DD Varisela
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Transcript of DD Varisela
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Varicella
Chickenpox is a highly infectious, acute contagious disease predominantly of
children under 10 years old, though it may occur at any age. Peak incidence Mar May. It is characterised by feer and a rash, and is caused by aricella !oster irus
"round #0$ of people %ho come into contact %ill deelop the disease.
&ransmission is through 1' direct person to person contact (' airborne droplet
infection )' through contact %ith infected articles such as clothing and bedding
"round #0$ of adults oer the age of 1* years hae immunity for ++ in the -
/eactiation of latent ++ %ill result in shingles %hich is more common in adults
In ngland and ales, the incidence of chickenpox is approximately 1(#0cases per 100,000 person2years
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Varicella clinical features
&he incubation period is from 13 up to (1 days
chicken pox is infectious from a fe% days before the onset of rash deelops and not more than six days after
first lesions appear
the rash begins as macular lesions %hich deelop into papular, or esicular lesions 4filled %ith fluid' and later
becomes pustular
chickenpox rash has a centripetal distribution 2 mostly on the face and trunk and sparsely on the limbs
there is erythema around the lesions and they are intensely itchy
usually the rash peaks at around 3* hours in immunocompetent people
esicles dry and crust oer, and sometimes scar if scratched to excess oropharynx and genital tract
mucous membranes may be inoled as %ell
ne% lesions can emerge for up to 5 days
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In children under 10 years, the disease is usually mild and self limiting, but a more seereinfection can be seen in
1' adults 2 especially in pregnant %omen and in smokers since they are
at an increased risk of deeloping fulminanting aricella pneumonia
(' neonates
)' immunosupressed indiiduals there is an increased risk of deeloping
disseminated or haemorrhagic aricella
6igns of seere infections include7 respiratory symptoms 4clinical respiratory signs are often absent'. densely cropping esicles haemorrhagic rash bleeding from gums, haemoptysis, 8I bleeding any neurological changes 2 cerebellar signs, encephalopathy persisting feer %ith ne% esicles 9: days after onset
Varicella
8eneral recommendationis for school exclusion for 5 days from onset of rash
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Treatment
&reatment is usually symptomatic in milder disease paracetamol or ibuprofen can be gien to
reduce flu like symptoms, feer and pain
antivirals should be considered for patients %ho presents %ithin (323* hours of ne% esicles
4indicating an eoling disease' antiiral therapy should be continued for at least 1 %eek
ral aciclovirmay also be gien to 1' immuocompetent adults and older adolescents
(' Infants )' seere infection at any age 3' immunosuppression 5'seere cardiorespiratory
disease :' chronic skin disorder
Varicella zoster immune globulin4+I8' +I8 prophylaxis can be used in indiiduals %ho
complete all of the follo%ing criteria7 significant exposure to chickenpox or herpes !oster
a clinical condition that increases the risk of seere aricella, this includes immunosuppressed
patients, neonates and pregnant %omen
no antibodies to + irus
Immunosuppressed patients should be gien immunoglobulin to aricella !oster and acicloir
%ithin t%o days of contact %ith aricella. If they deelop chicken pox they should be treated %ith
acicloir.
"ntibiotics should be gien for secondary infectionsgpnotebook.co.uk
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Differential diagnosis
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Differential Diagnoses
;ullous Pemphigoid
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acute onset of feer greater than 101 >?
4)*.) >C' follo%ed by a rash characteri!ed
by firm, deep seated esicles or pustules in
the same stage of deelopment %ithoutother apparent cause.
+"/I@A"
2MaBor
2Minor
produce characteristic
cytoplasmic inclusions, the most important
of %hich are kno%n as8uarnieri bodies
https://en.wikipedia.org/wiki/Cytoplasmichttps://en.wikipedia.org/wiki/Cytoplasmichttps://en.wikipedia.org/wiki/Guarnieri_bodieshttps://en.wikipedia.org/wiki/Guarnieri_bodieshttps://en.wikipedia.org/wiki/Cytoplasmichttps://en.wikipedia.org/wiki/Cytoplasmic -
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&he morphologies are myriad and includemorbilliform, urticarial, papulosuamous,
pustular, and bullous. Medications can also
cause pruritus and dysesthesia %ithout an
obious eruption.
