Chickenpox (varicella, Slovak sheep pox) is one of the most common pediatric infectious exanthema diseases. It is caused by the varicella-zoster virus (VZV) familyherpesviruses. It is a highly contagious disease that is transmitted primarily through direct contact. The incubation period is about 2 weeks. It is manifested by itchy vesicular rash and enanthema, which appears in waves, so all stages (macula, papule, vesicle, crust) are present on the body at the same time. It can be severe in immunocompromised individuals. The disease leaves lifelong immunity. When the virus is reactivated, it is formed shingles. Vaccination against varicella is voluntary. 
General characteristics[edit | edit source]
- typically aged 1-6 years;
- highest incidence: during winter and spring;
- transmission: droplets or direct contact with lesions;
- incubation: 14–16 days, more usually 1-3 weeks ;
- infectivity starts 2 days before the onset of blisters and ends together with the covering of the last blisters with crusts ;
- occurs after the disease long-term immunity;
- during primary infection the disease occurs with generalized rash – chickenpox - after healing the virus persists in the cells of the sensitive ganglia of the cerebral and spinal nerves and may reactivate;
- reactivation of the virus causes shingles.
Epidemiology[edit | edit source]
- The reported incidence of varicella in the Czech Republic in the years 2000–2009 is 33,500–52,500 cases per year, ie 330-515 patients per 100 000 population per year. 
Clinical picture[edit | edit source]
- the rash usually starts at head and torso, from where it spreads throughout the body;
- development of rash: red macules → papules → vesicles → pustules → crusts;
- the simultaneous occurrence of different stages is typical (sowing in several waves for 2-5 days);
- the rash also appears in forehead, it tends to be more on the torso and in places of skin irritation;
- also on the mucous membranesof the mouth - it quickly turns into small sores;
- other symptoms:
- in adults often prodromes - fever and greater alterations in general condition, more complications;
- in healthy children it usually takes place without complications;
- we will encounter a more difficult course:
- in neonates and infants of mothers who did not have varicella;
- in malnourished and weakened ( congenital immune defects], malignancies, immunosuppression, etc.):
Diagnostics[edit | edit source]
- clinically : typical rash, its distribution and development;
- serology : VZV IgM;
- direct detection of virus : electron microscopy blister fluid .
Differential diagnostics[edit | edit source]
- Streptococcus impetigo,
- insect stings,
- enterovirus vesicular rash,
- disseminated HSV,
- allergic rashes.
Treatment[edit | edit source]
- symptomatic (fever, itching):
- * topical (liquid powder, antiseptic ointment);
- * general (paracetamol, antihistamine, ATB in bacterial superinfection);
- ** we make sure there is a sufficient "fluid supply";
- ** we isolate the sick at home;
- ** we mainly protect children with reduced immunity from infection - we give specific immunoglobulins to the infectionno later than 72 hours after exposure ← this either prevents infection or prolongs the incubation and then alleviates the course;
- u immunosuppressed and in severe acyclovir, possibly immunoglobulin ;
- * varicella-zoster immunoglobulin is administered prophylactically:
- ** pregnant women with a negative history of varicella who have been exposed to the infection;
- ** neonates of seronegative mothers who have been exposed to the infection for the first 6 weeks of life;
- ** premature infants exposed to infection regardless of maternal history .
Complications[edit | edit source]
- efflorescence impetiginization;
- pneumonia - mainly in cystic fibrosis, otherwise rare;
- encephalitis - often affects the cerebellum ;
- in adults mainly interstitial pneumonia and serous arthritis;
- Orchitis as a complication of chickenpox is very rare , or there is no association with orchitis after or during VZV infection .
Prevention[edit | edit source]
- voluntary vaccination (measles + rubella + mumps + varicella)
Infections in pregnancy[edit | edit source]
- infection in the first 5 months of pregnancy:
- 2% risk of fetal harm;
- defects of the nervous system, eye, skeleton, scarring of the skin;
- is not a reason for abortion;
- infection last 5 days before delivery or 2 after delivery :
- in the newborn, the course of the varicella may be more severe than in the postnatal infection due to the absence of transmitted maternal antibodies .
Links[edit | edit source]
[edit | edit source]
- DermNet Varicella
- Pediatrics for practice: Viral exanthemas of childhood
- Pediatrics for practice: Infectious exanthematous diseases in childhood
Reference[edit | edit source]
- MUNTAU, Ania Carolina. Pediatrie. 4. edition. Praha : Grada, 2009. pp. 184-185. ISBN 978-80-247-2525-3.
- TASKER, Robert C. – MCCLURE, Robert J. – ACERINI, Carlo L.. Oxford Handbook od Paediatrics. 1. edition. New York : Oxford University Press, 2008. pp. 688. ISBN 978-0-19-856573-4.
- KELBLEROVÁ, Aneta. Infekční exantémová onemocnění v dětském věku. Pediatrie pro praxi [online]. 2009, y. 10, p. 176-179, Available from <https://www.pediatriepropraxi.cz/>. ISSN 1803-5264.
- Státní zdravotní ústav. Vybrané infekční nemoci v ČR v letech 2000-2009 [online]. ©2010. [cit. 2010-08-15]. <http://www.szu.cz/publikace/data/vybrane-infekcni-nemoci-v-cr-v-letech-1998-2007-absolutne>.
- GRAY, J A. Orchitis in chickenpox. Br J Gen Pract [online]. 1990, vol. 40, no. 341, p. 522, Available from <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371462/?tool=pubmed>. ISSN 0960-1643.
- ORMISTON, G. Orchitis as a complication of chicken-pox. Br Med J [online]. 1953, vol. 1, no. 4821, p. 1203-4, Available from <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2016300/?tool=pubmed>. ISSN 0007-1447.