Chicken Pox (Varicella) - Causes, Symptoms, Treatment and Prevention

Introduction - Chicken Pox (Varicella) 

Chicken pox is known as Varicella. Chicken pox is contagious infection caused by varicella-zoster virus. It causes fever and itchy red rash with fluid-filled blister. Chicken pox is highly contagious to people.

Chicken pox is primary infection lesion and shingles (herpes zoster) is reactivated lesion. Chicken pox is severe than small pox.

 

Causative Agent - Varicella-zoster virus (DNA Virus) 

 

Varicella-zoster virus cause two disease-

1. Shingles (herpes zoster)

2. Chicken pox (Varicella)

Portal of entry of virus is the respiratory tract.

 

 

Epidemiological Triad

Chickenpox is highly communicable.

Agent - The causative agent is Varicella-zoster virus, It present in orophangeal secretions  and lesions of skin  and mucosa of a case of  chicken pox.

 

Host-Chicken pox primarily occurs among children under 10 years of age and occurs in both sexes.

The disease can be severe in normal adult

During pregnancy if chicken pox infection presents a risk for the foetus and the neonate.

 

Environment- Overcrowding

Mot occurs in winter and spring.

 

Mode of Transmission

 

1. Air-borne disease – spread of vesicle fluid

2. Direct contact person to person

3. Spread easily through coughs and sneezes of an infected person

4. It may also spread through contact with the blister

5. Respiratory droplet

6. Indirectly through articles freshly soiled by discharge

7. Droplet nuclei

8. Portal of entry is the Respiratory tract.

 

Who is at Risk of Chickenpox?

 

1. Who haven’t had the disease before

2. Who haven’t vaccinated against it

 

Incubation Period

 

The incubation period of chickenpox usually 14-17 days (Ranges between 10 - 21 days)

 

Pathophysiology of Chickenpox

 

1. Inhalation of Respiratory Droplets

2. Infection of mucosa of upper respiratory track

3. Viral Replication in regional lymph nodes, of URT (2-4 days after initial infection)

4. Stage of primary viremia,

5. Viral infection in liver, spleen and other organs

6. Secondary viremia

8. Infection of skin and appearance of vesicular rash

 

 

 Clinical Manifestation

 

1. Rash, blister form

2.  Headache

3. Abdominal pain

4.  Moderate and High Fever

5. Sore throat

6.  Fatigue

7. Malaise

 8. Centripetal distribution of lesions

Get information about the signs and symptoms of smallpox and what are the causative agents of smallpox.

 

The clinical course of chickenpox may be divided into two stages-

 

1. Pre-eruptive stage

 Onset is sudden with mild or moderate  fever, pain in back, shivering and malaise.  This stage is brief and lasts about 24 hours.

In adults, the prodromal illness is generally more severe and may last for about 2 -3  days before the rash comes out.

 

2. Eruptive stage - Rash

 

 The rash is symmetrical distributed in body. It look like dew drop on the skin.  . It is centripetal distributed.  It first appears on the trunk where it is abundant, and then comes on the face, arms, axilla and legs. Palms and soles are not usually affected.

 

Pleomorphism  - A characteristic feature of the rash in chickenpox is its pleomorphism, that is, all stages of the rash (papules, vesicles and crusts) may be seen simultaneously one time, in the same area.

Incubation period - Usually 14-17 days

Predormal (1-3 day )

Rashes appear like dew drops on the skin.

 

Rashes go through stages of-

Macule

Papule (Raised pink or red bumps) 

Vesicles (Small fluid-filled blisters)

Pustules

Crust

Scabs (Protective tissue covering, cover the broken blisters) 

Take several more days to heal, Recovery usually takes 7 -10 days after Rash appears.

 

Laboratory Diagnosis

 

1. Isolation of vesicular fluid

2. Scrapings of the floor of vesicles  (Polymerase chain reaction (PCR) testing) 

3. Serology tests for  varicella  IgM antibody

4. ELISA (Enzyme-linked immunosorbent assay)  

 

Treatment of Chickenpox

 

1. Antiviral medication

Oral therapy with –

Acyclovir (zovirax)

Valacyclovir (Valtrex)

Famciclovir(famvir)

It is most effective if it is started within the first 24 hours after the onset of the rash.

 

Prevention of Chicken Pox

 

1. Chickenpox or Varicella vaccine  - Live attenuated varicella virus vaccine; derived from the Oka strain of VZV.

Varivax, approx.  0.5-mL dose - by subcutaneous injection into the outer aspect of the upper arm (deltoid region) or the anterolateral thigh.

Varilrix (SC)

2. Varicella-zoster immune globulin (VZIG) given with in 24 hours of exposure.

Dose  - 1.25 to 5ml I/M

3. Routine vaccination for children

Varicella or chicken pox is a vaccine preventable disease occurring commonly in children.

 

Chicken pox vaccine                     Chicken pox vaccine   age

 1^st dose                                            2-15 month of age

2^nd dose                                            4-6 year of age

People not vaccinated earlier       People 13 years of age                

Or chicken pox vaccine in adult    and older

 

Once attack of chickenpox gives durable immunity. The secondary attacks are rare.

 

Nursing Diagnosis

 

1. Hyperthermia related to viral infection evidence by vital sign report

2. Impaired skin integrity related to infection of skin evidence by physical examination

3. Risk for infection related to damaged skin tissue evidence by a present blister in the skin.

4. Deficient knowledge related to the disease condition and treatment needs

 

 

Control of Chicken Pox

 

1. Early diagnosis

1. Isolation

2. Quarantine

3. Protection of contacts

5. Treatment

 

Contraindication

 

Pregnancy- Infection during pregnancy presents a risk for the foetus and the neonate.

 

Complications of Chickenpox

 

1. Varicella pneumonia

2. Encephalitis

3. Acute cerebellar ataxia

4. Haemorrhages

5. Reye’s syndrome (swelling in the liver and brain) 

6. Maternal infection in the first trimester can give rise to “congenital varicella syndrome" (If chickenpox develops up to 20 weeks of pregnancy)  

 

 

Chickenpox FAQs

 

 

1. What is chickenpox?

Chickenpox is a very contagious disease caused by the varicella-zoster virus which is a DNA virus. Chicken pox is also known as Varicella. Primary infection with varicella-zoster virus (VZV) causes varicella.

2. How is chickenpox Transmitted?

Chickenpox is transmitted from person to person by direct contact, through coughs and sneezes of an infected person, droplet or air-borne contact with respiratory secretions or through contact with the blister (skin lesions) of an infected person.

In utero infection (infection within the womb) can occur if a mother infected with chickenpox diseases during pregnancy.

 

3. What are the Symptoms of chickenpox?

The symptoms include itchy rash, centripetal distribution of lesions, lesions blister form, Headache, moderate to high fever, Sore throat.

 

4. What is differences between chickenpox and shingles?

 First time get infected with the varicella zoster virus, chickenpox disease is caused.  After chickenpox  infection, the virus remains dormant in human body. Shingles (herpes zoster) occur when the varicella zoster virus becomes reactivated.

Herpes zoster also known as shingles, caused by the reactivation of the varicella-zoster virus. The same virus that causes chickenpox also causes shingles disease.

 

5. What treatment is available for chickenpox?

Oral and injection antiviral therapy is available for person who infected with chickenpox, administered according to severity and complications of varicella infection.