Friday, September 27, 2013

Chicken Pox (Varicella)

- Also known as Varicella\Theula (in Nepali).
- Chicken pox is an acute highly infectious disease caused by Varicella Zoster virus.
- Period of communicability : 1-2 days before to 4-5 days after appearance of rash.
- Incubation Period : 14-16 days (10-21 days)

Mode Of Transmission
1. By droplet infection or droplet nuclei
2. Face to face (Personal) contact.

Clinical Features
Clinical Features is divided into following stages :
1. Pre-eruptive Stage :-
- Onset with mild or moderate fever
- Pain in the back
- Malaise
- Lasting about 24 hours
2. Eruptive Stage :-
- Rash-often a first sign, it comes on the day the fever start.
- Rash is symmetrical, first appear on trunk and then comes on the face, arms and legs.
- Vesicles filled with clear fluid & looking like “Dew Drops” on the skin
- Scabbing begins 4-7 days after the rash appear.

Diagnosis
1. Clinical Features
2. Scarpings of floor of vesicles :- Tzanck smear multinucleated giant cells.
3. Serology : Anti IgM antibodies to varicella
4. Examination of vesicle fluid-under the electronic microscope-round viral particle.

Treatment
- Symptomatic : Antipyretics (except Aspirin)
- Oral Acyclovir (20mg/kg/day × 4 times a day for 5 days) within 24 hours of onset of rash in healthy children reduces the duration of rash by one day and lesions by 25%
- Isolation of cases for about 6 days after onset of  rash and disinfection of articles soiled by nose and throat discharge.

Complications

1. In most cases it is a mild, self-limiting disease
2. Hemorrhages (varicella hemorrhagic)
3. Pneumonia
4. Herpes Zoster
5. Reye’s Syndrome (acute encephalopathy with fatty liver)
6. Secondary bacterial infection
7. Meningoencephalitis
8. Optic neuritis

Prevention
- Varicella zoster immunoglobulin (VZIG) : It is given within 72 hours of exposure has been recommended for prevention.
- Live attenuated varicella vaccine.



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