A 12-year-old girl presents with a 3-day history of a body-wide pruritic vesicular rash (Figure 108-1). The episode started 24 hours before the rash with fever and malaise. The patient is diagnosed with varicella and no antiviral medications are given. Acetaminophen or ibuprofen are recommended for fever and comfort, avoiding aspirin to prevent Reyes syndrome.
Chickenpox in a child. Note lesions in various stages (papules, intact vesicles, pustules, and crusted papules) caused by multiple crops of lesions. The vesicles are on a red base. (Used with permission from Richard P. Usatine, MD.)
Varicella (chickenpox) is a highly contagious viral infection that can become reactivated in the form of zoster.
Varicella-zoster virus (VZV) is distributed worldwide.
The rate of secondary household attack is more than 90 percent in susceptible individuals (Figure 108-2).1
Adults and immunocompromised patients generally develop more severe disease than normal children.
Traditionally, primary infection with VZV occurs during childhood (Figure 108-3). In childhood, it is usually a benign, self-limited illness in immunocompetent hosts. It occurs throughout the year in temperate regions, but the incidence peaks in the late spring and summer months.
Neonatal varicella is a serious illness with a mortality rate up to 30 percent.2 The risk of infection and the case fatality rate are significantly increased if a mother has symptoms less than five days prior to delivery. The time to delivery allows insufficient time for the development of maternal IgG and passive transfer of protection to the fetus.3 Postnatally acquired varicella that occurs beyond 10 days after birth usually is mild.4
Prior to the introduction of the varicella vaccine in 1995, the yearly incidence of chickenpox in the US was approximately 4 million cases with approximately 11,000 hospital admissions and 100 deaths.5
As the vaccination rates steadily increased in the US, there has been a corresponding fourfold decrease in the number of cases of chickenpox cases down to disease rates of from 0.3 to 1.0 per 1000 population in 2001.5
Chickenpox in sisters seen before the varicella vaccine was available. The girls are feeling better now that the disease is resolving. (Used with permission from Richard P. Usatine, MD.)
Chickenpox in a child. Note the widespread distribution of the lesions. The honey-crusted lesion on the eyebrow suggests a secondary bacterial infection (impetigo) has developed. (Used with permission from Richard P. Usatine, MD.)
Etiology and Pathophysiology
Log In to View MoreYour institution's subscription does not include access to this resource. If you have an individual subscription to this resource, please sign in below. Otherwise, contact your librarian to request access for your institution or view individual subscription options below.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
Create a Free MyAccess Profile
Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.
Benefits of a MyAccess Profile:
- Remote access to the site off-campus on any device
- Notification of new content via custom alerts
- Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
- Save and download images to PowerPoint
- Self-Assessment quizzes saved for quick review
- Custom Curriculum access for both instructors and learners
AccessPediatrics Full Site: One-Year Subscription
Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.
Pay Per View: Timed Access to all of AccessPediatrics
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.