Chickenpox in children - symptoms, how it begins, treatment period

Chicken pox is an acute infectious viral pathology, manifested by a blistering rash and general intoxication syndrome. The causative agent of the disease is type 3 herpesviruses, which provoke the development of herpes zoster. Chickenpox in children is the most common viral infection, which is easily diagnosed by a doctor when characteristic symptoms appear: a rash accompanied by itching. Therapy is aimed at eliminating all signs of the disease, improving the child’s well-being and preventing dangerous complications.

What causes chickenpox, symptoms

Varicella Zoster is a DNA virus that is unstable outside the human body. Only in it is the replication of infectious pathogens possible. In the external environment, they are quickly inactivated at high temperatures, under the influence of sunlight and ultraviolet rays. The source of infection with herpes viruses becomes a sick person during the last 10 days of the incubation period, 2–3 days before the appearance of the rash. At first they are located inside the skin blisters, and after breaking through they spread throughout the body, forming new lesions. Chicken pox is manifested by both local signs and symptoms of intoxication:

• rashes accompanied by itching;
• general malaise;
• dyspeptic disorders (usually in adults);
• elevated temperature.

Chickenpox is a highly contagious viral disease. The transmission mechanism is aerosol, airborne droplets. The risk of infection increases with reduced immunity and prolonged contact with the virus carrier. The remaining pathways are considered difficult to implement due to the instability of pathogens in the environment.

When infectious patients cough, sneeze, or talk, herpes viruses are carried by air flow over fairly large distances.

Historical information and interesting facts

Chickenpox was first described in the mid-16th century in Italy by doctors Vidus-Vidius and Ingranus. For a long time, chickenpox was not recognized as an independent disease and was considered a type of smallpox. After the causative agent of chickenpox was discovered in the contents of chickenpox vesicles in 1911, the disease began to be considered a separate nosological form. The virus itself was isolated only in 1958. The chickenpox virus infects only humans, and the only reservoir of infection is also humans.

Diagnosis of the disease

Chickenpox is diagnosed by characteristic symptoms. Data from a general blood test are nonspecific; among its pathological changes there is only an increase in the erythrocyte sedimentation rate. This diagnostic sign is characteristic of all inflammatory diseases and is proportional to the intensity of systemic intoxication of the body.

When examining a patient, the doctor asks to describe the first symptoms and how long it took to increase their severity.

How does chickenpox begin in children and adults:

• Individual red spots form on the skin;
• after a few days they transform into bubbles filled with liquid contents;
• after the bubbles disintegrate, thin, quickly drying crusts remain.

After the rash appears, chickenpox spreads to large areas of the body. In adults, the situation is often complicated by chills, fever, and body aches. This also allows for an accurate diagnosis.

Vaccines

The chickenpox vaccines currently available on the market are produced using the so-called Oka VZV strain, which has been modified through sequential propagation in different cell cultures. Various formulations of such live, attenuated vaccines have undergone rigorous testing and have been approved for use in Japan, the Republic of Korea, the USA, and several European countries. Some vaccines are approved for use at ages 9 months and older.

From a logistical and epidemiological point of view, the optimal age for chickenpox vaccination is 12-24 months. In Japan and several other countries, one dose of vaccine is considered sufficient, regardless of age. In the United States, 2 doses of the vaccine given 4-8 weeks apart are recommended for adolescents and adults, of whom 78% seroconverted after the first dose and 99% after the second dose.

According to the current US vaccination schedule, children receive 2 doses of the vaccine (1st dose at 12 months, 2nd at 6 years).

More about vaccines

Classification of chickenpox disease

Chickenpox in children and adults occurs with different symptoms. In addition, there are several classifications of it. There are typical and atypical diseases, the latter being of the following types:

• rudimentary;
• pustular;
• bullous;
• hemorrhagic;
• gangrenous;
• generalized (visceral).

For specific treatment and symptomatic therapy, the severity of the adult or childhood infection matters:

mild is characterized by a temperature not higher than 38°C, no signs of intoxication, minor rashes;

moderately severe is manifested by a temperature of up to 39°C, moderate signs of intoxication, profuse rashes, including those affecting the mucous membranes;

severe is characterized by temperature fluctuations up to 39.5–40°C, severe intoxication, and profuse, large rashes.

