring.
Chickenpox has a 10-21 day incubation period and is spread easily through
aerosolized droplets from the nasopharynx of ill individuals or through direct contact
with secretions from the rash. Following primary infection there is usually lifelong
protective immunity from further episodes of chickenpox.
Chickenpox is rarely fatal, although it is generally more severe in adults than in
children. Pregnant women and those with a suppressed immune system are at highest
risk of serious complications. The most common late complication of chicken pox is
shingles, caused by reactivation of the varicella zoster virus decades after the initial
episode of chickenpox.

Contents
[hide]
• 1 Signs and symptoms
○ 1.1 Infection in Pregnancy and Neonates
• 2 Pathophysiology
• 3 Diagnosis
• 4 Prevention
• 5 Treatment
• 6 Prognosis
• 7 Epidemiology
• 8 History
• 9 See also
• 10 Further reading
• 11 References
• 12 External links

[edit] Signs and symptoms

Chickenpox is a highly contagious disease that spreads from person to person by
direct contact or through the air from an infected person's coughing or sneezing.
Touching the fluid from a chickenpox blister can also spread the disease. A person
with chickenpox is contagious from one to five days before the rash appears until all
blisters have formed scabs. This may take 5-10 days.[1] It takes from 10-20 days after
contact with an infected person for someone to develop chickenpox.[2]
The chicken pox lesions (blisters) start as a two to four millimeter red papule which
develops an irregular outline (a rose petal). A thin-walled, clear vesicle (dew drop)
develops on top of the area of redness. This "dew drop on a rose petal" lesion is very
characteristic for chickenpox. After about 8 to 12 hours the fluid in the vesicle gets
cloudy and the vesicle breaks leaving a crust. The fluid is highly contagious, but once
the lesion crusts over, it is not considered contagious. The crust usually falls off after
seven days sometimes leaving a crater-like scar. Although one lesion goes through
this complete cycle in about seven days, another hallmark of chickenpox is the fact
that new lesions crop up every day for several days. Therefore it may be a week
before new lesions stop appearing and existing lesions crust over. Children are not to
be sent back to school until all lesions have crusted over.[3]
Zoster, also known as shingles, is a reactivation of chickenpox and may also be a
source of the virus for susceptible children and adults. It is not necessary to have
physical contact with the infected person for the disease to spread. Those infected
can spread chickenpox before they know they have the disease - even before any
rash develops. People with chickenpox, in fact, can infect others from about two days
before the rash develops until all the sores have crusted over, usually four or five days
after the rash starts.
[edit] Infection in Pregnancy and Neonates
Varicella infection in pregnant women can lead to viral transmission via the placenta
and infection of the foetus. If infection occurs during the first 28 weeks of gestation,
this can lead to foetal varicella syndrome (also known as congenital varicella
syndrome). Effects on the foetus can range in severity from underdeveloped toes and
fingers to severe anal and bladder malformation. Possible problems include:
• Damage to brain: encephalitis, microcephaly, hydrocephaly, aplasia of brain
• Damage to the eye (optic stalk, optic cap, and lens vesicles), microphthalmia,
cataracts, chorioretinitis, optic atrophy
• Other neurological disorder: damage to cervical and lumbosacral spinal cord,
motor/sensory deficits, absent deep tendon reflexes, anisocoria/Horner's
syndrome
• Damage to body: hypoplasia of upper/lower extremities, anal and bladder
sphincter dysfunction
• Skin disorders: (cicatricial) skin lesions, hypopigmentation
Infection late in gestation or immediately post-partum is referred to as neonatal
varicella. Maternal infection is associated with premature delivery. The risk of the
baby developing the disease is greatest following exposure to infection in the period 7
days prior to delivery and up to 7 days post-partum. The neonate may also be
exposed to the virus via infectious siblings or other contacts, but this is of less
concern if the mother is immune. Newborns who develop symptoms are at a high risk
of pneumonia and other serious complications of the disease. [4]

