This is a presentation on chicken pox or

1. Project coordinator: Dr. Diva Singh
Co-investigator: Osama Bin Khalid
ID:20170702
UMANAND PRASAD
SCHOOL OF MEDICINE AND
HEALTH SCIENCES
MICROBIOLOGY PRESENTATION
2019

2. CHICKEN POX

3. OutlineChickenpox
Introduction
History
Glance over Fiji
Agent
Transmission
Pathophysiology
Brief comparison with other viral
infections
Clinical manifestation
Treatment
Prevention
Journal
Conclusion
Reference

4. INTRODUCTION
What is chickenpox?
•Acute, highly infectious and contagious disease caused
by varicella-zoster virus(vzv)
•Viral infection
•Acute phase of this virus
•Reactivation- Shingles
•Super itchy skin rashes with red blisters all over the body
•Blisters are of varying size.
•Most common in winter and spring

5. History
• It was not steadfastly distinguished from smallpox
until the 19th century.
• 1888- Von Bokay made important clinical observations
between varicella and herpes zoster.
• 1954-VZV was isolated from vesicular fluid of both
chickenpox and zoster lesions in cell culture by
Thomas Weller.
• 1970- live attenuated vaccine was developed in Japan

6. Glance over Fiji
•VZV has been a nuisance in Fiji previously, however
chicken pox incidence have improved drastically over
the past few years.
•The last outbreak was in July, 2015 by Ministry Of
Health when the chicken pox incident surpassed the
normal threshold of 53 cases per month. The peak
incidence of this VZV in Fiji is from July to October (
the cold season).
•With the cultural norms of our nation greatly
embedded on shaking hands and hugging, living
standards and the close proximity of population
setting is a major factor in riffing up the spread of this
infection.

7. Glance over Fiji contd..
•Ministry of health is yet to make Varicella Zoster
Vaccination compulsory for our infants; contrary to
other enforced vaccines such as measles, mumps and
rubella(MMR) and most recently the meningococcal
vaccination.

8. Agent (virus)
• Herpes virus group, human
(alpha) herpes virus 3
• Only affect humans
• Double stranded DNA
virus
• Latent infection of dorsal
root ganglia or extra medullary
cranial ganglia.
• Reactivation- severe
Family Herpersviridae
Viral
Subfamily
Alphaherpesvirinae
Genus Varicellovirus
Species Human herpesvirus 3 (HHV-3)
• Incubation period- 14 to 16 days

10. Transmission
•Person to person through droplet infection.
•Entryway (portal of entry) -respiratory tract.
•Patients who have shingles(Herpes Zoster) high chance
of spreading Chicken Pox
•Secondary attack rate in household contact up to 90% .

12. Infectivity
• Communicability period:
1 to 2 days before rashes appears
and
4 to 5 days after the appearance of rash.
(Virus tends to die out before pustular stage.)
• Take note- Once the lesions ceases, dries up and
crusts, its not contagious

13. Infection Host Factors
• Age
• Occurs primarily in children under 10yrs.
• Disease can be severe in adults.
Pregnancy
Infection leads to congenital varicella
Immunity
One attack gives durable immunity.
Cell mediated immunity helps in the recovery from VZV.
Antibodies persist for life time and prevents from
varicella.

14. Pathophysiology
Inhalation of
respiratory
droplets
Virus infects
upper
respiratory
tract
Regional lymph
nodes of the URT(
2-4 days after
initial infection)
Stage of
primary viremia
Viral replication
in other organs
(liver & spleen)
Stage of
secondary
viremia
Diffuse viral
invasion of
capillary
endothelial cells
and the epidermis.
characteristic
vesicle.

16. Clinical Manifestation
• Lesions may be found at all stages of development of
chicken pox infection
•Appear in crops
-(crop growth formation)
• Very pruritic(itchy)
•Medically divided into
2 stages:
Pre-eruptive stage
 Eruptive stage

18. Pre-eruptive stage
• General feeling of unwell-malaise
• Sudden/rapid onset with mild or moderate fever.
• Headache and loss of appetite
• Fever- mild and brief in children and worse in adults
• In children this stage is very brief (about 24hrs).

19. Eruptive stage
•In children the rash is often first sign coming on the day
the fever starts.
•Amazing speed of spread throughout the body
The distinctive features of rash are:
1. Centripetal Distribution
2. Rapid Evolution
3. Pleomorphism
4. Fever

20. 1. Distribution
•Centripetal in distribution.
a. First appears on the face and trunk
(abundant)
b. Then to arms and legs (less abundant)
•Mucosal surfaces are involved.
•Axilla may be affected. But palms and soles
are not affected.
•Density diminishes centrifugally.

21. 2. Rapid evolution
• Rash advances quickly
•"dew drop on a rose petal" appearance.
• Scabbing begins 4 – 7 days after the rash appearance
3. Pleomorphism
• All stages of the rash (Papule, vesicles & crusts) may be
seen simultaneously at one time in same area.

