• Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
  • excellent one however, more details about infection and its kinetic of development inside its host is in need. Also the action of vaccin
    Many thanks
    Are you sure you want to
    Your message goes here
No Downloads


Total Views
On Slideshare
From Embeds
Number of Embeds



Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

    No notes for slide


  • 1. Varicella Zoster DR.T.V.RAO MD
  • 2. Varicella Zoster and Chickenpox Varicella-zoster virus (VZV) causes chickenpox and herpes zoster (shingles). Chickenpox follows initial exposure to the virus and is typically a relatively mild, self-limited childhood illness with a characteristic exanthem, but can become disseminated in immunocompromised children. Reactivation of the dormant virus results in the characteristic painful dermatomal rash of herpes zoster, which is often followed by pain in the distribution of the rash (postherpetic neuralgia).
  • 3. Varicella Zoster ( Herpes Virus) DNA Virus Varicella - Chicken pox. Contagious Disease Mainly infects Children Generalized Vesicular eruptions on Skin and Mucous membranes Severe manifestations in Adults and Immune compromised.
  • 4. Shingles (Herpes Zoster ) Rash Limited to Distribution of Single Sensory Ganglion In Adults and immune compromised Sporadic
  • 5. Zoster. Associated with Immune compromised. Manifest with severe pain Vesicles on trunk , head, neck Trigeminal Neuralgia
  • 6. HERPES VARICELLA ZOSTER HVZ Causes chicken pox -fever + characteristic rash variable incubation period 14-21 days usually mild in children and more severe in adults complications ◦ secondary infection - uncommon ◦ varicella pneumonia ◦ secondary bacterial pneumonia S aureus & pneumococci ◦ post-infetious encephalitis ◦ generalized varicella (in immunocompromised patients) ◦ congenital and neonatal varicella
  • 7. Herpes Zoster Primary Contact - Chicken Pox Reactivation - Zoster (Partially Immune )
  • 8. Herpes zoster (shingles) The most common presentation is the shingles vesicular rash, which most commonly affects a thoracic dermatome After a prodromal illness of pain and paraesthesia's, erythematous macules and papules develop and progress to vesicles within 24 hours The vesicles eventually crust and resolve Pain and sensory loss are the usual symptoms Motor weakness also occurs and is frequently missed on examination Cases of actual monoplegia due to VZV brachial plexus neuritis have been reported
  • 9. Zoster multiplex Shingles may appear in multiple dermatomes, both contiguous and noncontiguous, on either side of the body Immunocompromised individuals are more susceptible Terminology depends on the number of involved dermatomes and on whether the condition is unilateral or bilateral (eg, zoster duplex unilateralis refers to the involvement of 2 unilateral dermatomes) Cases of zoster simultaneously occurring in 7 noncontiguous dermatomes have been reported
  • 10. Properties of Virus. Like Herpes Virus Icosahedrons shape ds DNA VZV virons are spherical and 180–200 nm in diameter. Their lipid envelope encloses the 100 nm nucleocapsid of 162 hexameric and pentameric capsomeres arranged in an icosahedral form. Its DNA is a single, linear, double-stranded molecule, 125,000 nt long.
  • 11. Progress of events in Varicella Zoster Infection
  • 12. Culturing virus Grows in Human embryonic Tissue Produce inclusion bodies No difference in virus In Chicken pox and zoster infection
  • 13. Pathogenesis and Pathology Varicella virus enter through URT/Conjunctiva. Lymph nodes Viremia Liver and spleen Secondary viremia Infects Mononuclear Cells Rash Vesicle formation
  • 14. Risk Factors Chickenpox Exposure to the virus if you have not had chickenpox nor received the vaccine Being under 10 years of age Time of year: late winter and early spring is the most common time that the virus is spread
  • 15. Shingles Age (most common in people over 60) Stress Weakened immune system (for example, people with HIV/AIDS, or those taking drugs to suppress the immune system due to autoimmune diseases or organ transplants) Having had chickenpox before age 1
  • 16. Herpes Zoster Skin Lesions Inflammation of Sensory Nerves and Ganglia Single Ganglion Dorsal root Ganglion
  • 17. Entry of Varicella Zoster virus
  • 18. Skin lesions showing different stages
  • 19. Clinical Findings. Varicella, Incubation 10-20 days Fever, Malaise Rash Trunk –Face –Limbs – Buccal and Pharyngeal mucosa Lesions at all stages Macules, Papules, Vesicles, Crusts, May last 5 days, Hundreds of eruptions.
  • 20. Skin lesions of chickenpox