Chickenpox in children and adults can be smooth or severe. In the latter case, a secondary infection occurs and (or) chronic diseases worsen.

Herpes viral infection: placing emphasis.

– The next, very relevant topic is “Herpesvirus infection”. And I am pleased to give the floor to Andrey Viktorovich Ignatovsky.

Andrey Viktorovich Ignatovsky , Candidate of Medical Sciences:

– Good afternoon, dear colleagues. We continue our conversation about infectious agents. Today, herpesvirus infection remains one of the most pressing problems for doctors of almost all specialties. We very often discuss the negative impact of herpes virus infection in relation to the impact on the reproductive tract - this problem is extremely interesting to obstetricians-gynecologists and urologists. I think that this presentation will show the relevance of this problem for general practitioners and general practitioners.

We usually talk about herpes simplex viruses - the first and second types, and the third type virus - this is the varicella zoster viral infection. And, of course, I would like to start today with the varicella zoster viral infection, because this infection, probably, in the aspect of general medical practice, has an incredible number of interesting and important aspects.

So, type 3 herpes virus. You see that the first encounter with the third type of herpes virus leads to the development of chickenpox. This is a primary infection caused by a type 3 virus. A certain important aspect is that in this case, with a primary infection, the encounter occurred for the first time, the patient does not have antibodies, and the patient is not protected against this infectious agent. Hence, a rather frivolous attitude towards chickenpox can result in fatal cases, which we periodically see in Russia and which are recorded. And, of course, looking at almost all cases, we see that the patient received standard therapy for a mild form, and it was not taken into account that the patient was not protected, and there are etiotropic drugs that were not used in almost all fatal cases prescribed by a doctor. Further, the virus in patients who have had chickenpox remains in the spinal ganglia, and relapses of herpesvirus infection occur in the form of herpes zoster.

For whom is a patient with herpes zoster dangerous? It is dangerous for those patients who have not had chickenpox or have not been vaccinated against it. Today there is vaccination, and we know that we can prevent the occurrence of chickenpox. As for clinical understanding, I would like it to be the same for type 3 virus. We call the primary infection “chickenpox”, the first encounter with the virus – there are no antibodies. But the reactivation of the herpes virus from the dorsal ganglion is already called herpes zoster or herpes zoster, or herpes zoster. This is a slide from one of the conferences where fatal cases were analyzed, and the lecturers presented, among other things, our frivolous attitude towards herpes virus infection caused by the third type virus. Indeed, it seems that it is easier to get over it if there is an outbreak of chickenpox in a children's group - it may be better to take children there who have not been sick, many parents believe. A child exposed to the virus will get sick. I would caution against such reckless tactics. It is better to vaccinate the child in this case, and carefully monitor those children who have chickenpox in order to promptly determine the indications for prescribing systemic etiotropic antiviral drugs. Professor Tatochenko said, in my opinion, a very beautiful and correct phrase: “Infection is always a risk. The doctor’s task is to reduce it to a minimum.” As for chickenpox, as for viral infection, today we can do this in a number of cases and completely avoid severe complications and sometimes deaths.

It must be remembered that etiotropic antiviral drugs that are effective against the first and second type of virus, that is, against the herpes simplex virus, are almost as effective against varicella zoster viral infection. There are differences, I think we will have time to talk about them today, between the effects of acyclovir and penciclovir on the herpes virus of the first, second and third types. But, nevertheless, these drugs are etiotropic in relation to the herpes virus of the first, second and third types.

What danger should expect pregnant women who have chickenpox? The situation is probably not so common, but this leads to a lot of problems. We always discuss this rather large block of issues with obstetricians and gynecologists at our round tables. But it is important for a general practitioner to remember that the risk of chickenpox pneumonia is about 10%.

Returning to the further course of herpes virus infection, it is necessary, of course, to touch upon the issue of herpes zoster. The traditional idea, which many remember from their student days, is that herpes zoster appears in the area of ​​the chest dermatomes, thoracic segments. Of course, yes, but we must remember that almost the entire human body is divided into dermatomes, and we can see the reactivation of a herpes virus infection in the form of herpes zoster in the area of ​​any dermatome.