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Bullous pemphigoidis an acute or
chronic autoimmune
skin disease, inoling the formation ofblisters, more appropriately kno%n as
bullae, at the space bet%een the skin layers
epidermis and dermis. It is classified as a
type II hypersensitiity reaction.
Clinically, the earliest lesions may appear
urticarial
DikolskyEs sign is negatie unlike
pemphigus ulgaris %here it is positie.
http://en.wikipedia.org/wiki/Acute_(medicine)http://en.wikipedia.org/wiki/Chronic_(medicine)http://en.wikipedia.org/wiki/Autoimmune_disorderhttp://en.wikipedia.org/wiki/Skin_diseasehttp://en.wikipedia.org/wiki/Blistershttp://en.wikipedia.org/wiki/Bulla_(dermatology)http://en.wikipedia.org/wiki/Epidermis_(skin)http://en.wikipedia.org/wiki/Dermishttp://en.wikipedia.org/wiki/Type_II_hypersensitivityhttp://en.wikipedia.org/wiki/Lesionhttp://en.wikipedia.org/wiki/Urticariahttp://en.wikipedia.org/wiki/Nikolsky's_signhttp://en.wikipedia.org/wiki/Pemphigus_vulgarishttp://en.wikipedia.org/wiki/Pemphigus_vulgarishttp://en.wikipedia.org/wiki/Nikolsky's_signhttp://en.wikipedia.org/wiki/Urticariahttp://en.wikipedia.org/wiki/Lesionhttp://en.wikipedia.org/wiki/Type_II_hypersensitivityhttp://en.wikipedia.org/wiki/Dermishttp://en.wikipedia.org/wiki/Epidermis_(skin)http://en.wikipedia.org/wiki/Bulla_(dermatology)http://en.wikipedia.org/wiki/Bulla_(dermatology)http://en.wikipedia.org/wiki/Blistershttp://en.wikipedia.org/wiki/Skin_diseasehttp://en.wikipedia.org/wiki/Autoimmune_disorderhttp://en.wikipedia.org/wiki/Chronic_(medicine)http://en.wikipedia.org/wiki/Acute_(medicine) -
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6cabies causes seere
itching that is usually %orse at night and a
rash %ith tiny blisters or sores
&here are four cardinal signs of scabies
Scabies
http://www.webmd.com/skin-problems-and-treatments/guide/default.htmhttp://www.webmd.com/skin-problems-and-treatments/tc/rash-age-12-and-older-topic-overviewhttp://www.webmd.com/skin-problems-and-treatments/tc/rash-age-12-and-older-topic-overviewhttp://www.webmd.com/skin-problems-and-treatments/guide/default.htm -
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Common infection of the skin or mucosa
may affect the face and mouth 4orofacial
herpes', genitalia 4genital herpes'
=erpes 6implex
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MaBority of children recoer %ithout any complications but neonates, adults,
pregnant %omen and those %ho are immunocompromised may hae more
serious complications
Complications
Pulmonary inolementFF.5213$ of adults
CD6 inolementFF.cerebellar ataxia andGor encephalitis
6econdary bacterial infectionsF.inc osteomyelitis
=aemorrhagic complicationsF..8I bleeds,
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Varicella vaccination
+aricella accine is a lyophilised preparation %hich contains lie attenuated organismsof the @ka strain of aricella !oster irus.
should be administered as deep subcutaneous inBection and can be gien together %ith
other lie accines such as MM/
children from one year to under 1) years of ageH a single dose of aricella accine %ill
gie protection for around #0$ of children
children aged 1) years or older and adults 2 should receie t%o doses of aricella accine
four to eight %eeks apart, around 5$ %ill hae protection against clinical chickenpox 41'
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