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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 in varying stages
of development and resolution (crusting), mild fever, and other
systemic symptoms. Complications include bacterial superinfection
of skin lesions, pneumonia, central nervous system involvement
(acute cerebellar ataxia, encephalitis), thrombocytopenia, and
other rare complications such as glomerulonephritis, arthritis,
and hepatitis. Varicella tends to be more severe in adolescents
and adults than in young children. Reye syndrome can follow
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 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, recurrent varicella or disseminated herpes
zoster can develop. Severe and even fatal varicella has been
reported in otherwise healthy children receiving intermittent
courses of high-dose corticosteroids (>2 mg/kg of prednisone
or equivalent) for treatment of asthma and other illnesses.
The risk especially is high when corticosteroids are given during
the incubation period for chickenpox.
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, which may last for weeks to months, is defined . . . [Go to Full Text]
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This topic has been referenced by these articles:
- Dodd, D. A., Burger, J., Edwards, K. M., Dummer, J. S.
(2001). Varicella in a Pediatric Heart Transplant Population on Nonsteroid Maintenance Immunosuppression. Pediatrics
108: e80-80
[Abstract]
[Full Version]
- Scheinfeld, N., Cohen, S. R.
(2000). Varicella Causes Skin Pits and Keloids{---}More Reasons for the Varicella Vaccine. Pediatrics
106: 160-160
[Full Version]
- Haddad, M. B., Hill, M. B., Pavia, A. T., Green, C. E., Jumaan, A. O., De, A. K., Rolfs, R. T.
(2005). Vaccine Effectiveness During a Varicella Outbreak Among Schoolchildren: Utah, 2002-2003. Pediatrics
115: 1488-1493
[Abstract]
[Full Version]
- Quinn, D.
(2001). Use of Psychoactive Medication During Pregnancy and Possible Effects on the Fetus and Newborn. Pediatrics
107: 1498-1498
[Full Version]
- Ziebold, C., von Kries, R., Lang, R., Weigl, J., Schmitt, H. J.
(2001). Severe Complications of Varicella in Previously Healthy Children in Germany: A 1-Year Survey. Pediatrics
108: e79-79
[Abstract]
[Full Version]
- Hall, S., Maupin, T., Seward, J., Jumaan, A. O., Peterson, C., Goldman, G., Mascola, L., Wharton, M.
(2002). Second Varicella Infections: Are They More Common Than Previously Thought?. Pediatrics
109: 1068-1073
[Abstract]
[Full Version]
- Perez, E. E., Bokszczanin, A., McDonald-McGinn, D., Zackai, E. H., Sullivan, K. E.
(2003). Safety of Live Viral Vaccines in Patients With Chromosome 22q11.2 Deletion Syndrome (DiGeorge Syndrome/Velocardiofacial Syndrome). Pediatrics
112: e325-325
[Abstract]
[Full Version]
- Bonilla, F. A.
(2004). SAFETY OF LIVE VIRAL VACCINES IN PATIENTS WITH CHROMOSOME 22Q11.2 DELETION SYNDROME (DiGEORGE SYNDROME/VELOCARDIOFACIAL SYNDROME). Pediatrics
114: 550-550
[Full Version]
- Hill, G., Chauvenet, A. R., Lovato, J., McLean, T. W.
(2005). Recent Steroid Therapy Increases Severity of Varicella Infections in Children With Acute Lymphoblastic Leukemia. Pediatrics
116: e525-e529
[Abstract]
[Full Version]
- Lesko, S. M., O'Brien, K. L., Schwartz, B., Vezina, R., Mitchell, A. A.
(2001). Invasive Group A Streptococcal Infection and Nonsteroidal Antiinflammatory Drug Use Among Children With Primary Varicella. Pediatrics
107: 1108-1115
[Abstract]
[Full Version]
- Laupland, K. B., Davies, H. D., Low, D. E., Schwartz, B., Green, K., the Ontario Group A Streptococcal Study Group, , McGeer, A.
(2000). Invasive Group A Streptococcal Disease in Children and Association With Varicella-Zoster Virus Infection. Pediatrics
105: 60e-60
[Abstract]
[Full Version]
- Ibia, E. O., Imoisili, M., Pikis, A.
(2003). Group A {beta}-Hemolytic Streptococcal Osteomyelitis in Children. Pediatrics
112: e22-26
[Abstract]
[Full Version]
- Ulloa-Gutierrez, R., Dobson, S., Forbes, J.
(2005). Group A Streptococcal Subdural Empyema as a Complication of Varicella. Pediatrics
115: e112-e114
[Abstract]
[Full Version]
- Kramer, J. M., LaRussa, P., Tsai, W. C., Carney, P., Leber, S. M., Gahagan, S., Steinberg, S., Blackwood, R. A.
(2001). Disseminated Vaccine Strain Varicella as the Acquired Immunodeficiency Syndrome-Defining Illness in a Previously Undiagnosed Child. Pediatrics
108
: e39-e39
[Abstract]
[Full Version]
- Cieslak, P. R., Hedberg, K., Lee, L. E.
(2004). Chickenpox Outbreak in a Highly Vaccinated School Population: In Reply. Pediatrics
114: 1131-1131
[Full Version]
- Heath, K., Watson, B.
(2004). Chickenpox Outbreak in a Highly Vaccinated School Population. Pediatrics
114: 1130-1131
[Full Version]
- Jumaan, A. O., Harpaz, R.
(2004). Chickenpox Outbreak in a Highly Vaccinated School Population. Pediatrics
114: 1130-1130
[Full Version]
- Tugwell, B. D., Lee, L. E., Gillette, H., Lorber, E. M., Hedberg, K., Cieslak, P. R.
(2004). Chickenpox Outbreak in a Highly Vaccinated School Population. Pediatrics
113: 455-459
[Abstract]
[Full Version]
- Brunell, P. A., Argaw, T.
(2000). Chickenpox Attributable to a Vaccine Virus Contracted From a Vaccinee With Zoster. Pediatrics
106: 28e-28
[Abstract]
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- Caruso, J. M., Tung, G. A., Brown, W. D.
(2001). Central Nervous System and Renal Vasculitis Associated With Primary Varicella Infection in a Child. Pediatrics
107: 9e-9
[Abstract]
[Full Version]
- Fischer;, H., Ploin, D., Floret, D.
(2001). Aspirin and Reye's Syndrome. Pediatrics
107: 214-214
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