Varicella Zoster

OVERVIEW

VZV = an alpha herpes virus
90% of adults have evidence of infection
spread via droplet excreted from the throat of patients with chicken pox OR via contact with vesicle fluid in chicken pox or shingles.
after infection:
1. asymptomatic
2. chicken pox
3. shingles (herpes zoster)

site of latency = nerve cell body (spinal cord and cranial nerves)

CLINICAL FEATURES

Chickenpox

febrile response
vesicular rash that appears in crops
generalized lymphadenopathy

Shingles

blistering rash that always stops at the midline
risk factors: increased age, immunosuppression or deficiency, stress

INVESTIGATIONS

clinical diagnosis
viral isolation from tissue culture
electron microscopy
antigen detection

MANAGEMENT

aciclovir
prevention = immunization with live vaccine or zoster immunoglobulin

COMPLICATIONS

chicken pox -> pneumonia, congenital varicella or neonatal chicken pox
shingles -> post-herpetic neuralgia, zoster keratitis, motor-nerve paralysis

Risk factors for developing pneumonia

Smoker
Contact with index case
> 100 spots
Duration of fever
Chronic Lung Disease
3rd trimester pregnancy
Immunosuppression

Critical Care

Compendium

…more CCC

Chris Nickson

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC