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Chapter: Paediatrics: Infectious diseases

Paediatrics: Rash: chickenpox and zoster

VZV infection typically occurs between the ages of 1 and 6yrs, with the maximal transmission during winter and spring.

Rash: chickenpox and zoster

 

VZV infection typically occurs between the ages of 1 and 6yrs, with the maximal transmission during winter and spring.

 

Signs and symptoms

 

   Prodrome: VZV is spread by respiratory droplets or direct contact with lesions. The infectious period begins 2 days before vesicles appear and ends when the last vesicle crusts over (it is possible to retrieve virus from a crust).

 

   Rash: usually starts on the head and trunk; then the rest of the body. Individual lesions start as red macules, then progress through stages: papule, vesicle, pustule, crusting. Different stages of the rash are seen at the same time and heal completely within 2wks.

 

   Other features. Headache, anorexia, signs of upper respiratory tract infection (i.e. sore throat, cough coryza), fever, and itching.

 

Diagnosis

 

   Clinical. Characteristic rash, its distribution, and progression.

 

   Other. Serology (VZV IgM), electron microscopy of vesicle fluid.

 

Management

 

   Symptoms: treatment of fever and itching.

 

   School exclusion: 5 days from start of skin eruption

   Antivirals: aciclovir is used in severe varicella, encephalitis, pneumonia, babies, and immunosuppressed patients (i.e. steroids, oncology, etc.).

   VZIG: Varicella zoster immunoglobulin should also be considered as prophylaxis following contact in at risk individual (see www.hpa.org.uk for guidance).

   Immunization: from age 1 not currently part of UK schedule

 

Complications

 

s bacterial infection may occur with invasive group A streptococcus lead-ing to necrotizing fasciitis or toxic shock syndrome. Other rare complica-tions include purpura fulminans, cerebrovascular stroke, and encephalitis. Life-threatening pneumonitis may occur in the young infant and immuno-suppressed child.

 

Herpes zoster (shingles)

 

A reactivation of latent infection may occur, leading to vesicular lesions in the distribution of a sensory nerve. Rare in childhood, but occurs in the immunosuppressed, or in those who had p infection in infancy.

 

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Paediatrics: Infectious diseases : Paediatrics: Rash: chickenpox and zoster |


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