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Chiken Pox- Varicella Zoster Infection

  1. Incubation period : 2-3 weeks ; man is the only reservoir and transmitted by direct contact
  2. Air borne infection is much less important.
  3. Period of infectivity: from 24–48 hr before the rash appears and until vesicles are crusted, usually 3–7 days after onset of rash.
  4. Secondary attack rate 65–86%
    1. All ages susceptible including neonates peak incidence 5-9yrs.
    2. Prodrome is minimal.
    3. Rash: appears on 1st day, centripetal pleomorphic , new rash appear for 1-7 days.
    4. 5-10 mm vesiculopapular lesions with erythematous base(dew drops on rose petal) skin lesions occur in crops for 3-4 days.
    5. Vesicles involve mucosal surfaces.
    6. Histopathologically it causes ballooning degeneration of cells in vesicles
    7. Severity more pronounced in adults, immunocompromised , pregnancy and steroid therapy. 


  1. Cutaneous:             
    1. secondary bacterial infection
    2. Purpura fulminous
    3. ITP
  2. Systemic:
    1. Acute cerebellar ataxia (most common CNS complication) Q
    2. GBS
    3. Transverse myelitis
    4. Optic neuritis
    5. Facial nerve palsy
    6. Post chicken pox encephalitis
    7. CNS sequelae are rare.
    8. Pneumonia
    9. Others such as arthritis , hepatitis and glomerulonephritis and Reye syndrome. 


  1. Symptomatic with antipyretic and sedatives .
  2. Aspirin contraindicated.
  3. Acyclovir recommended in :
  4. Uncomplicated varicella in nonpregnant individuals 13 yr of age or older
  5. Children 12 mo of age or older with chronic cutaneous or pulmonary disorders; receiving short-term, intermittent, or Aerosolized corticosteroids or receiving long-term salicylate therapy
  6. Immunocompromised patients
  7. Pneumonia, severe hepatitis, thrombocytopenia or encephalitis
  8. Recommendations for varicella-zoster immune globulin (VZIG) Q
    1. Newborns whose mothers develop varicella 5 days before to 2 days after delivery
    2. Every premature infant born to a mother with active chickenpox at delivery (even if present > 1 wk)

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