Varicella, commonly known as chickenpox, is a highly contagious disease caused by the varicella-zoster virus. It is characterized by a vesicular rash that may be accompanied by fever and malaise. While usually a mild, self-limiting disease in children, it can cause more severe complications in adults and immunocompromised individuals. After initial infection, the virus can remain dormant and later reactivate, causing herpes zoster or shingles. Vaccination has proven effective at preventing initial infection and reducing the incidence of both chickenpox and shingles.

1. (Varicella)
Dr. Kuldeep Vaishnav
Intern, NMCTH

2. INTRODUCTION
• Acute, Highly infectious
disease caused by Varicella-
zoster Virus.
• It is characterized By
vesicular rash that may be
accompanied by Fever and
Malaise.
• It is worldwide in
distribution and occurs in
both epidemic and endemic
forms.

3. INFECTIOUS AGENT
• Varicella Zoster Virus [Human
(alpha)herpes 3)
• DNA virus, member of herpes.
• VZV only affects Human &
Commonly causes Chicken pox
in childrens , teen & Young
adults,
• And Herpes Zoster (Shingles)
In adults & rarely in children.

4. HOST FACTOR
• Man is host of Virus.
• Age
– under 10 years of age
• Immunity
– One Attack give life long immunity.
– Secondary attack rate- chicken pox
is highly communicable.
– Secondary attack rate in
household contact is up to 90%

5. • Environmental
– Over crowding increases the chance of disease
– Show a seasonal trend- in temperate climate there is
little evidence of seasonal trend
• Reservoir
– Infected persons are reservoir
• Source of infection
– Oropharyngeal secretion
– Lesion of skin & Mucosa
• Infectivity
– Ranges from 1-2 days before the appearance of rash &
4-5 days thereafter
– Infectivity ceases once lesion are crusted
– Virus tend to die out before pustular stage

6. • Mode of transmission
– Direct
• Person to person through droplet or air borne spread
• Virus can cross the placenta
– Indirect
• Through articles freshly soiled by the discharge from
the mucus membrane of the patient
• Incubation Period
– 14-16 days
• Susceptibility & Resistance
– It is universal among those not previous attacked

7. PATHOGENESIS
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8. CLINICAL FEATURES
• May varies from a mild illness with only
scattered lesion to severe febrile illness with
widespread rash.
• Stages :
– Pre-eruptive stage
– Eruptive stage

9. PRE-ERUPTIVE STAGE
• Onset is sudden with mild or moderate fever,
pain in back, shivering & malaise.
• Very brief stage lasting for 24 hours.
• In adults more severe & last for 2-3 days
before rash comes out.

10. ERUPTIVE STAGE
• In children rash is the often the 1st sign
• It comes on the day the fever starts
• Distribution of Rash:-
– Symmetrical rashes
– Centripetal in distribution
• A- 1st appear on Trunk (Abundant)
• B- then face, arm & legs (Less abundant)
– Mucosal surface generally involved
– Axilla may be affected
– Palm & soles usually not affected
– Density of eruptions diminishes
centrifugally

11. • Rapid Evolution
– Macule→ papule → vesicles → pustule → scab
• Pleomorphism
• A characteristic features of the rash in chicken pox
• All stage of rash may be seen simultaneously at
one time in same area
• This is due to appearing in successive crop for 4 to
5 days in same area
• Fever
• Does not run high but shows exacerbation with
each fresh crop of eruption

12. DIAGNOSIS
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• Points for Diagnosis:
– Prodrome of low-grade fever
– Eruption of papules, vesicles
and pustule
– Typical Dew-drop on Rose
petal appearance
– Characteristic centripetal
distribution

13. INVESTIGATION
• Investigations are rarely
required.
• In doubtful cases
Tzank-smear Done from
floor of vesicles
– Floor of vesicles show of
multinucleated giant
cells.

14. DIFFERENTIAL DIAGNOSIS
• Vesicular exanthems
• Contact dermatitis
• Impetigo
• Insect bite
• Drug eruptions
• Small pox and other poxviruses
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15. TREATMENT
• Mild Case (chilldren)
– Calamine lotion
– Antihistamines
• Severe case (Adults, HIV+)
– Acyclovir 800 mg, 5 times x 7-10 days
– Famciclovir 250 mg TDS x 10 days
• Other:
– Topical antibacterial Ointment like Mupirocin to
prevent secondry bacterial infection
– Antipyretic

16. PREVNTION & CONTROL
• Control:
– Notification to the health authorities
– Isolation for 1 week
– Contact with susceptible patient is
avoided
– Disinfection of articles soiled by
nose an throat discharge
• Prevention:
– Live attenuated vaccine in
susceptible patients
– hyperimmunoglobulin

17. COMPLICATIONS
• In most cases, chicken pox a mild, self-limiting disease. The
mortality is less than 1 % in uncomplicated cases.
• Varicella Hemorrhage
• Pneumonia
• Encephalitis
• Acute cerebellar ataxia
• Reye’s syndrome
• Fetal death and Birth defects

18. HERPES ZOSTER (SHINGLES)
• Etiology
– Varicella zoster virus, after an attack of chicken
pox, virus lies dormant in secondary root ganglia.
– Zoster in manifestation of its reactivation
• Predisposing factor
– Old age
– Lymphoreticular malignancy
– HIV infection
– Sometimes without apparent cause
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19. • Clinical Features
– Prodrome of segmental pain
(usually excruciating !) begins 1-4
days before eruption
• Morphology
– Very painful, segmental eruption of
grouped papules & Vesicles on an
erythematous, slightly edematous
base.
– Self limiting
– Crust & heal in about 2 wks in
absence of immunocompromised
patients
• Site of Predilection
– Uni / multidermatomal.
– Thoracic intercostal nerves &
ophthalmic division of trigeminal
nerve
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20. • Treatment
– Symptomatic treatment with analgesics
– Specific treatment with antiviral (Acyclovir,
Famiciclovir & Valacyclovir)
• Severe zoster
• Ophthalmic zoster
• Immunocompromised patient
• Elderly (to reduced postherpetic neuralgia)
• Complication
– Postherpectic Neuralgia
– Facial palsy, secondary infection & generalization
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21. REFERENCE
• Dermatology and Sexually Transmitted Diseases- Neena
Khanna
• Dermatology in general medicine- Fitzpatrick’s
• Park’s textbook of Preventive and social Medicine- K. Park
• Medscape
• Internet

22. THANK
YOU
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