Infectious Disease Compendium

Chickenpox

Diagnosis

An acute disease with rash, fever, and constitutional symptoms for 3 to 5 days' duration. The rash has maculopapules, vesicles, and scabs in varying stages of evolution; they appear on the trunk and face and rapidly spread centripetally in successive crops over 2 to 4 days.

Occasionally acute disease can cause a meningoencephalitis and cerebellar ataxia.

Pneumonitis is common on CXR, less commonly symptomatic, especially adults; it is more likely to progress in those with hematologic malignancies or pregnancy. Chickenpox can be deadly in the leukemic/transplant with widespread, destructive disease. Hepatitis and myocarditis occur.

Epidemiologic Risks

Spread from person to person.

Microbiology

Varicella Zoster.

Empiric Therapy

- Normal hosts: acyclovir 800 mg 5 x a day ORvalacyclovir 1 g tid z 7 to 10 d OR famciclovir is given at 500 mg tid x 7 to 10 d.

- Heme malignancy/transplants: acyclovir at 10 mg/kg q 8 as well as Varicella zoster immune globulin (VZIG; see package insert);

- Pregnancy: balance the severity of disease vrs the massive paranoia of giving any medication to a pregnant woman; VZIG is also indicated for newborns whose mothers acquire varicella within 5 days before to 48 hours after delivery.

Pearls

There is a vaccine, it is live attenuated so cannot give to the immunoincompetent and the vaccine will occasionally lead to secondary cases, it does prevent shingles in the adult.

Rants

Remember, this guide is not written by someone who knows much about peds.

ICD9 Codes (Soon to be supplanted by ICD10)

Chickenpox 052.9.