How does chickenpox affect the eyes in children. What are the symptoms of varicella-related acute anterior uveitis. How is varicella-related acute anterior uveitis diagnosed and treated. What other ocular complications can occur with chickenpox infection.

Understanding Chickenpox and Its Ocular Manifestations

Chickenpox, caused by the varicella-zoster virus, is a highly contagious childhood disease typically affecting children under 16 years of age. While primarily known for its characteristic skin rash, chickenpox can also lead to various ocular complications, including acute anterior uveitis (AAU).

Ocular involvement in chickenpox may present with symptoms such as:

• Irritation
• Soreness
• Photophobia
• Tearing
• Redness
• Lid swelling

These symptoms can be indicative of several ocular manifestations, ranging from mild conjunctival involvement to more severe conditions like uveitis.

Acute Anterior Uveitis: An Underrecognized Complication of Chickenpox

Acute anterior uveitis (AAU) has traditionally been considered a rare complication of chickenpox infection. However, recent studies suggest that it may be more common than previously thought, especially in the early acute stages of the disease.

Is AAU truly rare in chickenpox cases. Some researchers propose that it might be relatively common if carefully looked for during the early stages of infection. This underscores the importance of thorough ophthalmic examination in children with chickenpox, particularly those presenting with ocular symptoms.

Case Study: AAU in an 8-Year-Old with Chickenpox

A noteworthy case involved an 8-year-old girl who developed AAU secondary to chickenpox. Her symptoms included:

• Red left eye
• No discharge
• Mild pain
• Intense photophobia

Upon examination, the patient exhibited:

• Perilimbal injection
• Tarsal conjunctival follicles
• Fine keratic precipitates on the cornea
• Cells and flare in the anterior chamber

This case highlights the importance of considering AAU in children with chickenpox who present with ocular symptoms, even when the condition is thought to be rare.

Diagnosis and Treatment of Varicella-Related Acute Anterior Uveitis

How is varicella-related AAU diagnosed. Diagnosis typically involves a comprehensive eye examination, including:

• Visual acuity testing
• Pupillary reflex assessment
• Slit-lamp examination of the anterior segment
• Intraocular pressure measurement
• Dilated fundus examination

In the case study, the patient was treated with gutt atropine 1% twice daily for comfort. Steroid eye drops were not used in this instance. The treatment duration lasted approximately two weeks until the inflammation resolved.

What is the typical prognosis for varicella-related AAU. In many cases, with appropriate treatment, the condition resolves without long-term complications. The patient in the case study experienced complete resolution of symptoms within four weeks, with no residual inflammation and normal visual acuity.

Other Ocular Complications Associated with Chickenpox

While AAU is an important ocular complication of chickenpox, it’s not the only one. Other potential ocular manifestations include:

1. Conjunctival lesions
2. Corneal involvement (e.g., superficial punctate keratitis, stromal disciform keratitis, interstitial keratitis)
3. Posterior uveitis
4. Secondary glaucoma
5. Cataracts
6. Optic neuritis
7. Optic atrophy
8. Internal ophthalmoplegia

Can corneal lesions cause long-term visual impairment. Generally, corneal lesions in chickenpox are mild and self-limiting. They often heal without treatment over approximately 12 days, typically leaving no visual impairment.

The Importance of Ophthalmic Assessment in Chickenpox Cases

Given the potential for ocular complications, including AAU, in children with chickenpox, ophthalmic assessment plays a crucial role in management. When should children with chickenpox undergo ophthalmic examination. It’s advisable for children to receive an eye examination if they develop any ocular symptoms during the course of their chickenpox infection.

Early detection and appropriate treatment of ocular complications can help prevent potential long-term visual impairment. Healthcare providers should be aware of the possibility of ocular involvement in chickenpox cases and refer patients for ophthalmic assessment when necessary.

Varicella Vaccination and Ocular Complications

Interestingly, the live attenuated varicella virus vaccine has also been associated with cases of AAU. This highlights the importance of monitoring for ocular complications not only in natural chickenpox infections but also in vaccinated individuals.

Does vaccination reduce the risk of ocular complications compared to natural infection. While vaccination generally reduces the severity of chickenpox and its complications, further research is needed to quantify its specific impact on the incidence of ocular complications.