[edit] Pathophysiology
Chickenpox is usually acquired by the inhalation of airborne respiratory droplets from
an infected host. The highly contagious nature of VZV explains the epidemics of
chickenpox that spread through schools as one child who is infected quickly spreads
the virus to many classmates. High viral titers are found in the characteristic vesicles
of chickenpox; thus, viral transmission may also occur through direct contact with
these vesicles, although the risk is lower.
After initial inhalation of contaminated respiratory droplets, the virus infects the
conjunctivae or the mucosae of the upper respiratory tract. Viral proliferation occurs
in regional lymph nodes of the upper respiratory tract 2-4 days after initial infection
and is followed by primary viremia on postinfection days 4-6. A second round of viral
replication occurs in the body's internal organs, most notably the liver and the spleen,
followed by a secondary viremia 14-16 days postinfection. This secondary viremia is
characterized by diffuse viral invasion of capillary endothelial cells and the epidermis.
VZV infection of cells of the malpighian layer produces both intercellular and
intracellular edema, resulting in the characteristic vesicle.
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 epidermal lesions
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 (shingles).

[edit] Diagnosis
 Please help improve this section by expanding it.
Further information might be found on the talk page or at
requests for expansion.

The diagnosis of varicella is primarily clinical. In a non-immunized individual with

typical prodromal symptoms associated with the appropriate appearing rash occurring
in "crops", no further investigation would normally be undertaken.
If further investigation is undertaken, confirmation of the diagnosis can be sought
through either examination of the fluid within the vesicles, or by testing blood for
evidence of an acute immunologic response. Vesicle fluid can be examined with a
Tsanck smear, or better with examination 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 (IgE).[5]
Prenatal diagnosis of foetal 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 foetal varicella syndrome.[4]

[edit] Prevention
Main article: Varicella vaccine
A varicella vaccine has been available since 1995 to inoculate against the disease.
Some countries require the varicella vaccination or an exemption before entering
elementary school. Protection is not lifelong and further vaccination is necessary five
years after the initial immunization.[6]
In the United Kingdom, varicella antibodies are measured in women with no history of
the disease as part of routine of prenatal care. By 2005 all National Health Service
personnel had determined their immunity and been immunized if they were non-
immune and have direct patient contact. Population-based immunization against
varicella is not otherwise practiced in the UK. It is feared that there would be a greater
number of cases of shingles in adults, until the vaccination was given to the entire
population—because adults who have had chickenpox as a child are less likely to have
shingles in later life if they have been exposed occasionally to the chickenpox virus
(for example by their children). This is because the exposure acts as a booster
vaccine.[7][8]

[edit] Treatment
Please help improve this section by expanding it.
Further information might be found on the talk page or at
requests for expansion.

There is no evidence to support the effectiveness of topical application of calamine

lotion, a topical barrier preparation containing zinc oxide in spite of its wide usage and
excellent safety profile.[9] It is important to maintain good hygiene and daily cleaning
of skin with warm water to avoid secondary bacterial infection.
If exposure to varicella in certain 'at risk' populations is confirmed
(immunosuppressed individuals, pregnant seronegative women, neonates), anti-
varicella zoster immunoglobulin may be given prior to onset of disease symptoms.
Infection in otherwise healthy adults tends to be more severe and active; treatment
with antiviral drugs (e.g. acyclovir) is generally advised. Patients of any age with
depressed immune systems or extensive eczema are at risk of more severe disease
and should also be treated with antiviral medication. In the U.S., 55 percent of
chickenpox deaths are in the over-20 age group, even though they are a tiny fraction
of the cases.

