Varicella
(chickenpox)
The
herpes virus varicella-zoster is spread by the respiratory route; its
incubation period is about 14 days.
Slight
malaise is followed by the development of papules, which turn rapidly into
clear vesicles, the contents of which soon become pustular. Over the next few
days the lesions crust and then clear, some-times leaving white depressed
scars. Lesions appear in crops, are often itchy, and are most profuse on the
trunk and least profuse on the periphery of the limbs (centripetal). Second
attacks are rare. Vari-cella can be fatal in those who are immunologically
compromised.
•
Pneumonitis, with pulmonary
opacities on X-ray.
•
Secondary infection of skin lesions.
•
Haemorrhagic or lethal chickenpox in
the immunocompromised.
•
Scarring.
Smallpox,
mainly centrifugal anyway, has been univer-sally eradicated, and the diagnosis
of chickenpox is seldom in doubt.
None
are usually needed.
Aciclovir,
famciclovir and valaciclovir should be
reserved for severe attacks and for immunocompromised patients; for the latter,
pro-phylactic aciclovir can also be used to prevent disease if given within a
day or two of exposure. In mild attacks, calamine lotion topically is all that
is required. A live attenuated vaccine is now available, and being more widely
used. It is not universally effective and should not be given to patients with
immunodeficien-cies or blood dyscrasias who might not be able to resist even
the attenuated organism.
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