Chickenpox natural history: Difference between revisions

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{{Chickenpox}}
{{Chickenpox}}
==Overview==
==Overview==
Primary varicella is a common childhood disease in Western countries, which presents as pruritic macules, papules, vesicles, pustules, and crusts, usually on the back, chest, face, and abdomen. Anyone who has recovered from chickenpox may develop shingles; even children can get shingles. Two of the most common complications associated with chickenpox are, bacterial infections of the skin and soft tissues in children and Pneumonia in adults. Chickenpox is rarely fatal (usually from varicella pneumonia), with pregnant women and those with a suppressed immune systems being more at risk. Pregnant women not known to be immune and who come into contact with chickenpox may need urgent treatment as the virus can cause serious problems for the baby. This is less of an issue after 20 weeks.
Primary [[Chickenpox|varicella]] presents with [[Pruritus|pruritic]] [[macules]], [[papules]], [[vesicles]], [[pustules]], and crusts, usually on the back, [[chest]], face, and [[abdomen]]. Reactivation of the [[virus]] can present as [[shingles]]. Common complications of [[chickenpox]] are [[bacterial]] [[Skin and soft-tissue infections|infections of the skin and soft tissues]] in children and [[pneumonia]] in adults. [[Chickenpox]] is rarely fatal. [[Pregnancy|Pregnant]] women and [[Immunodeficiency|immunocompromised]] patients are at a higher risk of developing varicella [[pneumonia]].


==Natural History==
==Natural History==
If left untreated, skin irritation from repeatedly scratching chicken pox sores allows the bacteria to invade the skin resulting in cellulitis. In some cases, varicella infection can spread to the lungs causing pneumonia and can be dangerous and fatal.
If left untreated, in healthy children [[Chickenpox|varicella]] manifestations develop within 15 days post exposure and typically present as: <ref name="pmid2829675">{{cite journal| author=Straus SE, Ostrove JM, Inchauspé G, Felser JM, Freifeld A, Croen KD et al.| title=NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. | journal=Ann Intern Med | year= 1988 | volume= 108 | issue= 2 | pages= 221-37 | pmid=2829675 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2829675  }} </ref>
*Generalized [[vesicular]] [[rash]] develops within 24 hours
*[[Fever]]
*[[Malaise]]
*[[Pharyngitis]]
*[[Loss of appetite]]
 
*[[Infection]] in adults can cause [[Varicella zoster virus|VZV]] [[pneumonia]]


==Complications==
==Complications==
The disease is usually mild, although serious complications sometimes occur. Two of the most common complications are bacterial infections of the skin and soft tissues in children and [[pneumonia]] in adults.<ref name="pmid12353193">{{cite journal| author=Gnann JW| title=Varicella-zoster virus: atypical presentations and unusual complications. | journal=J Infect Dis | year= 2002 | volume= 186 Suppl 1 | issue=  | pages= S91-8 | pmid=12353193 | doi=10.1086/342963 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12353193  }} </ref><ref name="pmid18419417">{{cite journal| author=Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX et al.| title=Varicella among adults: data from an active surveillance project, 1995-2005. | journal=J Infect Dis | year= 2008 | volume= 197 Suppl 2 | issue=  | pages= S94-S100 | pmid=18419417 | doi=10.1086/522155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18419417  }} </ref><ref name="pmid2829675">{{cite journal| author=Straus SE, Ostrove JM, Inchauspé G, Felser JM, Freifeld A, Croen KD et al.| title=NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. | journal=Ann Intern Med | year= 1988 | volume= 108 | issue= 2 | pages= 221-37 | pmid=2829675 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2829675  }} </ref>
The disease is usually mild, although serious complications sometimes occur. Two of the most common complications are [[Bacteria|bacterial]] [[Skin and soft-tissue infections|infections of the skin and soft tissues]] in children and [[pneumonia]] in adults.<ref name="pmid12353193">{{cite journal| author=Gnann JW| title=Varicella-zoster virus: atypical presentations and unusual complications. | journal=J Infect Dis | year= 2002 | volume= 186 Suppl 1 | issue=  | pages= S91-8 | pmid=12353193 | doi=10.1086/342963 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12353193  }} </ref><ref name="pmid18419417">{{cite journal| author=Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX et al.| title=Varicella among adults: data from an active surveillance project, 1995-2005. | journal=J Infect Dis | year= 2008 | volume= 197 Suppl 2 | issue=  | pages= S94-S100 | pmid=18419417 | doi=10.1086/522155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18419417  }} </ref><ref name="pmid2829675">{{cite journal| author=Straus SE, Ostrove JM, Inchauspé G, Felser JM, Freifeld A, Croen KD et al.| title=NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. | journal=Ann Intern Med | year= 1988 | volume= 108 | issue= 2 | pages= 221-37 | pmid=2829675 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2829675  }} </ref>


