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Chickenpox (Varicella)
Overview
Chicken pox is an acute infectious disease of viral etiology, characterized by the appearance of a characteristic blistering rash against the background of a general intoxication syndrome.
Characteristic:
Chickenpox is caused by the herpesvirus Varicella Zoster, which is also known as human herpesvirus type 3. This is a DNA-containing virus that can only replicate in the human body and is not particularly stable in the exterior environment. When exposed to sunshine, UV radiation, heating, or drying, the virus swiftly deactivates. Sick persons are the reservoir and source of chickenpox during the last 10 days of the incubation phase and the fifth to seventh day of the rash stage.
Chickenpox is spread by aerosol mechanism via airborne droplets. Contact-household transmission is difficult to conduct due to the virus's low resistance. The virus may be disseminated over a pretty long distance within the room by a tiny aerosol created by patients while coughing, sneezing, or talking, and it can be carried into neighbouring rooms by air movement. There is a chance of infection spreading transplacentally.
People are very susceptible to infection, and following exposure to chickenpox, strong lifetime immunity is maintained. Antibodies from the mother protect children in their initial months of life from infection. Chickenpox is particularly common in preschool and primary school-aged children who attend organised children's groups. Chickenpox affects around 70-90% of the population before the age of 15 years. The prevalence in cities is more than double that in rural regions. The autumn-winter season has the highest prevalence of chickenpox.
Pathogenesis:
The mucous membrane of the respiratory system serves as the infection's entry point. The virus infiltrates and concentrates in epithelial cells before spreading to regional lymph nodes and the general circulation. The virus's circulation in the bloodstream generates the phenomenon of universal intoxication. The varicella-zoster virus prefers the epithelium of integumentary tissues. The virus's multiplication in the epithelial cell adds to its death; in place of dead cells, cavities filled with exudate (inflammatory fluid) form a vesicle. Crusts persist after opening the vesicles. Following the splitting of the crust, a freshly developed epidermis is discovered beneath it.
Chicken pox is severe in persons with weaker immune systems, and it contributes to the development of complications, secondary infection, and chronic illness aggravation. During pregnancy, the risk of transmission of chickenpox from the mother to the foetus is 0.4% in the first 14 weeks and climbs to 1% until the 20th week, when the danger of infection of the foetus is virtually eliminated. Pregnant women with chickenpox are provided particular immunoglobulins as an effective prophylactic strategy, which assist lower the chance of transmission to the kid. More harmful is chickenpox, which appears a week before and a month after the delivery.
Persistent lifetime immunity consistently protects the body from re-infection; nevertheless, people who had chickenpox as a kid can become infected with it again due to a severe decline in the body's immunological characteristics. There is a process known as latent carriage of the varicella-zoster virus, which accumulates in nerve node cells and can be triggered, resulting in shingles. The mechanisms of viral activation in such carriage are yet unknown.
Symptoms
The incubation period for chickenpox ranges from 1-3 weeksLifetime immunity protects the body from re-infection; nevertheless, those who had chickenpox as a child can become infected with it again due to a significant reduction in the body's immunological properties. Latent carriage of the varicella-zoster virus occurs when the virus accumulates in nerve node cells and can be activated, resulting in shingles. The mechanisms of viral activation in this type of carriage are yet unclear.
The rash caused by chickenpox is called bullous dermatitis. Rashes are solitary components that can appear on any area of the body and spread randomly. The rash begins with red patches, then progresses to papules, and finally to tiny, even, single-chamber vesicles with a clear liquid that burst when penetrated. Crusts develop as the vesicles open. Chickenpox is distinguished by the coexistence of components at various stages of development as well as the formation of new ones (spilling).
The chickenpox rash produces acute itching, and scratching may infect the vesicles, resulting in pustule production. Pustules can leave a scar (pockmark) behind after they heal. Uninfected vesicles do not produce scars; instead, as the crusts separate, a healthy new epithelium is discovered. Suppuration of loose components frequently affects the overall state, and drunkenness intensifies. Adults often have a more severe rash, with pustules forming from the vesicles in the great majority of cases.