[edit] Prognosis
Please help improve this section by expanding it.
Further information might be found on the talk page or at
requests for expansion.
Chickenpox infection is milder in young children, and symptomatic treatment, with a
sodium bicarbonate baths or antihistamine medication may ease itching.[10]
Paracetamol (acetaminophen) is widely used to reduce fever. Aspirin, or products
containing aspirin, must not be given to children with chickenpox (or any fever-
causing illness suspected of being of viral origin), as this risks causing the serious and
potentially fatal Reye's Syndrome. [11]
In adults, the disease can be more severe, though the incidence is much less
common. Infection in adults is associated with greater morbidity and mortality due to
pneumonia, hepatitis and encephalitis. In particular, up to 10% of pregnant women
with chickenpox develop pneumonia, the severity of which increases with onset later
in gestation. In England and Wales, 75% of deaths due to chickenpox are in adults. [4]
Inflammation of the brain, or encephalitis, can occur in immunocompromised
individuals, although the risk is higher with herpes zoster.[12]Necrotizing fasciitis[13] is
also a rare complication.
Secondary bacterial infection of skin lesions, manifesting as impetigo, cellulitis, and
erysipelas, is the most common complication in healthy children. Disseminated
primary varicella infection, usually seen in the immunocompromised or adult
populations, may have high morbidity. Ninety percent of cases of varicella pneumonia
occur in the adult population. Rarer complications of disseminated chickenpox also
include myocarditis, hepatitis, and glomerulonephritis. [1]
Hemorrhagic complications are more common in the immunocompromised or
immunosuppressed populations, although healthy children and adults have been
affected. Five major clinical syndromes have been described: febrile purpura,
malignant chickenpox with purpura, postinfectious purpura, purpura fulminans, and
anaphylactoid purpura. These syndromes have variable courses, with febrile purpura
being the most benign of the syndromes and having an uncomplicated outcome. In
contrast, malignant chickenpox with purpura is a grave clinical condition that has a
mortality rate of greater than 70%. The etiology of these hemorrhagic chickenpox
syndromes is not known. [2]

[edit] Epidemiology
Primary varicella is an endemic disease. Cases of varicella are seen throughout the
year but more commonly in winter and early spring. This is unlike enteroviruses and
lends some support to the view that, like measles and rubella, varicella is spread
mainly by the respiratory route. In contrast, herpes zoster occurs sporadically and
evenly throughout the year. Varicella is one of the classic diseases of childhood, with
the highest prevalence in the 4 - 10 years age group. Like rubella, it is uncommon in
preschool children. Varicella is highly communicable, with an infection rate of 90% in
close contacts. Most people become infected before adulthood but 10% of young
adults remain susceptible. However, this pattern of infection is not universal, e.g. in
rural India, varicella is predominantly a disease of adults, with the mean age of
infection 23.4 years. It has been suggested that this could be due to interference by
other respiratory viruses that children are exposed to.[14]
Historically, varicella has been a disease predominantly affecting preschool and
school-aged children. In adults the pock marks are darker and the scars more
prominent than in children.[14]

[edit] History
One history of medicine book credits Giovanni Filippo (1510–1580) of Palermo with the
first description of varicella (chickenpox). Subsequently in the 1600s, an English
physician named Richard Morton described what he thought a mild form of smallpox
as "chicken pox." Later, in 1767, a physician named William Heberden, also from
England, was the first physician to clearly demonstrate that chickenpox was different
from smallpox. However, it is believed the name chickenpox was commonly used in
earlier centuries before doctors identified the disease.
There are many explanations offered for the origin of the name chickenpox:
• Samuel Johnson suggested that the disease was "less dangerous", thus a
"chicken" version of the pox;
• the specks that appear looked as though the skin was pecked by chickens;
• the disease was named after chick peas, from a supposed similarity in size of
the seed to the lesions;
• the term reflects a corruption of the Old English word giccin, which meant
itching.
As "pox" also means curse, in medieval times some believed it was a plague brought
on to curse children by the use of black magic.
From ancient times, neem has been used by Indians to alleviate the external
symptoms of itching and to minimise scarring. Neem baths (neem leaves and a dash
of turmeric powder in water) are commonly given for the duration. Neem branches
are hung at the entrance of households to announce that illness to visitors. Neem
branches are kept handy by the affected person to gently brush the skin, to soothe
the itching sensation.
During the medieval era, oatmeal was discovered to soothe the sores, and oatmeal
baths are today still commonly given to relieve itching.

[edit] See also

• Chickenpox party

[edit] Further reading

• Bernstein, Henry. Who Discovered Chickenpox?. Pediatrics Questions and
Answers. Family Education Network. Retrieved on 2005-10-16.
• Chickenpox (Varicella) Vaccine. Immunization Action Coalition (October 2005).
Retrieved on 2006-06-12.
• Centers for Disease Control and Prevention (CDC) (2005). "Varicella-related
deaths--United States, January 2003-June 2004." (PDF). MMWR Morb Mortal
Wkly Rep 54 (11): 272–4. PMID 15788992.
• Thomas S, Wheeler J, Hall A (2002). "Contacts with varicella or with children and
protection against herpes zoster in adults: a case-control study." (PDF). Lancet
360 (9334): 678–82. doi:10.1016/S0140-6736(02)09837-9. PMID 12241874.
• Jeff Aronson (2000). "When I Use a Word...Chickenpox" (web). BMJ 321 (7262):
682. doi:10.1136/bmj.321.7262.682. PMID 10987775.