Here are the traditional clinical manifestations - this is a chest dermatome. Classic manifestations are erythema, edema and grouped microvesicles, blistering rash. But we must remember that if we see lesions in the area of ​​​​several dermatomes, then, of course, we are talking about the fact that the herpes virus infection is acquiring, or in this case the patient has, a severe course. Dermatomes can be in different localizations, in particular, genital localization can be, these can be manifestations in the sacral area, and here it is necessary to differentiate these manifestations with the zosterophoric course of herpesvirus infection, which can be caused by the herpes simplex virus, but of the second type.

If we are talking about severe, atypical forms, then, of course, we must remember that the third type of virus also has such forms. And here we see the patient’s blisters filled with hemorrhagic contents. This is a hemorrhagic form. There may be typical rashes, but in the breast area. If the patient is not examined completely and does not see this linearity of the rash, then one might think that she has some manifestations on the mammary gland. However, a complete examination of the patient gives an idea and allows for a correct and timely diagnosis.

I would point out that previously the occurrence of herpes zoster in elderly patients was considered traditional. However (and we even wrote an article at our department, observing patients at the Ott Institute of Obstetrics and Gynecology), the patient population has just become younger. We also saw young women, just in the period of pregnancy, in the period of feeding.

We must not forget about special localizations, which are extremely dangerous, primarily due to life-threatening conditions. This is ophthalmoherpes. Ophthalmoherpes is dangerous because the path of development of this inflammatory process affects both the blood vessels and the membranes of the brain. And here the risk of complications is enormously higher. Starting from acute retinal necrosis and ending with stroke. That is why, having met such a patient, a doctor of almost any specialty should not redirect him, playing the role of some kind of “switchman,” but take over the initial stage of patient management, and then attract specialists of the required profile - ophthalmologists, neurologists. But an etiotropic antiviral drug should be prescribed as soon as the patient comes to your appointment. You can consider this an emergency.

The initial manifestations are very interesting. It is always erythema, swelling. There may be no microvesicles, but the fundamentally important point is that (we can go back to the previous slide and look at this slide) clearly half of the face is affected, as if a lesion was drawn along a ruler. But the apex of the nose is always involved if it is affected in the patient. And here we clearly see a unilateral lesion, which makes it easy to make a diagnosis. Neither the allergic process will proceed like this, clearly delineated, nor any other.

It must be remembered that in 10% of patients with normal immunity with herpes zoster, hematogenous spread of the infection with the development of a disseminated form is possible, which should also alert the doctor and make him especially attentive to such patients. We must remember that clinical manifestations are not only rashes, but also pain. It usually accompanies this process and is present in different forms. We will also talk to you about pain options today.

Postherpetic neuralgia is considered one of the most dangerous complications among all the main groups; we see that there are many of them: skin, visceral, neurological, and ocular complications. But postherpetic neuralgia is most difficult to treat with medication. Sometimes, even with correct and timely prescribed therapy, it is impossible to avoid such a complication.

What is postherpetic neuralgia, and who is at higher risk? These are elderly and older patients. The area of ​​the rash matters: the maximum risk is the area of ​​the trigeminal nerve and brachial plexus. Other areas have a moderate or lesser risk, but this does not exclude the occurrence of such pain syndrome. Of course, pain in the prodrome, preceding the rash, and a pronounced rash.

We must remember that the older the patient is, the higher the risk of developing postherpetic neuralgia. What do we mean by postherpetic neuralgia? Perhaps, this Dworkin classification is the most acceptable, and it most correctly shows us that we can consider postherpetic neuralgia to be pain that lasts four months or longer. Everything up to four months is divided into either acute herpetic neuralgia or subacute herpetic neuralgia. A fundamentally important point in this classification is the therapeutic approaches. They are different. At the initial stage of the disease, along with inflammatory pain caused by the influence of the virus, neuropathic pain also arises. The fundamental difference is that we can effectively control inflammatory pain with non-steroidal anti-inflammatory drugs and analgesics. But unfortunately, we cannot influence the pain, which is called neuropathic, with anti-inflammatory drugs and analgesics, and over time, just by the fourth month, the significance of inflammatory pain practically decreases, but the significance and role of neuropathic pain increases enormously. That is why for patients who have been ill for a long time, whose pain persists after suffering from herpes for four months or more, the prescription of analgesics is useless; completely different classes of drugs must be prescribed, involving a neurologist for consultation. Without a neurologist, competent treatment of such a patient is impossible.