With the exception of the palms and soles, the rash covers nearly the whole surface of the body and is mostly localised on the scalp, face, and neck. For 3 to 8 days, podsypanie (the appearance of new components) is likely; in adults, they are typically accompanied by fresh waves of fever. Both the intoxication and the rash stop at the same time. The mucous membranes of the oral cavity, sexual organs, and occasionally the conjunctiva might develop rashes. The progression of loose substances on the mucous membranes to erosion and ulceration. Damage to the lymph nodes is uncommon in children; in adults, the rash may be followed with lymphadenopathy.
In addition to the ordinary course, there are severe types of chickenpox that can be bullous, hemorrhagic, or gangrenous, and an erased form of chickenpox that develops without any outward indications of intoxication. The bullous type is characterised by a rash that looks like big, floppy blisters that, when they break apart, leave long-lasting ulcerative deformities. For those with severe chronic conditions, this shape is normal. Small haemorrhages are seen on the skin and mucous membranes in the hemorrhagic type, which is also accompanied with hemorrhagic diathesis. Nasal bleeding is also possible. Because of their hemorrhagic contents, vesicles have a brownish colour. The progression of chicken pox can take on a gangrenous form in those with considerably debilitated bodies: rapidly expanding vesicles with hemorrhagic contents break open, forming necrotic black crusts that are encircled by an inflammatory skin rim.
Prevention
The prognosis is good; the illness will conclude in recovery. Vesicles vanish with no sign of recovery, while pustules might leave smallpox scars. the prognosis for those suffering from severe systemic illnesses and immunodeficiency has significantly deteriorated.
The goal of chickenpox prevention is to stop the disease from spreading to organised children's groups, where quarantine measures are used when instances of the illness are found. From the moment the rash emerges, patients must be isolated for 9 days. Children who have come into touch with the ill person must be kept apart for 21 days. If the day of contact with the patient can be identified with accuracy, the kid is prohibited from participating in the children's team for 11 to 21 days after contact. Children with immunosuppressed contacts who have never had chicken pox are given anti-varicella immunoglobulin as a preventative intervention.
Chicken pox immunisation has been utilised recently. The vaccinations Varilrix (Belgium) and Okavax (Japan) are utilised for this purpose.
Treatment
Except in situations of a severe course with significant general intoxication signs, chicken pox is managed as an outpatient condition. Since etiotropic treatment has not been discovered, antibiotic medication is used for a brief period of time in moderate dosages when pustules occur. Antiviral medications including acyclovir, vidarabine, and interferon alfa (new generation interferon) may be recommended to people with immunological deficiencies. Early interferon administration lessens the risk of complications and helps the virus progress more slowly and mildly.
Vesicles are lubricated with antiseptic solutions as part of the chickenpox treatment to prevent problems from purulent skin infections. The terms "brilliant green" and "potassium permanganate" refer to a concentrated 1% solution of brilliant green. Hydrogen peroxide or ethacridine lactate at 3% dilution is used to treat mucosal ulcerations. Applying glycerin or rubbing on diluted vinegar or alcohol to the skin will reduce severe itching in rash-affected regions. Antihistamines are a pathogenetic substance that are prescribed. One particular anti-varicella immunoglobulin is recommended for expectant mothers and patients with a severe type.
Tests Required for Diagnosis
In clinical practise, the diagnosis of chickenpox is made based on a distinctive clinical presentation. A total blood count in cases of chickenpox is vague, and pathological abnormalities might indicate an inflammatory illness with symptoms proportionate to general intoxication symptoms or be restricted to an acceleration of ESR.
In a virological examination, virions are found by electromicroscopy of vesicular fluid that has been stained with silver. Serological diagnosis is carried out utilising RSK and RTGA in pairs of sera and has a retrospective value.