23. 4. Fever
•Not high or severe, but mild -38.3°C
•Temperature rises with each fresh crop of rash.
•Children -mild fever
• Adults -severe fever.

24. BREIF COMPARISON WITH OTHER
SIMILAR VIRAL INFECTIONS

25. Stephen kell

26. Chicken pox vs small pox
• They both have rashes and blisters, both called pox
• Chicken pox-VZV whereas Small pox- Variola virus
• Chicken pox- mild fever and condition
• Small pox severe, 3 out of 10 who got this died and survivors
had permanent scars or became blind
• Small pox last incidence any where in the world was in 1978-
pretty much extinct.

27. diagnosis
• This disease is diagnosed based on presenting
symptoms and asking few questions
• Confirmation of diagnosis may be aided by medical
lab tests such as PCR, examining the skin scrapings
under microscope, stained smears from vesicular
fluid, viral cultures or serology tests for varicella IGM
anti body
• On rare occasions chicken pox may be confused with
scabies or insect bite

28. Precautionary measures
• Tap or pad, don’t scratch your itch
• Wear loose cotton clothing, to allow enough
ventilation for skin
• Heat or sweat make you itch, use cool, wet washcloth
to calm your skin

29. COMPLICATIONS
• It is not an entirely harmless illness
• Secondary bacterial infection- highest risk
• Reyes syndrome - due to use of salicylates in young
adults
• Pneumonia
• Immuno-compramised, patients who have HIV,
Diabetics, severe asthmatics who take large amount of
steroids, chemotherapy patients. Their immune
system is suppressed, a bout of VZV can prove fatal for
them

30. Treatment
• Generally no treatment, most people will get over this
with very little complications.
• Supportive therapy/ symptom based treatment
• Antiviral Therapy (Acyclovir).
•Varicella-Zoster Immune Globulin Therapy.
• Dietary Measures.
• Calamine lotion on any itchy spots, avoiding the eyes
and face and OTC antihistamines such as Benadryl to
relieve itching

32. •Varicella Virus Vaccine (Varivax)
•live-attenuated Oka strain
• 2 doses of this vaccine for all children
• After the first dose at age 12-15 months, the
second should be administered at age 4-6 years.
• People 13 years of age and older : who have
never had chickenpox or received chickenpox
vaccine should get two doses, at least 28 days
apart

33. Dr. Michiaki Takahashi

34. Interview
• Dr.Nandan- Dermatalogist at
Bayley Clinic, Lautoka
• Mata Mai/Bara Mata
• Seasonal Spread common
• Peaks during cold weather
conditions
• Yaqona drinkers, diabetic patients
• Questioned on the usage of Haldi (Tumeric Bath and sleepover on
Neem leaves(Indian Iliac)- very good antibacterial, anti pruritic
agents.
• Cyclovior to be administered within the first 24 hours, after that its
not effective.

35. Journal Article

36. Prevention and Control of Varicella-Zoster Virus in
Hospitals (Webber.J, 2018)
ABSTRACT
Chicken pox is a virus of varicella zoster, and health care
facilities are extremely vulnerable to varicella zoster
infections.
Varicella Zoster Virus DNA has been found to contaminate the
rooms of patients greatly.
Gauze mat dressings , in room air purifier filters, indicating the
failure of gauze dressing to completely prevent the outspread
of the particles of the virus into the air.
Research Locations: University of North
Carolina Hospital, Harvard Medical School,
Alpert Hospital

37. •Health care workers include-clinicians, nurses,
therapists, technicians, pharmacists, lab personnel's,
students, clerical, dietary, housekeeping, laundry,
security and administrative staff.
•All HCP should wear N95 respirator when in contact with
VZV susceptible patients.
•Health care personnel's should be screened for VZV
infections and immunized. All patients with VZV
infection should be placed in private rooms meeting the
standard of isolation for Tuberculosis patients(Grade
1B).For hospital workers that do not have
contraindications to vaccination, the vaccine VariZig, is
suggested.

38. • Oral Acyclovir : [800mg 5 times daily for eight till
twenty one days upon exposure] are suitable
substitutes for hospital workers with contraindications
to vaccination.
• Upon exposure of the VZV virus to the health
professionals, they should be relieved from work for
about eight to twenty one days.

39. Conclusion
•Chicken pox which is spread by VZV, used to be classical
childhood disease, which is highly contagious infection.
•During illness, fever and characteristic blister-rashes appear
which first appears on face and trunk, then spreads
throughout the body.
•Although not life threatening, severe complications can
arise however occurrence now have subsided drastically
due to advancement in medical array and availability of
vaccines.

40. Reference
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• Tortora, G., Funke, B. and Case, C. (2010). Microbiology. San Francisco, CA: Benjamin
Cummings, p.596.
• Mark.H,Robert,Kaplan(2010) The Merck Manual of diagnosis and therapy.[18th edition]
West point USA,P 1603-1605
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[Accessed 24 Jun. 2019].
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