You see that the types of pain can be completely different - this is both acute and tearing pain. Sometimes it can be allodynia - pain with a light touch. But, nevertheless, all this causes extreme suffering to our patients. How to avoid this pain? How to avoid postherpetic neuralgia? Early appointment – ​​up to 72 hours. Doctors often misunderstand 72 hours. The patient came back after 74 hours, but he has rashes, there is activity of the process - we must still prescribe such therapy. We are talking about ideal conditions - the sooner such therapy begins, the better results we will get. Of course, the prescription of highly effective antiviral drugs, I am primarily talking about famciclovir, adequate pain relief in the acute stage. Quite good preliminary results have been obtained on the effectiveness of vaccination. What treatment principles exist today for herpes virus infection? Of course, this is etiotropic therapy. It must be remembered that nucleoside analogues are the drugs of choice today for the treatment of all forms of herpesvirus infection. Immunomodulatory therapy is pathogenetic therapy. We can do without her. It is not included in any protocol - international or domestic. Symptomatic therapy, of course, has a certain value.

And, of course, you need to remember that etiotropic drugs are acyclovir, its valino- and fervalocyclovir and famciclovir. (00:12:30) Symptomatic therapy will most likely be required for a patient with herpes zoster. These are analgesics, non-steroidal anti-inflammatory drugs and, at the stage of pain control, physiotherapy, but not ultraviolet radiation. It must be remembered that ultraviolet radiation is an aggressive, damaging factor. Tanning is a protective function of the skin.

When choosing a drug, you must remember that the most sensitive to acyclovir - the herpes simplex virus of the first and second types, varicella zoster - is more than 20 times, and cytomegalovirus is 470 times less sensitive to acyclovir than the herpes simplex virus of the first type. If we talk about drugs, then, of course, we need to remember that today both acyclovir drugs (acyclovir and valacyclovir, and famciclovir) differ in bioavailability. The bioavailability of drugs is different, due to their pharmacokinetic characteristics and, above all, accumulation in certain structures. And it is important for us, when speaking and discussing herpes virus infection caused by herpes simplex virus and herpes virus type 3, accumulation in Schwann cells, because the spread of the virus from the spinal ganglion occurs perineurally, periaxonally and, precisely, along Schwann cells. The concentration of penciclovir - the active substance famciclovir - is many times higher than the concentration of acyclovir.

And one more important point - we say that abnormal nucleosides become active under the influence of the enzymes of the herpes virus itself and accumulate only selectively in infected cells. We must remember that all acyclovir drugs (this applies to acyclovir, valacyclovir) are intracellular for less than an hour or about an hour. If we are talking about famciclovir, then you see, based on the table, which, in fact, is based on data from numerous studies, that the varicella zoster virus allows the drug to remain in the infected cell from 7 to 11 hours.

The route of elimination is the kidneys. We must now remember this very important aspect, because at the end of my presentation I will show questions, and we will touch upon the issues of medicinal safety of the use of these drugs. If we talk about comparative analysis and dosages of drugs, then, undoubtedly, such studies have also been conducted. And you see in this diagram the comparative dosages of famciclovir at a dose of 250 mg three times a day, 500 mg three times a day. And a comparison with acyclovir - the traditionally known dose of 800 mg five times a day.

We see, of course, that acyclovir is lagging behind. Its pharmacokinetic and pharmacodynamic properties differ from famciclovir. And, of course, the powerful effect with a more modern form of famciclovir provides better therapeutic indications, which is why today it is considered the number one drug for the treatment of herpes virus infection, caused, in particular, by the herpes virus type 3.

