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Rash: chickenpox and zoster
VZV infection typically occurs between the ages of 1 and 6yrs, with the maximal transmission during winter and spring.
• 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.
• Clinical. Characteristic rash, its distribution, and progression.
• Other. Serology (VZV IgM), electron microscopy of vesicle fluid.
• 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
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.
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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