Chickenpox is one of the five classical childhood exanthems or rashes, once a cause of significant morbidity and mortality, but now chiefly of historical importance—it was formerly one of the childhood infectious diseases caught by and survived by almost every child.
Chicken pox is a highly contagious viral infection caused by the varicella virus. The word chickenpox comes from the Old English word "gican" meaning "to itch" or from the Old French word "chiche-pois" for chickpea, a description of the size of the lesion.
Chickenpox has a 10-21 day incubation period and is highly contagious through physical contact two days before symptoms appear. Following primary infection there is usually lifelong protective immunity from further episodes of chickenpox.
Chickenpox is rarely fatal (usually from varicella pneumonia), with pregnant women and those with a suppressed immune system being more at risk. Pregnant women not known to be immune and who come into contact with chickenpox may need urgent treatment as the virus can cause serious problems for the fetus.
Causes:Chickenpox is a disease of childhood - 90% of cases occur in children aged 14 years and younger. Before widespread vaccination, the incidence of chicken pox in the United States approached the annual birth rate, averaging between 3.1 and 3.8 million cases per year. Chicken pox can occur at any time, but occurs most often in March, April, and May in temperate climates.
Chicken pox is acquired by direct contact with infected blister fluid or by inhalation of respiratory droplets. When a person with chicken pox coughs or sneezes, they expel tiny droplets that carry the varicella virus. A person who has never been exposed to chicken pox inhales these droplets and the virus enters the lungs, and then is carried through the bloodstream to the skin where it causes a rash. While the virus is in the bloodstream (before the rash begins) it causes typical viral symptoms like fever, fatigue, joint pains, headache, and swollen glands. These symptoms usually resolve by the time the rash develops.
Symptoms:
Symptoms of chicken pox include that:
* children sometimes have a prodrome of fever, malaise, headache, lack of appetite, and mild abdominal pain for 1 to 2 days.
* the rash typically appears first on a child's trunk, scalp, and face and consists of small, very itchy, flat red spots, which then turn into raised fluid filled vesicles, often described as looking like a 'dewdrop' that become umbilicated and cloudy and eventually crust over.
* the fever only lasts about 2 to 4 days.
* new 'crops' of the rash on the child's trunk and then arms and legs continue for about 4 days
* all of the lesions are crusted over about 6 to 7 days after the illness begins.
* the crusts then fall off in another 7 days, although it sometimes takes up to 20 days, usually without scarring.
Facts:
* The average child with chicken pox gets about 300 lesions.
* It is very typical or characteristic for children with chicken pox to have lesions in different stages at the same time, including the first flat red spots, the fluid filled vesicles, and the crusted vesicles.
* The fever with chicken pox usually ranges from 100 to 102 degrees Fahrenheit, but may be as high as 106 degrees in some cases.
* Children with chicken pox are contagious for 1 or 2 days before they develop a rash and until all of their vesicles have crusted.
* Chicken pox crusts that are scratched off or infected may lead to scars.
* Children who have chicken pox after having the chicken pox vaccine often have an atypical case, with much milder symptoms and fewer lesions.
Diagnosis:
Chicken pox is typically diagnosed clinically based on the history of viral symptoms and the characteristic appearance of the rash. However, sometimes chicken pox can be confused with herpes simplex, impetigo, insect bites, or scabies. Sometimes a viral culture can be performed to confirm the diagnosis, but it takes from 1 to 14 days to get the results.
Treatment:
Because chicken pox is usually a benign self-limited disease, treatment is typically aimed at treating symptoms and making the patient more comfortable. In some cases, the antiviral medication acyclovir may be used to treat chicken pox.
Patients with chicken pox typically have viral-type, prodromal symptoms such as headache, fever, fatigue, and muscle aches. These symptoms can be treated with acetaminophen (Tylenol) with doses determined by the weight of the patient.