Differentiating Varicella-Related Ocular Complications from Herpes Zoster Ophthalmicus

It’s important to note that while varicella (chickenpox) and herpes zoster (shingles) are caused by the same virus, their ocular manifestations can differ significantly. How do ocular complications in chickenpox compare to those in herpes zoster. In contrast to chickenpox, where ocular lesions are relatively uncommon, up to 72% of patients with herpes zoster ophthalmicus experience ocular complications.

This stark difference underscores the importance of accurately diagnosing the underlying condition when presented with ocular symptoms in patients with a history of varicella-zoster virus infection.

Key Differences Between Chickenpox and Herpes Zoster Ocular Involvement

• Frequency: Ocular complications are more common in herpes zoster than in chickenpox
• Age of onset: Chickenpox typically affects children, while herpes zoster is more common in older adults
• Distribution: Chickenpox lesions can affect both eyes, while herpes zoster usually affects one side
• Severity: Herpes zoster ophthalmicus often leads to more severe and chronic ocular complications

Understanding these differences can aid in proper diagnosis and management of ocular complications related to varicella-zoster virus infections.

Long-Term Follow-Up and Management of Varicella-Related Ocular Complications

While many ocular complications of chickenpox resolve without long-term sequelae, some patients may require ongoing monitoring and management. What factors determine the need for long-term follow-up? Considerations include:

• The specific ocular structures involved
• The severity of the initial complication
• The response to initial treatment
• The presence of any residual inflammation or structural changes

In the case of AAU, patients typically achieve full resolution with appropriate treatment. However, in rare cases where complications such as secondary glaucoma or cataracts develop, long-term ophthalmological care may be necessary.

How often should patients with a history of varicella-related ocular complications undergo follow-up examinations? The frequency of follow-up should be tailored to each individual case, based on the specific complication and its course. In uncomplicated cases that achieve full resolution, like the case study presented, patients may be discharged after confirming the absence of inflammation and normal visual function.

Potential Long-Term Consequences of Varicella-Related Ocular Complications

While most cases resolve without lasting effects, potential long-term consequences of severe or untreated ocular complications may include:

• Corneal scarring
• Chronic uveitis
• Glaucoma
• Cataract formation
• Retinal detachment (in cases of severe posterior uveitis)
• Optic nerve damage

These potential outcomes emphasize the importance of prompt recognition, appropriate treatment, and adequate follow-up of ocular complications in chickenpox cases.

Prevention Strategies for Varicella-Related Ocular Complications

While not all ocular complications of chickenpox can be prevented, certain strategies may help reduce their incidence and severity. What measures can be taken to minimize the risk of ocular complications in chickenpox? Consider the following approaches:

1. Vaccination: Widespread use of the varicella vaccine has significantly reduced the incidence of chickenpox and its complications, including ocular manifestations.
2. Early recognition: Educating parents and healthcare providers about potential ocular symptoms can lead to earlier detection and treatment.
3. Proper hygiene: Encouraging children with chickenpox to avoid touching or scratching their eyes can help prevent secondary bacterial infections.
4. Protective eyewear: In severe cases, protective glasses or shields may be recommended to prevent accidental trauma to the eyes.
5. Prompt referral: Early referral to an ophthalmologist when ocular symptoms develop can ensure timely diagnosis and treatment.

By implementing these preventive strategies, the incidence and severity of varicella-related ocular complications may be reduced, leading to better outcomes for affected children.

The Role of Antiviral Therapy in Preventing Ocular Complications

Can antiviral therapy help prevent ocular complications in chickenpox? While not routinely prescribed for uncomplicated chickenpox in healthy children, antiviral medications may be considered in certain high-risk cases or when complications develop.

Antiviral drugs like acyclovir, when administered early in the course of infection, may help reduce the severity and duration of chickenpox. This, in turn, could potentially lower the risk of ocular and other complications. However, the specific impact of antiviral therapy on the incidence of ocular complications requires further study.

Future Research Directions in Varicella-Related Ocular Complications

While our understanding of varicella-related ocular complications has improved, several areas warrant further investigation. What are some key research questions that need to be addressed? Consider the following areas for future study:

• Incidence and prevalence: More comprehensive epidemiological studies to accurately determine the frequency of various ocular complications in chickenpox.
• Risk factors: Identification of factors that predispose certain individuals to develop ocular complications.
• Pathogenesis: Further elucidation of the mechanisms by which the varicella-zoster virus affects ocular tissues.
• Treatment protocols: Development and optimization of treatment strategies for various ocular complications.
• Long-term outcomes: Studies tracking the long-term visual outcomes of children who experience ocular complications from chickenpox.
• Vaccine impact: Evaluation of how widespread vaccination has affected the incidence and severity of ocular complications.

