Chickenpox natural history
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 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. When 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.
Natural History
- If left untreated, in healthy children varicella manifestations develop within 15 days post exposure and typically present as: [1]
- Fever
- Malaise
- Pharyngitis
- Loss of appetite
- Generalized vesicular rash develops within 24 hours.
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
Some of the severe complications associated with chickenpox include:[2][4][5][3]
- Toxic shock syndrome
- Necrotizing fasciitis
- Septicemia
- Osteomyelitis
- Bacterial pneumonia
- Cerebellar ataxia
- Encephalitis
- Viral pneumonia
- Hemorrhagic conditions.
- Septic arthritis
Complications in Immunocompromised
- Hemorrhagic complications are more common in the immunocompromised or immunosuppressed populations, although healthy children and adults have been affected.
- Five major clinical syndromes have been described: febrile purpura, malignant chickenpox with purpura, postinfectious purpura, purpura fulminans, and anaphylactoid purpura.
- The etiology of these hemorrhagic chickenpox syndromes is not known.
- These syndromes have variable courses, with febrile purpura being the most benign of the syndromes and having an uncomplicated outcome.
- In contrast, malignant chickenpox with purpura is a grave clinical condition that has a mortality rate of greater than 70%.
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.
- 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.
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 3.0 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.
- ↑ 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.
- ↑ de Benedictis FM, Osimani P (2008). "Necrotising fasciitis complicating varicella". Arch Dis Child. 93 (7): 619. doi:10.1136/adc.2008.141994. PMID 18567772.