Frequent baths are sometimes helpful to relieve itching. Adding finely-ground (colloidal) oatmeal such as Aveeno can help improve itching. Oatmeal baths can be prepared at home also by grinding or blending dry oatmeal into a fine powder and adding about 2 cups to the bath water. One-half to one cup of baking soda may also be added to bath water to reduce itching.
Over-the-counter and prescription antihistamines may be used to control severe itching. Diphenhydramine (Benadryl) is available over-the-counter and hydroxyzine (Atarax) is available by prescription. Both of these antihistamines cause drowsiness and may be helpful at night to help the patient sleep. The newer antihistamines such as loratadine (Claritin), certrizine (Zyrtec), and fexofenadine (Allegra) can be used to control itching but do not cause drowsiness.
Chicken pox is acquired by direct contact with infected blister fluid or by inhalation of respiratory droplets. When a person with chicken pox coughs or sneezes, they expel tiny droplets that carry the varicella virus. A person who has never been exposed to chicken pox inhales these droplets and the virus enters the lungs, and then is carried through the bloodstream to the skin where it causes a rash. While the virus is in the bloodstream (before the rash begins) it causes typical viral symptoms like fever, fatigue, joint pains, headache, and swollen glands. These symptoms usually resolve by the time the rash develops.
Symptoms:
Symptoms of chicken pox include that:
* children sometimes have a prodrome of fever, malaise, headache, lack of appetite, and mild abdominal pain for 1 to 2 days.
* the rash typically appears first on a child's trunk, scalp, and face and consists of small, very itchy, flat red spots, which then turn into raised fluid filled vesicles, often described as looking like a 'dewdrop' that become umbilicated and cloudy and eventually crust over.
* the fever only lasts about 2 to 4 days.
* new 'crops' of the rash on the child's trunk and then arms and legs continue for about 4 days
* all of the lesions are crusted over about 6 to 7 days after the illness begins.
* the crusts then fall off in another 7 days, although it sometimes takes up to 20 days, usually without scarring.
Facts:
* The average child with chicken pox gets about 300 lesions.
* It is very typical or characteristic for children with chicken pox to have lesions in different stages at the same time, including the first flat red spots, the fluid filled vesicles, and the crusted vesicles.
* The fever with chicken pox usually ranges from 100 to 102 degrees Fahrenheit, but may be as high as 106 degrees in some cases.
* Children with chicken pox are contagious for 1 or 2 days before they develop a rash and until all of their vesicles have crusted.
* Chicken pox crusts that are scratched off or infected may lead to scars.
* Children who have chicken pox after having the chicken pox vaccine often have an atypical case, with much milder symptoms and fewer lesions.
Diagnosis:
Chicken pox is typically diagnosed clinically based on the history of viral symptoms and the characteristic appearance of the rash. However, sometimes chicken pox can be confused with herpes simplex, impetigo, insect bites, or scabies. Sometimes a viral culture can be performed to confirm the diagnosis, but it takes from 1 to 14 days to get the results.
Treatment:
Because chicken pox is usually a benign self-limited disease, treatment is typically aimed at treating symptoms and making the patient more comfortable. In some cases, the antiviral medication acyclovir may be used to treat chicken pox.
Patients with chicken pox typically have viral-type, prodromal symptoms such as headache, fever, fatigue, and muscle aches. These symptoms can be treated with acetaminophen (Tylenol) with doses determined by the weight of the patient.
Frequent baths are sometimes helpful to relieve itching. Adding finely-ground (colloidal) oatmeal such as Aveeno can help improve itching. Oatmeal baths can be prepared at home also by grinding or blending dry oatmeal into a fine powder and adding about 2 cups to the bath water. One-half to one cup of baking soda may also be added to bath water to reduce itching.
Over-the-counter and prescription antihistamines may be used to control severe itching. Diphenhydramine (Benadryl) is available over-the-counter and hydroxyzine (Atarax) is available by prescription. Both of these antihistamines cause drowsiness and may be helpful at night to help the patient sleep. The newer antihistamines such as loratadine (Claritin), certrizine (Zyrtec), and fexofenadine (Allegra) can be used to control itching but do not cause drowsiness.
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