Chickenpox (chickenpox) in children and adults: symptoms, complications, how not to get infected

2018-01-09

• Source
• Manifestations
• Complications
• Vaccines

Chickenpox (varicella, chickenpox) is an acute and highly contagious disease. It is caused by a primary infection with the varicella zoster virus. Varicella outbreaks occur throughout the world and, in the absence of a vaccination program, affect a large proportion of the population by mid-life.

When did chickenpox start?

Chickenpox has been known since ancient times. For some time it was considered a mild form of smallpox, and only in 1772 was it identified as a separate disease. And in 1909, it was found that chickenpox and shingles have the same pathogen, which was later confirmed by laboratory tests. Subsequent study of the virus led to the development of a live attenuated varicella vaccine in Japan in the 1970s. The vaccine was licensed for use in the United States in March 1995.

Diagnostics

It is not difficult to recognize typical chickenpox after a thorough physical examination, since the disease has a classic clinical picture. The atypical form can be confused with herpes simplex, bullous dermatosis, eczema, congenital syphilis, pyoderma; laboratory tests will help differentiate chickenpox from other infections.

What tests need to be taken:

• clinical blood test to determine the level of ESR;
• microscopic examination of fluid from vesicles;
• blood chemistry;
• serological tests - RSK, RTGA.

In severe cases of the disease, a general urine test, ultrasound of the abdominal organs, CT scan of the brain, and electrocardiogram are additionally prescribed to identify which organs have been affected by the virus.

What causes chickenpox and how can you get infected?

Varicella zoster virus (VZV) is a virus that causes chickenpox and belongs to the herpesvirus family. Like other viruses in this group, it has the ability to persist in the body after the initial infection.

After a person has had chickenpox, VZV does not leave the body but remains in the sensory nerve ganglia.

Thus, primary VZV infection leads to chickenpox, and herpes zoster is the result of reactivation of a latent infection of this virus, which is caused by decreased immunity due to various circumstances (hypothermia, stress, etc.) or concomitant diseases that are accompanied by immunodeficiency (malignant blood diseases, HIV etc.). Due to the presence of this property, the chickenpox virus belongs to the group of pathogens of slow infections. It is worth noting that the chickenpox virus itself has an immunosuppressive property.

VZV is thought to have a short survival time in the environment. All herpes viruses are sensitive to chemical and physical effects, including high temperature.

The source of infection is a person with chickenpox or herpes zoster. The virus is contained on the mucous membranes and in the elements of the rash. A patient is considered contagious from the moment the rash appears until crusts form (usually up to 5 days after the last rash).

The chickenpox virus is highly contagious, meaning it is very likely to be transmitted through respiratory droplets or direct contact with characteristic skin lesions of an infected person. This is due to the fact that most of the population becomes ill in childhood.

80-90% of cases occur under the age of 14 years. Chickenpox is also characterized by high susceptibility (90-95%).

Most countries tend to have higher incidence rates in urban areas (700-900 per 100,000 population) and significantly lower rates in rural areas. The epidemiology of the disease differs in different climatic zones, for example, a significant difference is observed in temperate and tropical climates. The reasons for these differences are poorly understood and may relate to properties of the virus (which are known to be heat sensitive), climate, population density, and exposure risk (eg, daycare or school attendance, or number of siblings in the household).

Why is chickenpox so relevant in the modern world?

The relatively mild course and low mortality rate have long been the reason for an extremely calm attitude towards this infection.

However, at the moment, as a result of numerous studies, it has been established that the pathogen can affect not only the nervous system, skin and mucous membranes, but also the lungs, digestive tract, and genitourinary system.

The virus has an adverse effect on the fetus when the disease occurs in pregnant women. It is worth remembering that the mother can transmit the infection to the fetus if she is sick with chickenpox or herpes zoster (the virus can penetrate the placenta throughout pregnancy).

Possible consequences and complications

The negative consequences of chickenpox in children are rarely diagnosed; most often, dermatological purulent complications occur - abscess, phlegmon, boils, which leave scars. If the disease is severe, the virus affects internal organs and dangerous concomitant diseases develop.

Possible consequences of chickenpox:

1. Encephalitis - pathology manifests itself 7–12 days after the onset of the disease, characterized by frequent convulsions, severe headache, and impaired consciousness. In rare cases, idiocy develops.
2. Myocarditis - the virus provokes the development of an inflammatory process in the heart muscle, shortness of breath occurs, the pulse rate is disturbed, and the child may complain of chest pain.
3. Pneumonia – occurs in infants with neonatal chickenpox; the condition is dangerous and can be fatal.
4. Nephritis is an inflammation of the kidneys that develops 10 days after the first signs of pathology appear; the disease goes away on its own and no specific treatment is required.