Addressing these research questions could lead to improved prevention strategies, more effective treatments, and better outcomes for children affected by varicella-related ocular complications.

Emerging Diagnostic Technologies

How might advances in diagnostic technologies improve the detection and management of varicella-related ocular complications? Several emerging technologies show promise:

1. High-resolution optical coherence tomography (OCT) for detailed imaging of ocular structures
2. Advanced molecular diagnostic techniques for rapid and accurate detection of varicella-zoster virus in ocular tissues
3. Artificial intelligence-assisted analysis of retinal images for early detection of subtle changes
4. Non-invasive biomarker detection for monitoring inflammatory activity in the eye

These technological advancements could potentially lead to earlier detection, more precise diagnosis, and improved monitoring of varicella-related ocular complications, ultimately resulting in better patient outcomes.

Unusual presentation of more common disease/injury: Red eye in chickenpox: varicella-related acute anterior uveitis in a child

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BMJ Case Rep. 2010; 2010: bcr0120102678.

Published online 2010 Sep 17. doi: 10.1136/bcr.01.2010.2678

Unusual presentation of more common disease/injury

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Varicella-zoster virus is a common viral infection of childhood. This report concerns an 8-year-old girl who presented with a 5-day history of a typical varicella rash. She then developed red left eye ‘conjunctivitis’. She had no discharge, mild pain and intense photophobia. She was referred to the acute eye clinic after 1 day and she was noted to have acute anterior uveitis. She was treated with gutt atropine 1% for 2 weeks until the inflammation resolved. She had no sequalae.

This report highlights that, even though it is thought to be rare, acute anterior uveitis (AAU) is more common than first thought in a child who has chickenpox. Other serious ocular conditions caused by primary varicella infection include keratitis and posterior uveitis. Such children would require ophthalmic assessment and possibly treatment.

An 8-year-old girl presented to her general practitioner with a vesicular rash for 5 days; she gave a 1–2 day history of ‘conjunctivitis’. She had a red left eye, with no discharge, no foreign body sensation, but a deep ache. She had not noticed a change in her vision but had intense photophobia. She was referred to the acute eye clinic.

On examination she saw 4/4 unaided. Her left pupil was small but reactive with no relative afferent pupillary defect. She had perilimbal injection and tarsal conjuctival follicles. The cornea had a few fine keratic precipitates inferiorly and her anterior chamber had 1+ on cells with 1+ flare. Intraocular pressure was 16. The other eye was normal. Dilated fundus examination showed no vitreitis and the retina was normal.

She was diagnosed with AAU secondary to chickenpox.

She was treated with gutt atropine 1% twice daily only for comfort. No gutt steroids were used.

She was seen 3 days later. She was comfortable with only occasional cells in the anterior chamber. At 1 week there was only one cell seen. Atropine was stopped as she was comfortable. At 4 weeks she was comfortable with a white eye and visual acuity of 4/3-1; she had no inflammation. Her fundus was normal. She was discharged from clinic.

Varicella is a highly communicable disease of childhood occurring principally in children under 16 years of age.^1–3 Varicella-zoster virus is a DNA virus of the herpes virus family. It is the cause of two clinically very distinct diseases: varicella (chickenpox) and herpes zoster (shingles).⁴ In contrast to zoster ophthalmicus, where up to 72% of patients have ocular complications, varicella ocular lesions are not common.⁵ Live attenuated varicella virus vaccine has also been a cause of AAU.⁶

In primary varicella, crops of erythematous papules that develop over a 2–6 day period mean there are lesions in varying stages in the same area.² The lesions of chickenpox may affect the lids and lid margins. Healing is usually complete within 2 weeks.²

Children with ocular involvement typically complain of irritation, soreness, photophobia, tearing, redness and lid swelling. ⁵ The ocular manifestations include conjunctival, corneal lesions, anterior and posterior uveitis, secondary glaucoma, cataracts, optic neuritis and optic atrophy, and internal ophthalmoplegia.^1–12

Corneal lesions usually appear 2–3 days after the onset of the skin vesicles.²⁵ In the cornea, varicella can cause superficial punctuate keratitis, stromal disciform keratitis or an interstitial keratitis.¹²⁵ Atypical dendrites have also been reported. Corneal involvement is often only mild punctate staining of the cornea without dendrite formation that lasts only a few days.⁵ Corneal lesions usually heal without treatment over 12 days leaving no visual impairment.⁵⁹¹³