===Complications in Immunocompetent===
===Complications in Immunocompetent===
Some of the severe complications associated with chickenpox include:<ref name="pmid12353193">{{cite journal| author=Gnann JW| title=Varicella-zoster virus: atypical presentations and unusual complications. | journal=J Infect Dis | year= 2002 | volume= 186 Suppl 1 | issue=  | pages= S91-8 | pmid=12353193 | doi=10.1086/342963 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12353193  }} </ref><ref name="pmid10799624">{{cite journal| author=Laupland KB, Davies HD, Low DE, Schwartz B, Green K, McGeer A| title=Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 5 | pages= E60 | pmid=10799624 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10799624  }} </ref><ref name="pmid18567772">{{cite journal| author=de Benedictis FM, Osimani P| title=Necrotising fasciitis complicating varicella. | journal=Arch Dis Child | year= 2008 | volume= 93 | issue= 7 | pages= 619 | pmid=18567772 | doi=10.1136/adc.2008.141994 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18567772  }} </ref><ref name="pmid18419417">{{cite journal| author=Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX et al.| title=Varicella among adults: data from an active surveillance project, 1995-2005. | journal=J Infect Dis | year= 2008 | volume= 197 Suppl 2 | issue=  | pages= S94-S100 | pmid=18419417 | doi=10.1086/522155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18419417  }} </ref>
Common complications associated with [[chickenpox]] in [[Immunocompetent|immunocompeten]]<nowiki/>t individuals include:<ref name="pmid12353193">{{cite journal| author=Gnann JW| title=Varicella-zoster virus: atypical presentations and unusual complications. | journal=J Infect Dis | year= 2002 | volume= 186 Suppl 1 | issue=  | pages= S91-8 | pmid=12353193 | doi=10.1086/342963 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12353193  }} </ref><ref name="pmid10799624">{{cite journal| author=Laupland KB, Davies HD, Low DE, Schwartz B, Green K, McGeer A| title=Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 5 | pages= E60 | pmid=10799624 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10799624  }} </ref><ref name="pmid18567772">{{cite journal| author=de Benedictis FM, Osimani P| title=Necrotising fasciitis complicating varicella. | journal=Arch Dis Child | year= 2008 | volume= 93 | issue= 7 | pages= 619 | pmid=18567772 | doi=10.1136/adc.2008.141994 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18567772  }} </ref><ref name="pmid18419417">{{cite journal| author=Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX et al.| title=Varicella among adults: data from an active surveillance project, 1995-2005. | journal=J Infect Dis | year= 2008 | volume= 197 Suppl 2 | issue=  | pages= S94-S100 | pmid=18419417 | doi=10.1086/522155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18419417 }} </ref><ref name="pmid27188665">{{cite journal| author=Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D et al.| title=Varicella zoster virus infection. | journal=Nat Rev Dis Primers | year= 2015 | volume= 1 | issue=  | pages= 15016 | pmid=27188665 | doi=10.1038/nrdp.2015.16 | pmc=5381807 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27188665  }} </ref><ref name="pmid12585787">{{cite journal| author=Clark P, Davidson D, Letts M, Lawton L, Jawadi A| title=Necrotizing fasciitis secondary to chickenpox infection in children. | journal=Can J Surg | year= 2003 | volume= 46 | issue= 1 | pages= 9-14 | pmid=12585787 | doi= | pmc=3211661 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12585787 }} </ref>


*[[Toxic shock syndrome]]
*[[Toxic shock syndrome]]
*[[Viral pneumonia]]
*Zoster [[paresis]]
*[[Post-herpetic neuralgia]])
*[[VZV]] [[meningoencephalitis]]
*[[VZV]] [[Vasculopathies|vasculopathy]]
*[[VZV]] and [[giant cell arteritis]]
*[[VZV]]-induced [[stromal]] [[keratitis]]
*[[Necrotizing fasciitis]]
*[[Necrotizing fasciitis]]
*[[Septicemia]]
*[[Septicemia]]
Line 22: Line 36:
*[[Cerebellar ataxia]]
*[[Cerebellar ataxia]]
*[[Encephalitis]]
*[[Encephalitis]]
*[[Viral pneumonia]]
*[[Hemorrhagic]] conditions
*[[Hemorrhagic]] conditions.
*[[Septic arthritis]]
*[[Septic arthritis]]


===Complications in Immunocompromised===
===Complications in Immunocompromised===
 
Common complications associated with [[chickenpox]] in [[Immunosupression|immunosupressed]] individuals include:
* Hemorrhagic complications are more common in the [[immunocompromised]] or [[immunosuppressed]] populations, although healthy children and adults have been affected.
* [[Hemorrhagic]] complications
* Five major clinical syndromes have been described: [[febrile purpura]], malignant chickenpox with purpura, [[postinfectious purpura]], [[purpura fulminans]], and [[anaphylactoid purpura]].
* [[Febrile]] [[purpura]]
* The etiology of these hemorrhagic chickenpox syndromes is not known.
* [[Malignant]] [[chickenpox]] with [[purpura]] ([[mortality rate]] of greater than 70%)
* These syndromes have variable courses, with febrile purpura being the most benign of the syndromes and having an uncomplicated outcome.
* [[anaphylactoid purpura|Anaphylactoid purpura]]
* In contrast, malignant chickenpox with purpura is a grave clinical condition that has a mortality rate of greater than 70%.