Since the virus can penetrate all tissues and mucous membranes, the consequences of chickenpox can be blurred vision, damage to the mucous membranes of the eyes, hepatitis, problems with the pancreas and spleen.

What are the manifestations of chickenpox (chickenpox)?

The chickenpox virus enters through the respiratory tract and conjunctiva. It is believed that the virus multiplies in the mucous membrane of the nasopharynx and regional lymph nodes.

The initial entry of the virus into the blood occurs a few days after infection and contributes to the entry of the virus into the epithelial cells of the skin, where further reproduction of the virus and corresponding skin changes occur.

Then a secondary entry into the blood . It should be remembered that not only the skin epithelium can be affected, but also the mucous membranes of the gastrointestinal tract, respiratory tract, and genitourinary system. Considering that the virus is tropic to nervous tissue, degenerative and necrotic changes can develop in the nerve ganglia, sensory nerve roots and spinal cord.

Incubation period . The period from the virus entering the body to the onset of clinical manifestations ranges from 5 to 21 days after exposure, usually 1-2 weeks. The incubation period may be longer in immunocompromised patients.

Infected people may have a mild prodrome that precedes the onset of the rash. In adults, this may be 1 to 2 days of fever and malaise, but in children, a rash is often the first sign of illness.

The onset is most often acute . Fever lasts 2-7 days, longer in severe cases. Patients complain of an itchy rash, body aches, decreased appetite, sleep disturbance, and headache. Nausea and vomiting may occur.

The first elements of the rash appear on the face and torso, and then on the scalp and extremities; The greatest concentration of lesions is on the torso with the appearance of rashes within 4-6 days. In this case, elements of the rash are present at several stages of development (for example, redness and papules can be observed simultaneously and in the same area as vesicles and crusts).

The rash can also occur on the mucous membranes of the oropharynx, respiratory tract, vagina, conjunctiva and cornea.

The rash elements usually have a diameter of 1 to 4 mm. Vesicles (bubbles) are superficial, single-chambered and contain clear liquid, surrounded by a red rim. Over time, they dry out and turn into crusts, after rejection of which temporary pigmentation and occasionally small scars remain.

The number of rash elements ranges from single to multiple. The vesicles may rupture or fester before they dry out and take on a crusty appearance. The rash is accompanied by severe itching.

In 20-25% of patients, rashes may occur on the mucous membranes of the mouth and gums. Usually they quickly open, form erosions and are accompanied by pain, burning and increased salivation.

About 2-5% of patients have elements of a rash on the conjunctiva.

Also, with chickenpox, as a rule, the lymph nodes (submandibular, cervical, axillary, inguinal) become enlarged.

Recovery from the initial chickenpox infection usually results in lifelong immunity. But recently, cases of recurrent chickenpox have become increasingly common. This is not common in a healthy person, and most often occurs in immunocompromised individuals.

What complications can occur with chickenpox?

The disease is usually mild, but complications may occur, including bacterial infections (eg, bacterial skin lesions, pneumonia) and neurological infections (eg, encephalitis, meningitis, myelitis), which can be fatal.

Secondary bacterial skin infections , which are caused by streptococcus or staphylococcus, are the most common cause of hospitalization and outpatient medical visits. Secondary infection with invasive group A streptococci can cause abscesses and cellulitis.

Pneumonia after chickenpox is usually viral, but can also be bacterial. Secondary bacterial pneumonia is more common in children under 1 year of age. It is characterized by an increase in temperature up to 40⁰C, an increase in pallor and cyanosis of the skin, the appearance of a substernal dry cough and shortness of breath. Patients can take a forced position in bed.

Damage to the central nervous system in chickenpox ranges from aseptic meningitis to encephalitis. Cerebellar involvement followed by cerebellar ataxia is the most common presentation of central nervous system disorders but usually has a positive outcome.

Encephalitis is one of the most dangerous complications of chickenpox (10-20% of cases are fatal). This complication manifests itself as headache, nausea, vomiting, convulsions and often leads to coma. Diffuse brain involvement is more common in adults than in children. Chickenpox meningitis may occur together with encephalitis or independently .

Rare complications of chickenpox include Guillain-Barré syndrome, thrombocytopenia, hemorrhagic and bullous chickenpox, glomerulonephritis, myocarditis, arthritis, orchitis, uveitis, iritis and hepatitis.