AAU is usually considered a rare finding in varicella infection,³⁵⁸⁹¹¹ but some postulate that it is probably common in the early acute stage of chickenpox if carefully looked for. ⁵⁹¹¹¹⁴

In one study of 24 children referred to an ophthalmologist with varicella, 62.5% had vesicular lesions of the lids, 33.3% had conjunctival involvement, 8.3% had corneal complications and 25% had uveal involvement.⁵ The AAU was noted 3–5 days after the appearance of the vesicles and lasted 5–25 days. All but one patient was treated with a topical steroid antibiotic combination for 10–14 days. All cases resolved without complication.⁵ Another prospective study included 82 consecutive children with chickenpox seen by five paediatricians.¹⁵ Altogether, 25% of children without pox on their lids were found to have AAU. Follow-up of children with objective evidence of uveitis revealed no long-term sequelae.¹⁵ In a third prospective study of 100 children with chickenpox, 21% of patients had ocular involvement excluding eyelid rash.¹⁴ A varicella eyelid rash was present in 28.6% of patients with ocular involvement and 13. 9% without eyelid involvement. Of the 21% with ocular findings, 38.1% had conjunctivitis, 57.1% had anterior uveitis and 4.8% had disciform keratouveitis.¹⁴ There was no significant association between severity of chickenpox and severity of ocular involvement or between eyelid rash and ocular involvement.¹⁴

There is normally a good visual outcome post-infection.^12591415 It has been suggested that those with corneal lesions and those complaining of photophobia should receive early ophthalmic assessment as they are more likely to have ocular involvement.⁵¹⁵ As the prognosis and sequelae of ocular involvement in varicella infection is good, only those patients with ocular signs and symptoms need be referred for an ophthalmologic examination.¹⁴ In most reported cases, gutt steroids with or without antibiotics and cycloplegics are used but, as in our case report, some argue that steroids are not required for varicella except in interstitial keratitis. ¹⁸⁹

Pavan-Langston summarised her treatment of ocular varicella as¹:

1. Good hygiene, cool compresses, low illumination.

2. Cycloplegics for uveitis or keratitis.

3. Topical antibiotic for surface vesicle or ulcers.

4. Antivirals are not established as useful.

5. Cautious use of topical steroid for non-ulcerative interstitial keratitis.

This treatment is very similar to how we treated our patient who has had no long-term sequelae.

Learning points

• Ocular involvement is frequent in children with varicella; 12–25% of children with varicella may develop AAU but it is usually mild.

• Most are self-limiting and may not require treatment with steroids, but cycloplegia is often useful.

• Varicella may cause more serious ocular complication but these are rare.

• Significant lid swelling, discomfort, irritation, reduced vision, perilimbal injection or photophobia should warrant an ophthalmologic review.

• Most children with primary varicella have no long-term ocular damage.

Competing interests None.

Patient consent Obtained.

1. Pavan-Langston D. Varicella-zoster ophthalmicus. Int Ophthalmol Clin 1975;15:171–85 [PubMed] [Google Scholar]

2. Ostler HB, Thygeson P. The ocular manifestations of herpes zoster, varicella, infectious mononucleosis, and cytomegalovirus disease. Surv Ophthalmol 1976;21:148–59 [PubMed] [Google Scholar]

3. Belfair N, Levy J, Lifshitz T. Panuveitis as presenting sign of chickenpox in a young child. Can J Ophthalmol 2006;41:97–9 [PubMed] [Google Scholar]

4. Fernandez de Castro LE, Sarraf OA, Hawthorne KM, et al. Ocular manifestations after primary varicella infection. Cornea 2006;25:866–67 [PubMed] [Google Scholar]

5. Jordan DR, Noel LP, Clarke WN. Ocular involvement in varicella. Clin Pediatr (Phila) 1984;23:434–6 [PubMed] [Google Scholar]

6. Esmaeli-Gutstein B, Winkelman JZ. Uveitis associated with varicella virus vaccine. Am J Ophthalmol 1999;127:733–4 [PubMed] [Google Scholar]

7. Appel I, Frydman M, Savir H, et al. Uveitis and ophthalmoplegia complicating chickenpox. J Pediatr Ophthalmol 1977;14:346–8 [PubMed] [Google Scholar]

