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Chickenpox (Complications (Encephalitis. Can occur during the early phase…
Chickenpox
Complications
Secondary bacterial infection:
Often group A strep, can be others. May even have further serious complications like nec fasc, TSS syndrome.
NEW FEVER (fever initially settles and then recurs a few days later = likely 2ndary infection) or PERSISTENT fever after a few days
Encephalitis. Can occur during the early phase of the illness. Generally good prognosis. Conservative management (i.e. just let it get better by itself). Resolves within a month.
ATAXIA with cerebellar signs (cerebellitis), ~1 week after rash appears
Cerebellitis, aseptic meningitis, generalised encephalitis
Purpura fulminans
Vasculitis in the skin and soft tissues. Cross reaction of antiviral Abs produced against coagulation factor (protein S) >> dysregulation of clotting, manigestation in the skin.
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Reye syndrome: nausea, vomiting, headache, excitability, delirium, and combativeness with frequent progression to coma
Aspirin use in fever identified as a risk factor for this - stopped using aspirin in children and the rates of Reye syndrome have gone down a lot
Clinical features
Typical vesicular rash
Rash comes in crops for 3-5 days. Papules >> Vesicles >> Pustules >> Crusts (when fever has come down)
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Illness probably lasts about a week after rash appears, spikes in temperature that wiggle around 40 degrees
Incubation
10-23 but median average is 2 weeks. Spread through close contact (15 minutes), respiratory droplets, direct contact with vesicular lesions
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Management
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In pregnancy
In first 20 w if mother gets primary VZV (not previously immune) Foetus at risk of severe scarring of the skin and possibly ocular and neurological damage and digital dysplasia
Within 5 days of and 2 days after delivery - ,fetus is NOT PROTECTED by maternal antibodies and the viral dose is high. About 25% develop a vesicular rash. The illness has a mortality as high as 30%.
Exposed susceptible mothers can be protected with varicella zoster immune globulin (VZIG) and treated with aciclovir. Infants born in the high-risk period should also receive zoster immune globulin and are often also given aciclovir prophylactically.