The Medical Symptom Guide

Symptoms of Chicken Pox

Posted in Fever With Rash, Infectious Diseases, Paediatrics by Dr Ryan

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Chicken pox is also known as Varicella or third disease. It is a common and highly infectious disease, affecting mainly children (age 2 to 8 years), but no age group is exempted. The varicella virus is one of the human herpes viruses and is an extremely infectious exanthema.

The characteristic crops of small vesicles have a central distribution (face, scalp, trunk). The virus remains latent after initial infection and reactivate later in life as herpes zoster (shingles).

Epidemiology It is one of the most easily transmitted viruses, probably by airborne spread, usually via a person with chicken pox (occasionally with herpes zoster). Varicella is contagious only while the patient has symptoms and vesicles remain; drying of the vesicles indicates that infectivity has stopped. The scabs are not infectious.

The incubation period is 10-21 days (usually 2 weeks). Laboratory diagnosis is by serology or immunofluorescence of vesicular fluid.

In infants or children, specific anti-varicella IgG may be needed to prevent or ameliorate the disease on exposure.

Symptoms of Chicken Pox

In children, the onset has no prodrome but in adults, there is an influenze-like prodrome (muscle aches, fever, headaches) for 2-3 days.

In children, the maculopapular rash appears almost simultaneously as the fever, starting in the scalp and descending to the body and the extremities. The typical vesicles form without 24 hours. The rash is itchy.

Diagnosis

Varicella is readily diagnosed on clinical grounds, although the virus may be detected from the fluid within the vesicles.

Complications

• Bacterial infection of the cutaneous lesions are the commonest
• Viral pneumonia is uncommon in adults and rare in children
• Rare complications include thrombocytopenia, acute cerebellitis, meningoencephalitis and purpura fulminans
• Death is rare except in the immunocompromised and neonates with congenital varicella

Varicella encephalitis is a complication occuring in approximately 1 case per 1000. Symptoms include headache, vomitting, neck stiffness and ataxia. This complication tends to present between the fifth and eighth day of the illness.

Management

No specific therapy is required and management is symptomatic. Many people worry about scarring, but the lesions invariably heal, leaving normal skin, unless they become infected.

Medications

• Antihistamines – for itch
• Antibiotics – for secondary bacterial skin infection
• Antiviral agents – to be started within the first 3 days of the eruption for severe cases.
• Zoster immune globulin (ZIG) – for children with malignany disease, neonates and others with compromised immune systems and who are varicella contacts.

School exclusion

It is recommended until full recovery, usually for 7 days. A few remaining scabs are not an indication to continue exclusion. Except for immunocompromised children, contacts should not be excluded from school.

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