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Section 3. Summaries of Infectious Diseases
Varicella-Zoster Infections
Clinical ManifestationsEtiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
Care of Exposed People
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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. Breakthrough chickenpox cases usually are mild and can occur in immunized children, as described later in Active Immunization (p 721). Reye syndrome can follow cases of chickenpox, although today Reye syndrome is very rare because of decreased use of salicylates during varicella. 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 much more common among immunocompromised patients than among 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 (greater than 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.
Varicella-zoster virus (VZV) establishes latency in the dorsal root ganglia during primary infection. Reactivation results in herpes zoster ("shingles"), characterized by grouped vesicular lesions in the distribution of 1 to 3
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