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:
- asymptomatic
- chicken pox
- 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
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and 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 two amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
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Hi Chris,
Firstly thanks for the great work!!
My Name is Andrew, I’m a paramedic and in recent weeks I have come across pt’s with shingles. Because a lot of the patients are elderly some are poor historians but majority were prescribed an SSRI for their shingles.
Could you please shed some light on this?
Regards
Andrew Haynes