8. Cox J, Fraser H. Varicella iritis. Med J Aust 1970;2:792–3 [PubMed] [Google Scholar]

9. Duke-Elder S, Perkins ES. Diseases of the uveal tract. In: Duke-Elder S, (Ed). System of ophthalmology. London: Henry Kimpton, 1966 [Google Scholar]

10. Goldsmith MO. Tonic pupil following varicella. Am J Ophthalmol 1968;66:551–4 [PubMed] [Google Scholar]

11. Strachman J. Uveitis associated with chicken pox. J Pediatr 1955;46:327–8 [PubMed] [Google Scholar]

12. Hallett JW. Report of a case of iridocyclitis associated with chickenpox. Am J Ophthalmol 1946;29:459–60 [PubMed] [Google Scholar]

13. Thygeson P, Hogan MJ, Kimura SJ. Observations on uveitis associated with viral disease. Trans Am Ophthalmol Soc 1957;55:333–49; discussion 349–52 [PMC free article] [PubMed] [Google Scholar]

14. Sungur G, Hazirolan D, Duran S, et al. The effect of clinical severity and eyelid rash on ocular involvement in primary varicella infection. Eur J Ophthalmol 2009;19:905–8 [PubMed] [Google Scholar]

15. Kachmer ML, Annable WL, DiMarco M. Iritis in children with varicella. J Pediatr Ophthalmol Strabismus 1990;27:221–2 [PubMed] [Google Scholar]

Articles from BMJ Case Reports are provided here courtesy of BMJ Publishing Group

Chickenpox

Is this your child’s symptom?

• A rash all over the body caused by the chickenpox virus.
• The chickenpox rash starts as small red bumps. The bumps change to blisters or pimples. The bumps change to open sores, and finally they scab over.
• A doctor has told you that your child has chickenpox.
• Or your child had close contact with another person who has it (or shingles). The contact should be 10-21 days earlier.

Symptoms of Chickenpox

• Chickenpox starts with some small water blisters or pimples on the head and trunk.
• Chickenpox progress within 24 hours through the next 5 stages:
  1. Small red bumps
  2. Thin-walled water blisters
  3. Cloudy blisters
  4. Open sores, and finally
  5. Dry brown crusts.
• Rash is all over the body. Most often, starts on the head and back.
• Repeated crops of new chickenpox keep appearing for 4 to 5 days. Therefore, all 5 stages are present at same time.
• Sores (ulcers) can also occur in the mouth, on eyelids, and on genitals.
• Fever is most often present. The more the rash, the higher the fever.
• Known contact to a child with chickenpox or shingles 10 – 21 days earlier
• Main related problems: skin infections from scratching.

Cause of Chickenpox

• Chickenpox is caused by a virus. It is called Varicella.
• Chickenpox can be prevented by getting this vaccine against this virus.

When to Call for Chickenpox

Call 911 Now

• Not moving or too weak to stand
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Bright red skin or red streak
• Very painful swelling or very swollen face
• New red rash in addition to chickenpox rash
• Walking is not steady
• Trouble breathing
• Bleeding into the chickenpox
• Fever over 104° F (40° C)
• Age less than 1 month old
• Vomits 3 or more times
• Eye pain or constant blinking
• Took a steroid medicine within past 2 weeks
• Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
• Chronic skin disease (such as eczema)
• Chronic lung disease (such as cystic fibrosis)
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Age less than 1 year old
• Teen 13 years or older has chickenpox
• Been near to person with chickenpox or shingles in last 5 days. Also, healthy person who never had a chickenpox vaccine.
• One lymph node gets larger and more tender
• Fever lasts more than 4 days
• Fever returns after being gone more than 24 hours
• Scab or sore drains yellow pus
• One sore gets much larger in size than the others
• Gets new chickenpox after day 6
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Chickenpox with no other problems