Once infected, the virus remains hidden in nerve cells and can be reactivated, causing a secondary infection, herpes zoster. It usually occurs in adults over the age of 50 or with a weakened immune system and is associated with a painful rash that can cause permanent nerve damage.

What is herpes zoster?

Herpes zoster (shingles) occurs in people as a manifestation of the reactivation of a latent infection caused by a virus that was in the nerve ganglia after chickenpox. The localization of subsequent rashes will depend on which nerve ganglion the virus (VZV) was in a latent (dormant) state.

Localization of the rash in case of damage to the trigeminal nerve ganglion - on the scalp, in the forehead, nose, eyes, lower jaw, palate, tongue; if the virus is present in the spinal ganglia - on the neck, trunk, upper and lower extremities.

Features of the rash with herpes zoster are:

• vesicles are located on the skin in groups along the corresponding nerve,
• the disease most often begins with pain, followed by redness and corresponding rashes,
• over time the pain becomes less and less,
• the process is always one-sided,
• Usually the rashes are accompanied by fever, malaise, and weakness.

Types of allergic rashes

An allergic reaction occurs when any external or internal allergen enters the body. Usually expressed as rashes and itching. The human body makes every effort to neutralize the allergen. The blood vessels dilate, the skin becomes red and inflamed, and swelling appears. You must call an ambulance immediately.

Sometimes allergies occur in a milder form. The main types of allergic rashes:

• Hives. It can appear in the form of medium to large blisters. They sometimes merge with each other. The blisters are matte in color and have a pink border around the edges.
• Atopic dermatitis. The skin is itchy, dry and irritated. This is a reaction to plants, animals, certain types of food, perfumes and deodorants, household chemicals, creams and dust, and medications.
• Contact dermatitis. Blisters appear on the body, the skin turns red and itches. Rashes are localized where the allergen has entered, as a reaction to cosmetics, synthetic clothing, and medications.
• Eczema. It is most often localized on the hands and face. These are numerous pinpoint rashes with serous fluid. Causes severe itching. This may be due to stress, disruption of the endocrine system, metabolism, reaction to food, cosmetics, household chemicals.

There is also toxicoderma, neurodermatitis, Leyell's syndrome and so on. An experienced dermatologist or allergist will help determine the diagnosis and prescribe appropriate treatment.

Common symptoms and manipulations in dermatology:

• Skin rashes
• Calling a dermatologist to your home
• Itching in the urethra
• Itchy skin
• Skin rash
• Prevention of casual sex
• Skin neoplasms
• Pyoderma
• Pityriasis rosea
• Streptoderma
• Scabies
• Peeling skin
• Fungal infections
• Skin infection
• Pus on the skin
• Blisters on the skin
• Papillomas on the foreskin
• Sexually transmitted diseases
• Skin structure

What methods exist for diagnosing chickenpox?

Usually the diagnosis is made on the basis of the clinical picture and an objective examination of the patient.

To confirm the diagnosis using laboratory methods, blood, cerebrospinal fluid, and the contents of vesicles and pustules are taken. Microscopy is used as an oriented method.

In modern practice, serological diagnostic methods are used (ELISA, RSK, RNGA, RIA). In this case, blood is taken twice: at the beginning of the disease and during the period of convalescence. The reaction is considered positive if the antibody titer increases 4 times or more.

It is worth noting that ELISA and PCR are the most commonly used. There is also a method for cultivating the virus, but due to labor intensity and high costs, it is not currently used.

How to treat chickenpox?

Patients with an uncomplicated course are most often treated at home. Elements of the rash are treated with a concentrated solution of potassium permanganate. The oxygen that is released as a result of this prevents the addition of a secondary infection and also reduces itching. For a small number of rashes, you can use brilliant green.

Only in severe or complicated cases is treatment directed at the pathogen necessary. These are drugs acyclovir, valacyclovir, famciclovir, which can only be taken after consulting an infectious disease specialist or family doctor. Antiviral treatment is mandatory for herpes zoster. Local application of acyclovir ointments is also possible.

If the itching is severe, those with chickenpox should take antihistamines. For severe pain in patients with herpes zoster - analgesics. If there is a high temperature and severe intoxication, detoxification therapy (intravenous administration of certain solutions) is indicated. Immunoglobulin is indicated for persons who have a reduced level of immunity.

