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, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, 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