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

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Care Advice for Chickenpox

1. What You Should Know About Chickenpox:
   • Chickenpox is caused by the varicella virus.
   • It’s now uncommon because of the chickenpox vaccine.
   • Your job is to keep your child comfortable and to limit the itching.
   • Here is some care advice that should help.
2. Cool Baths for Itching:
   • For itching, give cool or lukewarm baths for 10 minutes as often as needed.
   • Caution: avoid any chill.
   • Can add baking soda 2 ounces (60 mL) per tub.
   • Baths don’t spread the chickenpox.
   • Do not use soaps. Reason: soaps cause dry skin and make the itch worse.
3. Calamine Lotion for Itching:
   • Put calamine lotion on the chickenpox that itch the most.
   • You can also use an ice cube on the itchy spots for 10 minutes.
   • Don’t use any lotion containing Benadryl in it. Reason: it can be absorbed across the skin. This can cause side effects in kids.
4. Allergy Medicine for Itching:
   • If itching becomes severe, give a dose of Benadryl.
   • No prescription is needed. Age limit: 1 and older.
5. Try Not to Scratch:
   • Try not to let your child pick and scratch at the sores. This can lead to infected sores.
   • Trim fingernails.
   • Wash hands often with soap.
6. Fever Medicine:
   • Give acetaminophen (such as Tylenol) for fever above 102° F (39° C).
   • Never use aspirin. Reason: risk of Reye syndrome.
   • Also, don’t use ibuprofen products (such as Advil). Reason: may increase risk of bad strep skin infections.
7. Fluids and Soft Diet:
   • The mouth and throat ulcers are painful. Try to get your child to drink adequate fluids.
   • Goal: keep your child well hydrated.
   • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
   • Solids. Offer a soft diet. Also, avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: fluid intake is more important than eating any solids.
   • For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: the nipple can increase the pain.
8. Liquid Antacid for Mouth Pain (Age 1 Year and Older):
   • For mouth pain, use a liquid antacid (such as Mylanta or the store brand). Give 4 times per day as needed. After meals often is a good time.
   • Age 1 to 6 years. Put a few drops in the mouth. Can also put it on with a cotton swab.
   • Age over 6 years. Use 1 teaspoon (5 mL) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
   • Caution: do not use regular mouth washes, because they sting.
9. Ointment For Pain With Passing Urine:
   • For girls with painful genital ulcers, use petroleum jelly (such as Vaseline).
   • Put on the sores as needed.
   • For males with painful pox on the tip of the penis, this also works.
10. Return to School:
    • Your child can go back to school after all the sores have crusted over.
    • Most often, this is day 6 or 7 of the rash.
11. What to Expect:
    • Expect new chickenpox every day for 4 or 5 days.
    • Most children get 400 to 500 chickenpox.
    • They get less pox if they’ve had the vaccine.
12. Prevent the Spread of Chickenpox in the Office:
    • If your child needs to be seen, call first to the office.
    • Try to bring another adult. Have one adult enter the office first for instructions.
    • For nonurgent problems, the doctor may do an exam in the car.
13. Call Your Doctor If:
    • Chickenpox look infected (draining pus, scabs become larger)
    • Gets any new chickenpox after day 6
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 06/21/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.

treatment, symptoms, diagnosis and causes

General practitioner (family doctor)

Gutorova

Natalia Konstantinovna

Experience 23 years

Doctor

Make an appointment

Chicken pox, or, as they say, varicella, is an acute viral disease that occurs mainly at a young age and affects the skin. The causative agent belongs to a variety of herpesviruses and, after penetrating into the body, remains in it for life. So, after the disease passes, it is stored in nerve cells.

Causes

As a cause of chickenpox, one can only name the ingestion of a specific virus into the human body, which in the vast majority of cases is transmitted by airborne droplets and can also be a consequence of herpes zoster.

Who is most susceptible to illness?

According to studies, residents of large cities are more susceptible to the disease, in contrast to those living in rural areas.

Age also matters: chickenpox in children 2.5-6 years old, as well as younger schoolchildren, is most common. However, there are also cases of the disease among middle-aged men and women. The later a person becomes ill with it, the more pronounced the symptoms become.

Symptoms of disease

The onset of the first symptoms of chickenpox occurs after the incubation period. On average, it lasts from 7 to 21 days after the pathogen enters the human body.

In most cases, the initial manifestation of the disease is a severe fever, which persists for 3-7 days and may be accompanied by body aches, headache, insomnia, disturbed sleep, and loss of appetite.

This is followed by the main symptom of chickenpox – a rash that appears on the trunk and head (up to its scalp) and spreads to the limbs. Rashes can be found in the most unexpected areas, for example, in the vaginal area, on the mucous membrane of the mouth and the cornea of ​​​​the eyes.

The diameter of one such formation is 1-4 mm. At first they look like bubbles surrounded by reddened tissue, inside which a clear liquid accumulates. Then the bubbles become drier and form crusts instead.

At this stage, most people with chickenpox suffer from unbearable itching. However, it is strictly forbidden to comb the papules: otherwise, they will leave traces in the form of scars.