[edit] References
 1. ^ New Zealand Dermatological Society (14 Jan 2006). Chickenpox (varicella).
Retrieved on 2006-08-18.
2. ^ General questions about the disease. Varicella Disease (Chickenpox). CDCP
(December 2 2001). Retrieved on 2006-08-18.
3. ^ Heather Brannon (December 25, 2005). Chicken Pox - Varicella Virus
Infection. Retrieved on 2006-08-18.
4. ^ Royal College of Obstetricians and Gynaecologists (September 2007).
a b c

Chickenpox in Pregnancy. Retrieved on 2008-04-12.

5. ^ McPherson & Pincus: Henry's Clinical Diagnosis and Management by
Laboratory Methods, 21st ed., 2007, Chapter 54.
6. ^ Chaves SS, Gargiullo P, Zhang JX, et al. (2007). "Loss of vaccine-induced
immunity to varicella over time". N Engl J Med 356 (11): 1121–9.
doi:10.1056/NEJMoa064040. PMID 17360990.
7. ^ NHS Direct: Why isn’t the chickenpox vaccine available in the UK?
8. ^ UK Health Protection Agency (Prevention section)
9. ^ Tebruegge M, Kuruvilla M, Margarson I (2006). "Does the use of calamine or
antihistamine provide symptomatic relief from pruritus in children with varicella
zoster infection?". Arch. Dis. Child. 91 (12): 1035–6.
doi:10.1136/adc.2006.105114. PMID 17119083.
10. ^ Somekh E, Dalal I, Shohat T, Ginsberg GM, Romano O (2002). "The burden of
uncomplicated cases of chickenpox in Israel". J. Infect. 45 (1): 54–7. PMID
12217733.
11. ^ US Centers for Disease Control and Prevention. Varicella Treatment Questions
& Answers. CDC Guidelines. CDC. Retrieved on 2007-08-23.
12. ^ Definition of Chickenpox. MedicineNet.com. Retrieved on 2006-08-18.
13. ^ Is Necrotizing Fasciitis a complication of Chickenpox of Cutaneous Vasculitis?.
atmedstu.com. Retrieved on 2008-01-18.
14. ^ a b
Epidemiology of Varicella Zoster Virus Infection, Epidemiology of VZV
Infection, Epidemiology of Chicken Pox, Epidemiology of Shingles. Retrieved on
2008-04-22.

[edit] External links

Wikimedia Commons has media related to:

Chickenpox
• Varicella Disease (Chickenpox): Varicella, although a common disease, can be
dangerous and even deadly.. CDC (May 26, 2005).
[show]
v • d • e
Viral diseases (A80-B34, 042-079)

VPoliomyelitis (Post-polio syndrome) - Subacute sclerosing panencephalitis -

iProgressive multifocal leukoencephalopathy - Rabies - Encephalitis lethargica -
rLymphocytic choriomeningitis - Tick-borne meningoencephalitis - Tropical spastic
aparaparesis
l
i
n
f
e
c
t
i
o
n
s

o
f

t
h
e

C
N
S

AMosquito (Dengue fever - Chikungunya - Rift Valley fever - Yellow fever -

rO'nyong'nyong - West Nile - Japanese Encephalitis - St. Louis Encephalitis - Murray
tValley encephalitis - Ross River) Tick (Crimean-Congo hemorrhagic fever - Omsk
hhemorrhagic fever - Kyasanur forest disease - Alkurma - Powassan)
r
o
p
o
d
-
b
o
r
n
e

v
i
r
a
l

f
e
v
e
r
s

a
n
d

v
i
r
a
l

h
a
e
m
o
r
r
h
a
g
i
c

f
e
v
e
r
s

Z
o
o
n
o
t
i
c

v
i
Menangle - Nipah - BDV Rat (Lassa fever - Venezuelan hemorrhagic fever - Junin -
r
Argentine hemorrhagic fever - Bolivian hemorrhagic fever - Puumala - Andes - Sin
u
Nombre - Haantan) Bat (Australian bat lyssavirus - Ebola - Marburg hemorrhagic fever
s
- Mokola - Duvenhage)
e
s

