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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.
Section 3. Summaries of Infectious Diseases
Varicella-Zoster Infections
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
Care of Exposed People
CLINICAL MANIFESTATIONS: Primary infection results in varicella (chickenpox), manifesting as a generalized, pruritic, vesicular rash typically consisting of 250 to 500 lesions, mild fever, and other systemic symptoms. Complications include bacterial superinfection of skin lesions, thrombocytopenia, arthritis, hepatitis, cerebellar ataxia, encephalitis, meningitis, and glomerulonephritis. Varicella tends to be more severe in adolescents and adults than in young children. Reye syndrome can follow some cases of chickenpox, although the incidence of Reye syndrome has decreased dramatically with decreased use of salicylates during varicella or influenza-like illnesses. In immunocompromised children, progressive severe varicella characterized by continuing eruption of lesions and high fever persisting into the second week of illness, as well as encephalitis, hepatitis, and pneumonia, can develop. Hemorrhagic varicella also is more common among immunocompromised patients than immunocompetent hosts. Pneumonia is relatively less common among immunocompetent children but is the most common complication in adults. In children with human immunodeficiency virus (HIV) infection, chronic or recurrent varicella (disseminated herpes zoster) can develop, with new lesions appearing for months. Severe and even fatal varicella has been reported in otherwise healthy children receiving intermittent courses of corticosteroids for treatment of asthma and other illnesses. The risk is especially high when corticosteroids are given during the incubation period for chickenpox.
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The virus establishes latency in the dorsal root ganglia during primary infection. Reactivation results in herpes zoster ("shingles"). Grouped vesicular lesions appear in the distribution of 1 to 3 sensory dermatomes, sometimes accompanied by pain localized to the area. Postherpetic neuralgia is defined as pain that persists after resolution of the rash. Systemic symptoms are few. Zoster occasionally can become disseminated in immunocompromised patients, with
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