In some cases, patients among the symptoms of chickenpox may have an increase in lymph nodes – selectively or all at once.

Possible complications

As a rule, the disease goes away without serious consequences, especially if you do not comb the papules. However, in rare cases, complications from chickenpox can still occur.

Among them:

• bacterial infection caused by streptococcus;
• viral pneumonia, more common in babies of the first year of life and manifested in the form of high body temperature, excessive blanching of the skin, dry cough and severe shortness of breath even at rest;
• temporary disruption of the central nervous system;
• encephalitis;
• varicella meningitis.

To avoid such consequences, monitoring the development of the disease and treatment should be carried out under the supervision of a general practitioner, pediatrician or infectious disease specialist.

Diagnostic features

Diagnosis of chickenpox, as well as its treatment, is carried out by a pediatrician, therapist (if an adult is ill) or an infectious disease specialist.

The general clinical picture of the patient is taken as the basis. To clarify the diagnosis, blood sampling is possible (a general analysis is performed, as well as PCR or ELISA, which are taken twice – in the initial and final stages of the disease) and a microscopic examination of the contents of the formed vesicles on the skin.

Treatment

Treatment of chickenpox with its standard course occurs at home after consulting a doctor. It is aimed at improving the general well-being of the patient: to reduce elevated body temperature, drugs are used, the active ingredient of which is paracetamol.

In the vast majority of cases, patients suffer from unbearable itching of the skin. To alleviate the condition, special ointments and solutions based on zinc and potassium permanganate are prescribed, with the addition of tea tree oil. Antihistamines may be recommended. Often, a specialist prescribes ointments, the action of which is aimed at the destruction of a viral pathogen.

In more serious cases (especially in the presence of concomitant shingles), the doctor prescribes analgesics. With extremely reduced immunity, immunoglobulins are administered to the patient, and with intense intoxication of the body, detoxification solutions.

When should I make an appointment?

Having found the first symptoms of chickenpox in children or adults, you should isolate the sick person as soon as possible and call a doctor at home. With suspicion of this ailment, it is categorically not recommended to arrive at the medical facility on your own. Such measures are dictated by the protection of other people who can easily become infected.

The sooner a specialist examines the patient, the better.

Self-treatment of chickenpox

The process of treatment must be supervised by a doctor. This is due to possible complications dictated by the individual characteristics of the body and illiterate selection of drugs.

So, drugs based on ibuprofen for chickenpox are contraindicated, while paracetamol is allowed. These and other nuances are known only to specialists.

Answers to common questions

Is there a cure for chickenpox?

A preventive measure – not to contact with sick people – is not always effective. The fact is that infection can occur even before the first manifestations of the disease are detected in the patient. That is, he can communicate with friends without knowing that he is contagious.

It is possible to prevent the onset of the disease by vaccinating with special live vaccines, which are based on a weakened chickenpox virus.

Which specialist should I contact for treatment?

The treatment of chickenpox in children is carried out by a pediatrician or a pediatric infectious disease specialist. If an adult is ill, then a therapist or an adult infectious disease specialist should be called immediately after the first symptoms of chickenpox are detected.

Is it possible to swim with chickenpox?

Due to the fact that the quality of tap water in most cities leaves much to be desired, with this disease, you should take a shower (not a bath) using boiled or filtered water. Otherwise, there is a risk of joining the viral form of a bacterial infection, which, in turn, can cause serious complications. It is better to wash with warm water. It is strictly forbidden to use a washcloth, rub the skin and steam it.

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Chickenpox

Chickenpox is a contagious infectious disease caused by a virus, most often found in children, sometimes among adults who have not been sick before. After the infection, stable lifelong immunity is developed.

Who is the source of the disease and how is it transmitted?

You can get chickenpox from a sick person through airborne droplets, i.e. when talking, coughing, sneezing. The varicella-zoster virus is unstable in the external environment, but it is very volatile. It is thanks to the speed of infection in the air that this disease got its name – chickenpox. If one child falls ill in the children’s team, then in the coming months up to 70% of children will get chickenpox. It is considered possible infection of the fetus from the mother during pregnancy, which can cause congenital malformations.

How does the virus enter the body?

The virus enters the body through the upper respiratory tract and invades the epithelial cells of the mucous membrane. Then the virus penetrates into the blood and is fixed in the skin, causing a pathological process in its surface layer: limited expansion of capillaries (stain), serous edema (papule), detachment of the epidermis (vesicle).