Treatment of chickenpox in children

Sluggish or asymptomatic chickenpox does not require special treatment; therapy is aimed at eliminating unpleasant symptoms; for a speedy recovery, you must adhere to the drinking regime and diet.

First aid

At the first stage of the disease, the temperature may rise; if the readings are above 38.5 degrees, it is necessary to give the child an antipyretic. The main problem with chickenpox is severe itching, to avoid scratching, you need to cut your nails short, infants should wear protective anti-scratch pads, and wipe the affected areas with a weak soda solution - 1 hour. l. soda per 250 ml of water. All other medications will be prescribed by the doctor after examination and diagnosis.

Medicines

There are no specific drugs against chickenpox; medications help fight the manifestations of the disease and reduce the risk of complications.

How to treat:

• antiherpetic drugs – Acyclovir;
• antipyretics - only Ibuprofen and Paracetamol, reduce temperature, eliminate signs of the inflammatory process;
• anti-inflammatory sprays - Tantum Verde, Hexoral, prescribed for viral infection of the throat mucosa, Turkish chickenpox;
• dental gels - Kalgel, Kamistad, promote the healing of ulcers in the oral cavity;
• antihistamines in the form of tablets, drops - Erius, Fenistil;
• sorbents – Polysorb, Smecta, eliminate manifestations of intoxication;
• homeopathic remedies – Flacozide, Allizarin, Helepin.

Aspirin is contraindicated for the treatment of children; for chickenpox, acetylsalicylic acid is especially dangerous - the combination of the virus and the drug can lead to severe liver pathologies.

General recommendations

If you have chickenpox, it is necessary to avoid excessive sweating - limit the child's activity, but it is not necessary to observe strict bed rest. Clothing should be spacious, made of light natural materials, the room should always be fresh and cool, bed linen should be changed every day.

Lack of appetite is a normal phenomenon in viral diseases; there is no need to force feed sick children. If everything is fine with your appetite, the basis of your diet should be light dietary dishes in liquid or ground form. It is strictly prohibited to consume salty, fried, fatty foods, carbonated drinks, and junk food.

Drinking plenty of fluids promotes a speedy recovery, since the body will quickly cleanse itself of toxic waste from viruses. You can drink plain and mineral water, fruit drinks, rosehip infusion, chamomile, and natural juices.

How to prevent chickenpox?

Chickenpox can be prevented through vaccination. Specific prevention is carried out with live vaccines from a weakened varicella zoster virus (for example, the Belgian vaccine Varilrix). Vaccination is especially recommended for young children, and in the United States for the elderly, to prevent herpes zoster and postherpetic neuralgia.

In clinical trials, it was found that individuals who were vaccinated were either not susceptible to chickenpox or experienced it in a very mild form.

Chickenpox vaccines

Vaccination is necessary for those categories of people who have reduced immunity and, as a result, a high risk of severe and complicated course of the disease. These include the following categories:

• persons with malignant diseases,
• HIV-infected,
• those groups of people who have severe chronic pathology,
• patients taking glucocorticosteroids.

Vaccination indicated:

• for preventive purposes, especially recommended for high-risk categories: - routine vaccination at the age of 12-15 months, - routine second dose at the age of 4-6 years.
• for emergency prevention of those who have not had chickenpox and have not been vaccinated, but are in contact with patients.

The minimum interval between doses of varicella vaccine is 3 months for children under 13 years of age.

Although single-dose programs are effective in preventing severe varicella disease, as demonstrated by a study in Australia (one of the few countries to include varicella vaccination as part of its national immunization program), evidence suggests that it is not necessary to interrupt transmission of the virus. two doses are required. Emerging school outbreaks and high rates of chickenpox, although usually not severe, have prompted some countries to implement a two-dose vaccination schedule.

Vaccination is the most effective medical intervention ever invented by man.

Used materials

• https://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html - etiology, pathogenesis, clinical features, prevention of chickenpox
• https://www.who.int/immunization/sage/meetings/2014/april/5_The_potential_impact_Varicella_vaccination_Low_Middle_Income_Countries_feasibility_modeling.pdf?ua=1&ua=1 – vaccination for chickenpox
• https://www.who.int/immunization/diseases/varicella/en/ - about the epidemiology of chickenpox and herpes zoster
• https://www.who.int/bulletin/volumes/92/8/13-132142/en/ - research on the effectiveness of vaccination against chickenpox and herpes zoster in Australia.
• https://www.who.int/immunization/position_papers/varicella_grad_effectiveness_2_doses.pdf?ua=1 - about the effectiveness of vaccination against chickenpox.
• https://www.who.int/wer/2014/wer8925.pdf?ua=1&ua=1 – epidemiology, diagnosis, treatment, some positions on vaccination for chickenpox and herpes zoster.
• Vozianova Zh. I. Infectious and parasitic diseases: In 3 volumes - K.: Health, 2000. - T. 1. - 904 p.
• Golubovskaya O. A. Infectious diseases. - M.: VSV "Medicine", 2012. - 728 p. + 12 s. color. on