If you and I are discussing indications, then, of course, in this case herpes zoster is important to us. We have already discussed accumulation in Schwann cells. And the dosages will vary: in patients with normal immunity, the dosage is 250 mg three times a day, or 500 mg twice a day. The only difference, when the dosage will need to be doubled or increased, is ophthalmoherpes. Essentially, we have to say that in immunocompromised patients the dosages will always be doubled. And patients with ophthalmoherpes, even with normal immunity, still require high dosages. This is a dosage of 500 mg three times a day. If we are talking about herpes zoster in patients with reduced immunity, then famciclovir is also prescribed in double dosage, and the duration of therapy is 10 days.

Pay attention to this slide - this is a patient with ophthalmograpes. Here the dosage should also be 500 mg three times a day. Undoubtedly, it is necessary to involve a neurologist and an ophthalmologist for consultation.

Speaking about immunocompromised patients, with insufficient immunity, we must, of course, not forget about patients with the immunodeficiency virus. The thing to remember here is that famciclovir is the only drug approved by the FDA to treat both herpes zoster and genital herpes in HIV-positive patients.

If we touch on the issue of treating postherpetic neuralgia, it should be noted that drugs such as gabapentin and pregabalin will be effective in influencing neuropathic pain. And, we discussed this aspect, it is imperative to involve a neurologist. It is he who should prescribe such drugs. They may be given concomitantly with famciclovir or another abnormal nucleoside, or may be given soon after. That is, in fact, there is no need to wait for the development of postherpetic neuralgia and such a diagnosis. Recent studies have shown that the earlier we prescribe such drugs, the better the effectiveness in treating this condition. You see that there are drugs for second-line treatment, and, of course, there are certain approaches. First of all, we focus on the visual analog pain scale. And, understanding that we received or did not receive the effect of the therapy, we can adjust this therapy. This means that you need to understand that therapy is not straightforward. It is difficult for the patient, its tolerance is not always easy and simple. This requires special attention, and, I repeat once again, it is better to prevent it - by early adequate prescription of an etiotropic antiviral drug.

In the second block I would like to discuss herpes virus infection caused by herpes simplex virus types 1 and 2. Traditionally, we have divided: conventionally, we believed that the first type of virus affects the upper part of the body, localizing in the area of ​​the face and lips. And the second herpes virus was considered genital. However, laboratory diagnostics are improving, and today we know that these viruses no longer have the clear anatomical connection that we previously distinguished.

We must, of course, remember that we distinguish between primary herpes and recurrent forms of herpes virus infection. Clinical features: acute onset of primary infection, symptoms of intoxication, enlargement of regional lymph nodes - these are, in fact, the main clinical signs. And the laboratory results will be an increase in the level of antibodies. More often we encounter primary infection in children. And this form is herpetic gingivostomatitis, herpetic manifestations in the lip area - labial herpes. If we are talking about genital localization, about the period when a person did not encounter this virus in childhood, but, having already begun sexual activity, received the virus - in this case, of course, primary genital herpes develops. Other manifestations are also possible.

If we talk to you about the symptoms of relapse, they are well known. Prodromal phenomena in the form of pain, itching, burning, discomfort in the rash area, and later clinical manifestations. They may not always be in the form of erythema and edema; both typical and atypical forms may appear. In the case of an atypical course, we will not see bubbles, as we discussed, either these bubbles will be filled with hemorrhagic contents, or they may even be blisters.

Of course, it is necessary to distinguish between degrees of severity - mild, moderate and severe. It is this aspect that will determine the doctor’s approach, planned activities and, of course, the aspect of patient consultation. If we talk about clinical manifestations, they are well known. However, it is necessary to clarify whether this is a primary herpesvirus infection or a relapse. Clinical manifestations may be somewhat similar; only laboratory tests will allow us to distinguish between primary infection and relapse. In the event of a complication, as you see on this slide, a discussion will be required regarding the use of topical or perhaps even systemic antibacterial drugs.

In the case of herpetic glossitis - a lesion of the oral mucosa - topical drugs, of course, cannot be used, and only systemic etiotropic antiviral drugs will necessarily be discussed here. Well, in this case, one should, of course, not forget that there is a risk of developing ophthalmoherpes, developing herpetic keratitis, and here an extremely important issue will, again, be a discussion not only of the use of eye drops that have an antiviral effect, but also necessarily in the prescription of systemic etiotropic antiviral drugs.