How quickly do symptoms appear after infection?

The incubation period (the period of infection before the onset of clinical manifestations of the disease) in chickenpox lasts up to 21 days. An infected person becomes contagious 2-3 days before the first rash appears on the body. The patient remains contagious until the new eruptions stop and all the old ones have crusted over.

What are the symptoms of chickenpox?

The disease often begins with trembling, fever, abdominal pain, headache and general malaise. Rashes appear on the face, scalp and are very similar to small pimples, which after a while turn into small bubbles. Later, the bubbles burst and tighten with a crust. On the body of a sick person, pimples, vesicles, and crusts can be present at the same time. A typical location of the rash is the chest and skin of the abdomen, arms and legs, face and even the scalp. Sometimes rashes appear on the mucous membrane of the mouth, eyelids, in the genital area and anus. The body temperature rises, which stabilizes for 3-5 days. Rashes differ in frequency and last 3-4 days. As a rule, the crusts that form on the sites of the vesicles fall off on the 7-14th day from the moment the first rash appears.

In children 7 to 15 years of age and adults, the rash appears 1-2 days later than in children and may be more severe. The crusts are rejected much later. In most patients, the vesicles turn into pustules with purulent or purulent-hemorrhagic contents. Symptoms of the disease are characteristic: more pronounced intoxication and fever, which lasts longer. Combing the blisters contributes to the formation of depressions on the skin, which do not heal well and form chickenpox scars – smallpox.

How does the disease progress and what should be done about it?

In children, chickenpox is usually mild, but it is much more serious than a simple runny nose and cough. With a mild form, the temperature rises to 37.5-38.5 ° C, symptoms of intoxication are practically absent, rashes are not plentiful.

In the moderate form, the body temperature reaches 39°C, the symptoms of intoxication are moderately expressed, rashes are plentiful, including on the mucous membranes. With this form, the disease does not cause complications.

In the smallest, who constantly scratch the vesicles (vesicles), thereby introducing microbes into the combed wounds, a secondary pustular infection may join, which happens often. To speed up the healing process of wounds and prevent infection, certain rules and recommendations should be followed. From the first day of the appearance of rashes, you can take baths with a weak solution of potassium permanganate. It is necessary to change underwear and bed linen daily. To prevent scratching the bubbles, the baby should cut his nails in time and periodically wash his hands with soap, at night you can put thin cotton mittens or gloves on his hands. It is impossible to remove the crusts on your own, as rough and ugly scars on the skin may remain.

A severe course is observed in newborns, in people taking hormonal drugs, suffering from severe somatic diseases (diabetes mellitus, immunodeficiency states, bronchial asthma, peptic ulcer, etc. ). In severe cases, internal organs can be affected, body temperature rises to higher numbers (up to 40 ° C), which, in turn, can lead to convulsions and rashes with hemorrhages. This can even lead to death.

What are the possible complications?

Chickenpox complications are more common in adolescents and adults, including pregnant women. As a complication of the disease, pneumonia, brain damage (headache, confusion, increased sensitivity to light, nausea), heart, kidney, eye, up to loss of vision, etc. can develop. Sometimes chickenpox is complicated by inflammation of the joints and muscle pain that continues for throughout the duration of the rash. Very rarely, chickenpox is complicated by inflammation of the optic nerve or spinal cord.

In the first trimester of pregnancy, chickenpox is dangerously high risk of damage to the fetus (more than 25%). Chicken pox is also dangerous for newborns if, shortly before the birth, the pregnant woman had chicken pox or up to one month after the birth.

What should I do if I have signs of illness?

If you develop symptoms of illness, you should immediately consult a doctor. In severe general condition and severe skin manifestations, hospitalization may be required. It is necessary to drink cool liquids, for mouth ulcers, eat a sparing diet, avoid eating salty foods, as well as citrus fruits and juices.

Do not take aspirin if you have a fever! If the temperature is above 38 degrees for more than 4 days, you need to re-consult a doctor.

What measures are available to prevent chickenpox?

In children’s institutions, a sick child is isolated from the first days of the disease until recovery at home. Children who were in close contact with the patient are observed by health workers 21 days after the last case of the disease. If the date of contact with a person diagnosed with chickenpox is set accurately, children under 7 years of age are admitted to preschool education within 10 calendar days, from 11 to 21 days, isolation at home is provided.