(
V
e
c
t
o
r
)
VHerpes simplex - Chickenpox - Herpes zoster - Smallpox - Monkeypox - Measles -
iRubella - Cowpox - Vaccinia - Molluscum contagiosum - Roseola - Fifth disease - Hand,
rfoot and mouth disease - Foot-and-mouth disease - KSHV - Wart
a
l

i
n
f
e
c
t
i
o
n
s

c
h
a
r
a
c
t
e
r
i
z
e
d

b
y

s
k
i
n

a
n
d

m
u
c
o
u
s

m
e
m
b
r
a
n
e

l
e
s
i
o
n
s

V
i
r
a
l

h
e
Hepatitis A - Hepatitis B - Hepatitis C - Hepatitis D - Hepatitis E - Hepatitis G
p
a
t
i
t
i
s

VAvian influenza - Acute viral nasopharyngitis - Infectious mononucleosis - Influenza -

iSevere acute respiratory syndrome - Viral pneumonia - Human parainfluenza viruses -
rRSV - hMPV
a
l

i
n
f
e
c
t
i
o
n
s

o
f

t
h
e

r
e
s
p
i
r
a
t
o
r
y

s
y
s
t
e
m

S
e
x
u
a
l
l
y

tHIV (AIDS, AIDS dementia complex) - HPV (Genital warts, Cervical cancer) - Adult T-
rcell leukemia
a
n
s
m
i
t
t
e
d

V
Rotavirus - Norovirus - Astrovirus - Coronavirus - Adenovirus
i
r
a
l

g
a
s
t
r
o
e
n
t
e
r
i
t
i
s

V
i
r
u
s
e
s

a
n
HTLV (induces leukemia) - VSV (oncolytic)
d

c
a
n
c
e
r
s

O
t
h
e
r

v
i
r
a
Cytomegalovirus - Mumps - Bornholm disease
l

d
i
s
e
a
s
e
s

[show]
v • d • e
Varicella zoster

IChickenpox - Herpes zoster - Postherpetic neuralgia

n
f
e
c
t
i
o
n
s

O
t
h
Varicella zoster virus - Varicella vaccine - Zostavax - Pox party
e
r
Retrieved from "http://en.wikipedia.org/wiki/Chickenpox"
Categories: Articles needing expert attention since March 2008 | Viral diseases |
Pediatrics | Poxviruses
Hidden categories: Cleanup from March 2008 | All pages needing cleanup | Medicine
articles needing expert attention | Pages needing expert attention | Articles to be
expanded since March 2008 | All articles to be expanded
Views
• Article
• Discussion
• Edit this page
• History
Personal tools
• Log in / create account
Navigation
• Main Page
• Contents
• Featured content
• Current events
• Random article
Interaction
• About Wikipedia
• Community portal
• Recent changes
• Contact Wikipedia
• Donate to Wikipedia
• Help
Search
Top of Form

Go Search

Bottom of Form

Toolbox
 • What links here
• Related changes
• Upload file
• Special pages
• Printable version
• Permanent link
• Cite this page
Languages
• ‫العربية‬
• Български
• Česky
• Dansk
• Deutsch
• Español
• Esperanto
• ‫فارسی‬
• Français
• Bahasa Indonesia
• Italiano
• ‫עברית‬
• Latina
• Lëtzebuergesch
• Magyar
• Македонски
• Bahasa Melayu
• Nederlands
• 日本語
• Norsk (bokmål)
• Norsk (nynorsk)
• Polski
• Português
• Română
• Runa Simi
• Русский
• Simple English
• Slovenčina
• Slovenščina
• Suomi
• Svenska
• ไทย
• Tiếng Việt
• 中文

• This page was last modified on 18 June 2008, at 13:45.

• All text is available under the terms of the GNU Free Documentation License.
(See Copyrights for details.)
Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc., a U.S.
registered 501(c)(3) tax-deductible nonprofit charity.
• Privacy policy
• About Wikipedia
• Disclaimers