  • 21. Chicken pox lesions in the buccal cavity
  • 22. Herpes Zoster involving a Nerve segment
  • 23. Other Complications. Encephalitis, Mother to Child transmission Varicella Pneumonia. Fatal Complications.
  • 24. Events in Varicella Zoster Infection
  • 25. Immune compromised HIV / AIDS Malignancies. Organ transplantations Corticosteroid usage Leukaemia's.
  • 26. HERPES VARICELLA ZOSTER HVZ Causes chicken pox -fever + characteristic rash variable incubation period 14-21 days usually mild in children and more severe in adults complications ◦ secondary infection - uncommon ◦ varicella pneumonia ◦ seconday bacterial pneumonia S aureus & pneumococci ◦ post-infetious encephalitis ◦ generalised varicella (in immunocompromised patients) ◦ congenital and neonatal varicella
  • 27. Pain and hyperesthesia
  • 28. Pain and hyperesthesia
  • 29. Ramsay-Hunt syndrome This syndrome occurs when the geniculate ganglion is involved. The clinical presentation includes the following: A peripheral facial palsy Pain in the ear and face Vesicles in the external ear canal (not always present) Additional auditory and vestibular symptoms in some case
  • 30. Keratitis (herpes ophthalmicus) Caused by reactivation of VZV infection in the ophthalmic division of the trigeminal nerve. The presentation may include conjunctivitis or corneal ulcers Complications include blindness Vesicles do not have to be present Rarely, the virus migrates along the intracranial branches of the trigeminal nerve, causing thrombotic cerebrovasculopathy with severe headache and hemiplegia
  • 31. Laboratory Diagnosis. Smears --Scrapings from Lesions Demonstration of Multi nucleated giant cells Tzanck smears DNA Demonstration Cell cultures, Fluorescent –antibody ELISA PCR
  • 32. Treatment Specific treatment is indicated mainly in Immunodeficient and elderly subjects and also in complicated with Varicella pneumonia ,encephalitis,and disseminated zoster Acyclovir and Famiciclovir.
  • 33. Antiviral Medications Antiviral medications decrease the duration of symptoms and the likelihood of post herpetic neuralgia, especially when initiated within 2 days of the onset of rash. Oral acyclovir may be prescribed in otherwise healthy patients who have typical cases. Compared with oral acyclovir, other medications (eg, valacyclovir, penciclovir, famciclovir) may decrease the duration of the patient's pain.
  • 34. Varicella zoster Immune globulins Varicella zoster immune globulin (VariZIG) is indicated for administration to high- risk individuals within 10 days (ideally within 4 days) of chickenpox (VZV) exposure.[4] High- risk groups include the following: Immunocompromised children and adults New-borns of mothers with varicella shortly before or after delivery Premature infants Infants less than younger than 1 year of age Adults without evidence of immunity Pregnant women
  • 35. Epidemiology Communicable Disease World wide prevalence Common in < 10 year olds. Zoster in Adults Droplet spread is common
  • 36. Prevention of Chickenpox Susceptible population children adults living in close proximity Do nothing Immunize live attenuated vaccine Protect if contact with patient with chickenpox and at risk of severe disease Zoster Immune Globulin (ZIG)
  • 37. Recent advances in research The introduction of DNA analysis techniques has shown some complications of varicella-zoster to be more common than previously thought. For example, sporadic meningoencephalitis (ME) caused by varicella-zoster was regarded as rare disease, mostly related to primary varicella, and occurring mainly in children or immunocompromised people.
  • 38. Approval of Vaccine by FDA In 2006, the United States Food and Drug Administration approved Zostavax for the prevention of shingles. Zostavax is a more concentrated formulation of the Varivax vaccine, designed to elicit an immune response in older adults whose immunity to VZV wanes with advancing age. A systematic review by the Cochrane Library shows that Zostavax reduces the incidence of shingles by almost 50%
  • 39. Vaccine available A live modified Varicella virus lyophilised vaccine which can be stored at low temp is available for protection Children 1 -12 years given single dose.>12 years 2 doses 2 -6 weeks apart High titre serum from convalescing from herpes zoster protect Immunocompromised children. But not useful for treatment
  • 40. For More Articles of Interest on Infectious Diseases Visit me on ……
  • 41. Programme Created by Dr.T.V.Rao MD from Scientific searches on World wide web for Medical Students for Universal education on Infectious Diseases Email doctortvrao@gmail.com