==Prognosis==
==Prognosis==


*[[Chickenpox]] is rarely fatal (usually from varicella [[pneumonia]]), with pregnant women and those with a suppressed immune systems being more at risk. Pregnant women not known to be immune and who come into contact with chickenpox may need urgent treatment as the virus can cause serious problems for the baby. This is less of an issue after 20 weeks.
*[[Chickenpox]] is rarely [[fatal]] except if the patient develops varicella [[pneumonia]].
 
*[[Prognosis]] in the [[Immunodeficiency|immunocompromised]] is poor.
*Later in life, viruses remaining dormant in the nerves can reactivate causing localised eruptions of [[shingles]]. This occurs particularly  in people with compromised immune systems, such as the elderly, and perhaps even those suffering sunburn. Unlike chickenpox which normally fully settles, shingles may result in persisting [[post-herpetic neuralgia]] pain.
*[[Varicella zoster virus]] remains dormant in [[Nerve|nerves]] which can be reactivated later in life, resulting in [[shingles]]. It is most commonly seen in the [[immunocompromised]] and the elderly.
 
*Chickenpox infection is milder in young children, and symptomatic treatment with a [[sodium bicarbonate]] baths or [[antihistamine]] medication may ease itching.<ref>{{cite journal |author=Somekh E, Dalal I, Shohat T, Ginsberg''''' GM''''', Romano O |title=The burden of uncomplicated cases of chickenpox in Israel |journal=J. Infect. |volume=45 |issue=1 |pages=54-7 |year=2002 |pmid=12217733 |doi=}}</ref> [[Paracetamol]] (acetaminophen) is widely used to reduce fever.  [[Aspirin]], or products containing aspirin, must not be given to children with chickenpox (or any fever-causing illness), as this risks causing the serious and potentially fatal [[Reye's Syndrome]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 20:53, 29 July 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]

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Overview

Primary varicella presents with pruritic macules, papules, vesicles, pustules, and crusts, usually on the back, chest, face, and abdomen. Reactivation of the virus can present as shingles. Common complications of chickenpox are bacterial infections of the skin and soft tissues in children and pneumonia in adults. Chickenpox is rarely fatal. Pregnant women and immunocompromised patients are at a higher risk of developing varicella pneumonia.

Natural History

If left untreated, in healthy children varicella manifestations develop within 15 days post exposure and typically present as: [1]

Complications

The disease is usually mild, although serious complications sometimes occur. Two of the most common complications are bacterial infections of the skin and soft tissues in children and pneumonia in adults.[2][3][1]

Complications in Immunocompetent

Common complications associated with chickenpox in immunocompetent individuals include:[2][4][5][3][6][7]

Complications in Immunocompromised

Common complications associated with chickenpox in immunosupressed individuals include:

Prognosis

References

  1. ↑ 1.0 1.1 Straus SE, Ostrove JM, Inchauspé G, Felser JM, Freifeld A, Croen KD; et al. (1988). "NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention". Ann Intern Med. 108 (2): 221–37. PMID 2829675.
  2. ↑ 2.0 2.1 Gnann JW (2002). "Varicella-zoster virus: atypical presentations and unusual complications". J Infect Dis. 186 Suppl 1: S91–8. doi:10.1086/342963. PMID 12353193.
  3. ↑ 3.0 3.1 Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX; et al. (2008). "Varicella among adults: data from an active surveillance project, 1995-2005". J Infect Dis. 197 Suppl 2: S94–S100. doi:10.1086/522155. PMID 18419417.
  4. ↑ Laupland KB, Davies HD, Low DE, Schwartz B, Green K, McGeer A (2000). "Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group". Pediatrics. 105 (5): E60. PMID 10799624.
  5. ↑ de Benedictis FM, Osimani P (2008). "Necrotising fasciitis complicating varicella". Arch Dis Child. 93 (7): 619. doi:10.1136/adc.2008.141994. PMID 18567772.
  6. ↑ Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D; et al. (2015). "Varicella zoster virus infection". Nat Rev Dis Primers. 1: 15016. doi:10.1038/nrdp.2015.16. PMC 5381807. PMID 27188665.
  7. ↑ Clark P, Davidson D, Letts M, Lawton L, Jawadi A (2003). "Necrotizing fasciitis secondary to chickenpox infection in children". Can J Surg. 46 (1): 9–14. PMC 3211661. PMID 12585787.


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