Speaking about treatment strategies for herpesvirus infection, you need to remember that there is treatment, it differs in dosage, primary infection of relapse and two options for suppressive therapy - episodic suppressive therapy in anticipation of medical manipulations and long-term suppressive therapy to prevent relapses and prevent transmission to a partner. What is important? It is important that the use of external forms today should be limited. European guidelines for the management of patients with genital herpes in 2010, citing previously published work, showed that the use of topical drugs contributes to the development of resistance to this drug. Therefore, it is necessary to limit the use of topical forms. If we are talking about the use of the drug for primary infection, here I will say what differs today is the dosage. For famciclovir they remained 250 mg three times a day, but for valacyclovir the CDC since 2010, and the World Health Organization increased the dosage since 2003. This dosage for the treatment of primary infection is 1000 mg twice daily. If we are talking about the use of valacyclovir and acyclovir, we must remember that the active substance remains the same acyclovir. By combining with the amino acid valine, a complex is obtained, which, yes, is well absorbed, but the active ingredient remains acyclovir. The dosages used to treat recurrent infections are presented on the slide. Famciclovir has the smallest dosage - it is 125 mg twice a day, for valacyclovir this dosage is 500 mg twice a day, for acyclovir this dosage can vary, ranging from 200 mg to 400 mg per single dose, and the number of such doses is from three until five.

The new dosage for famciclovir, registered in the instructions, is short courses. In fact, the whole world is fighting for such short courses. The use of the drug in case of frequent relapses contributes to the rapid relief of symptoms, while the level of antibodies increases, which further contributes to an easier course of the herpes virus infection. And this three-day treatment regimen is quite convenient for our patients. It is necessary, of course, to remember the difference in drugs, because the development of acyclovir-resistant strains today will probably slowly take one of the leading leading positions.

How do the drugs work? So, the virus has entered the cell, and then the assembly of viral DNA begins under the influence of two viral enzymes - viral thymidine kinase and viral polymerase. And the drugs that enter the cell - acyclovir and penciclovir - are similar to guanosine, one of the components of viral DNA. Next, the thymidine kinase of the virus makes acyclovir active, and this acyclovir molecule remains, relatively speaking, alone. If we are talking about penciclovir, then the situation is as follows: the thymidine kinase of the virus also activates penciclovir, but the thymidine kinase of the virus has a hundred times greater aggregation of penciclovir, and the number of penciclovir molecules is many times higher intracellularly. And then the viral polymerase mistakenly integrates penciclovir into the terminal sections of DNA, since they are abnormal, there is no complementary tail and, accordingly, the assembly of viral DNA stops. Thus, the drugs only work in those cells where the virus is present. Where there is no virus, where the virus does not replicate, the drug will not work. This is extremely important. Well, the concentration of penciclovir on the left graphs is high and stable and does not decrease over time. But acyclovir triphosphate, unfortunately, leaves the plasma very quickly, and its therapeutic concentrations quickly fall.

Speaking about labial herpes, concluding our conversation, it must be said that there is a short single-dose regimen - three tablets of 500 mg, a convenient pulse regimen, and we must, of course, not miss this opportunity, because labial herpes is often a start for some patients development of complications from the nervous system. This must be remembered.

And in conclusion, I would like to cite the work that was published in 2008. It struck me with its abstract - we don’t often pay attention to side effects and drug safety issues, but the abstract is quite interesting. The instructions for acyclovir preparations indicate that it is necessary to ensure adequate hydration of the patient even in tablet forms. But, please note, this article discusses issues when patients were given intravenous acyclovir, high dosages were required due to the severity of this process, and complications in the form of acute renal failure were obtained. What causes such complications? First of all, the molecular structure of acyclovir. It has a crystalline structure, and these crystals can damage the tubular apparatus of the kidney and, in fact, lead to the development of acute renal failure. These patients were subsequently switched to famciclovir and recovered successfully. Just the same, when using acyclovir preparations, you need to remember that both when administered intravenously and when prescribing tablet forms, it is necessary to provide the patient with good hydration.

Thank you for attention.

How does the disease progress in children?