Author: Anastasia Lishnevskaya, infectious disease doctor Source: MMK Formed

Causes of chickenpox in children

Chickenpox is an infectious disease caused by the herpes virus type 3 Varicella Zoster (VZV). The disease spreads by airborne droplets; pathogenic microorganisms quickly die in the external environment, but can be transported with air currents over long distances. To become infected with chickenpox, you do not have to be in close contact with a sick person, just being in the same room with him is enough.

The only source of infection is the carrier of the infection; the virus is not transmitted through objects, third parties and animals. The causative agent of the disease does not tolerate high temperatures or exposure to ultraviolet radiation, so the child needs to walk more in sunny weather, but only away from other children.

Important! The contagiousness of the Zoster virus is 100%; if there is at least one sick child in a children's group, all children will get sick. It’s just that sometimes the disease manifests itself in the form of several pimples, while the temperature is normal, parents may not even notice that the baby has had chickenpox.

Prevention

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It is almost impossible for a child to avoid infection with chickenpox, since he is constantly in contact with other people. The main method of prevention is strengthening the body’s protective functions and observing hygiene rules.

Important! Vaccination against chickenpox is not included in the list of mandatory vaccines for children; parents can vaccinate with Okavax and Varilrix for a fee - the average cost of the procedure is 2.5–4.5 thousand rubles.

Key Similarities Between Chickenpox and Allergies

Many people often confuse an allergic rash with chickenpox. This is not surprising, because chickenpox in the initial stages is very similar to an allergic rash. Allergic blisters are characterized as reddish and raised spots on the skin that can quickly appear in different parts of the body. The level of itching with an allergic rash often coincides with the rash with chickenpox. Among the first symptoms of chickenpox can be found:

• chills;
• elevated temperature;
• headache;
• rash on the body.

Basic allergy symptoms include:

• rash;
• itching of the skin;
• runny nose;
• itching in the eye area.

With both chickenpox and allergies, the rash initially appears on the upper torso, face, and flexures of the joints of the arms and legs.

In the photo below we depict the first signs of chickenpox and allergies in a child:

Table: First signs of chickenpox and allergies in a child

Allergy

Skin allergies in children are a manifestation of individual intolerance to various substances (food, medications, detergents, skincare products, etc.). A rash is a fairly common manifestation of allergies; this disease is characterized by:

• Uneven distribution of rashes throughout the body. Most often they are concentrated in those areas that were affected by the allergen (with contact allergies). If the culprit of the disease is food intolerance, then elements of the rash can appear on the cheeks, forearms, etc.
• The occurrence of accompanying symptoms, for example, itching, swelling, redness of the skin.
• Respiratory symptoms are also often associated, for example, sneezing, watery eyes, etc.

Experienced pediatricians know exactly how to distinguish chickenpox from allergies. Therefore, if a specific rash appears on the body, it is better to seek medical help.

Types of rashes and localization

If you are in doubt what type of rash you have on your skin and you don’t know how to determine whether you have chickenpox or an allergy, consult a doctor who will help determine what kind of illness you have. The rash caused by chickenpox and allergies have certain differences. Let's look at them in more detail:

Chickenpox rash

It is usually not difficult for parents to recognize chickenpox in a child. Chickenpox rashes appear on the scalp or abdomen and gradually spread throughout the body.

Chickenpox pockmarks appear in waves. During each wave, a child or an adult experiences an increase in temperature. Rashes of all three stages can be observed on the body.

It is strictly forbidden to scratch pockmarks with chickenpox, because this increases the risk of infection and can leave scars on the skin. Antihistamines cannot have a visible effect on chickenpox rash, but they can dull the itching a little.

Allergy rash

Allergy rashes are local in nature. They are usually grouped in a certain area and tightly.

Allergic rashes look the same and occur, mainly, simultaneously forming spots with redness.

With an allergic reaction, the rashes look the same and all appear at the same time.

If you take antihistamines and follow a hypoallergenic diet (if necessary), the rashes will go away and the skin will recover after them.

Table: Difference between chickenpox rash and allergy rash