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Home | CCC | Varicella Zoster

Varicella Zoster

by Dr Chris Nickson, last update April 23, 2019

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

CCC 700 6

Critical Care

Compendium

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About Dr Chris Nickson

An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. @Twitter | INTENSIVE| SMACC

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