Chickenpox in children is much milder than in adults, usually without any consequences. Complications are predominantly local - in the form of bacterial skin lesions. Due to severe itching, children scratch it, which leads to injury. Bacteria penetrate microcracks from the surface of the skin, aggravating the course of herpes virus infection. The complication is easily eliminated with antimicrobial agents.

What does chickenpox look like in children at different stages:

• small red spots form;
• papules form, then painless blisters;
• After opening the blisters, dry crusts remain on the skin.

Spots, papules, blisters, crusts can exist simultaneously. Regardless of the number of rashes, chickenpox in children is not severe. After 10 days, the child recovers without any consequences.

When to see a doctor?

If you suspect that you or your child has chickenpox, consult your doctor. The doctor will be able to make a diagnosis simply by examining you, studying the elements of the rash and accompanying symptoms. Your doctor may also prescribe medications to reduce the severity of chickenpox and reduce the risk of complications, if necessary. Call the pediatrician in advance and warn that you suspect chickenpox - the doctor will see you in a separate room, without waiting in line, to avoid the risk of infecting other patients.

Also, be sure to tell your doctor if you have any of these complications:

• The rash has spread to one or both eyes.
• The skin around some parts of the rash becomes very red, hot, or painful, indicating a secondary bacterial skin infection.
• The rash is accompanied by dizziness, disorientation, rapid heartbeat, shortness of breath, tremors (shaking hands), loss of muscle coordination, increasing cough, vomiting, difficulty bending the head forward, or a fever above 39.4 C.
• a history of any immunodeficiency, or age younger than 6 months.

Treatment of chickenpox in children

Therapy for herpetic infections is no different from the treatment of viral diseases caused by other pathogens. In children, it is aimed only at eliminating symptoms, among which itching is especially pronounced. Rashes are treated with antiseptic solutions. The first choice drug is still a solution of brilliant green, the effect of which has been tested by time. Skin treatment with other antiseptic agents has also proven itself to be effective.

What to apply to a chickenpox rash:

• fucorcin;
• iodine;
• potassium permanganate.

Applying antiseptics with a sterile cloth or cotton swab to the rash should be done at least twice a day, always after bathing the child.

Chickenpox requires different treatment for debilitated children and for the vast majority of adults. It cannot be done without the use of antiviral ointments, and sometimes tablets with acyclovir, valacyclovir and other active substances.

To strengthen the immune defense of patients, immunostimulants or immunomodulators are recommended. When prescribing treatment, the doctor takes into account the clinical situation and severity of symptoms. If chickenpox is severe, treatment is carried out using the following drugs:

• non-steroidal anti-inflammatory drugs to relieve pain and hyperthermia;
• antihistamines to relieve itching and swelling.

A course of multivitamins, drinking plenty of fluids, and eliminating fatty foods rich in spices and salt from the diet can also speed up recovery.

How to help with chickenpox?

There is currently no cure for chickenpox. Usually the disease goes away on its own, and therapy is limited to smearing the rash with aniline dyes with bactericidal properties. A solution of brilliant green (“zelenka”) is usually used. You can take an antipyretic to relieve your general condition.

To relieve itching use:

• solution of iodine tincture (2-3%);
• solution of potassium permanganate (1:5000);
• hydrogen peroxide (3%);
• glycerol.

In some cases, antihistamines can help relieve itching. But you should not take them uncontrollably: it is better to call a doctor at home and determine acceptable medications. Showering is allowed, but without a washcloth to avoid damaging the bubbles. The same applies to the use of towels - after water procedures, you need to carefully pat your body dry with a cloth.

What is chickenpox pneumonia

Chicken pox can cause a serious complication - pneumonia. As a rule, generalized lung disease is diagnosed in adults. The pathology develops quickly, the first signs of pulmonary failure often appear simultaneously with the rash. It appears as follows:

• shortness of breath, feeling of lack of air when inhaling;
• chest pain;
• cough with sputum;
• bluishness of the skin.

Many focal nodules are visible on radiographic images. Viral pneumonia is a rare but very serious complication. It mainly occurs in patients with immunodeficiency conditions and chronic lung diseases.

The risk of complications of an infectious disease is high during pregnancy. Chickenpox can also be worsened by the development of bacterial pneumonia. Pneumonia is caused by pathogenic bacteria that have invaded a weakened body.

Herpes virus type 8

Herpes virus type 8 can cause Kaposi's sarcoma and Castleman's disease. Kaposi's sarcoma is a serious pathology that is accompanied by the appearance of malignant skin tumors. It is quite difficult, especially with immune deficiency. May be complicated by inflammation of the mucous membrane of the palate and lymph nodes.

Castleman's disease is a rare disease in which fever, enlargement of the liver and spleen, anemia, and a sharp decrease in body weight are observed.

Neurological complications

In the absence of adequate treatment, chickenpox in adults can lead to secondary encephalitis. Most often this happens 5–10 days after the first rash appears on the skin. The areas of localization of inflammatory foci are different:

• in the meningitis form, the membranes of the brain are affected;
• with ataxic, the cerebellum is affected;
• with myelitis, the spinal cord becomes inflamed.

In clinical practice, there have been cases of combined lesions - encephalomyelitis, meningoencephalitis. A decrease in the functional activity of the central nervous system is characterized by coordination disorders, involuntary movements of the eyeballs, hand tremors, and dizziness. There is information about cases of partial or complete loss of vision, paralysis, and severe mental disorders.

Chickenpox: course of the disease

Chickenpox is characterized by stages, which allows you to assess the course of the disease and navigate the quarantine period.

The incubation period of chickenpox is the time that elapses between the virus entering the body and the appearance of the first symptoms of the disease. It usually lasts 2 weeks, but can range from 10 to 21 days. The incubation period for chickenpox in adults and children is usually the same length.

The prodromal period is the initial stage of chickenpox. It is short (1-2 days), and may be absent altogether. Its characteristic symptoms are poor health, fever, muscle and headaches, and catarrhal phenomena in the nasopharynx. The first symptoms of chickenpox in adults are usually more pronounced than in children.

The rash period lasts 3-10 days. Elements of the rash appear in waves, this is accompanied by an increase in body temperature and poor health. 1-2 days pass between “waves” of rashes. There are usually 2-5 of these “waves”, then new elements stop appearing and gradually heal. The next stage begins - healing.

The recovery period begins from the moment when new elements cease to form, and all that appear become covered with crusts.

The period of convalescence (recovery) after chickenpox can last up to 1 year. The varicella-zoster virus causes a serious blow to the human immune system, and the process of its recovery is usually quite long. During this period, the body's resistance to other viral infections, such as ARVI, decreases.

How many days chickenpox lasts depends on the individual characteristics of the disease, the patient’s age, and the state of his immunity. On average, from the moment the first signs of chickenpox appear in a child until the elements of the rash completely heal, 3 weeks pass; in adults it may be longer.

The danger of chickenpox for a pregnant woman and fetus

If the disease is detected in a pregnant woman, the symptoms leave no doubt about the nature of the pathology, and she is usually hospitalized. In the early stages, it is fraught with severe consequences for the fetus:

• underdevelopment of the limbs;
• skeletal abnormalities;
• defects of the visual apparatus;
• damage to the skin;
• lesions of the central nervous system;
• developmental delay.

If the infection occurred in the third trimester, the disease will appear in the baby immediately after birth. Within a week, symptoms caused by herpes viruses will appear. The course of the disease is extremely severe - in a third of diagnosed cases the child does not survive

Prevention

Specific prevention consists of taking measures aimed at preventing the appearance of a sick child in an organized children's group. If this happens, a strict quarantine is declared.

Chicken pox in a child requires isolation for 9–10 days from the formation of the first eruptive elements. Children who came into contact with him remain at home for 3 weeks. In cases of weakened immunity, the use of anti-chickenpox immunoglobulin is practiced to prevent infection.

Latest epidemics

The incidence of chickenpox is widespread in all countries of the world. In Russia, there is an annual increase in the number of diseases of this infection. From 1998 to 2007, the incidence of chickenpox increased 1.8 times annually; 500–700 thousand cases of chickenpox are registered every year.

An interesting fact: the chickenpox vaccine became available in the Russian Federation in 2009. From the end of 2013 to 2015 there was a break in the supply of vaccines to our country. According to Rospotrebnadzor, in 2015 there was an increase in the incidence of chickenpox by 16% compared to 2014.