Varicella ( chickenpox) in adults and children - Causes, Symptoms and Treatment .MF .
Varicella (chicken pox, varicella) - acute, vysokokozaraznaya anthroponotic (only men) viral infection transmitted by airborne droplets and by contact, accompanied by a rash and related vezikulёznoy intoxication.
Chickenpox is known since ancient times, but only the end of XVIII (1800) in her began to separate as a distinct disease, separate from smallpox, due to works of Vogel.1911 - H. Aragao described small inclusions in the content of the vesicles - elementary bodies, considering their agents.The very same virus isolated in 1940;1958 and 1972 - the proof of the identity of the pathogen in patients with chickenpox and shingles!
Varicella zoster virus, the model
causative agent of chicken pox
Varicella zoster virus (Varictlla-herpes zoster - is 3 type of herpes virus infection) - DNA virus whose capsid surrounded by a lipid envelope that it is possible anddetermines its location in the body for life.
Varicella zoster virus
Features virus chickenpox: rapidly spreading cell cultures (fo
maloustoychiv Varicella zoster virus in the environment, quickly dies at low and high temperatures, UV radiation, and disinfectants, at room temperature can be maintained up to several hours.
susceptibility to the virus chickenpox high (since he is a very volatile - overcomes distances up to 20 meters from floor to floor, ventilation), especially for those who have not previously been ill with chickenpox or have not been immunized.Infection with chickenpox occurs even with fleeting contact with the patient.Seasonal diseases autumn and winter, and epidemic outbreaks recorded every 5 years.Often sick chickenpox children 5-9 years old, children up to 6 months usually do not get sick because of the antibodies produced by the mother (if the mother is a child ill with chicken pox).Adults also suffer from rare.
after suffering an infection formed lifelong immunity, but in 3% of cases re-infection.It should also be mentioned that previously infected people are not only native, but also an exacerbation of sources of infection;their disease is in the form of herpes zoster (shingles).
Causes chickenpox infection
Source - sick chickenpox and herpes zoster.Patients are contagious one day before the catarrhal symptoms (ie before the prodromal period) and 5 days after the onset of rash.Ways of transmission - airborne (talking, coughing, crying loudly, screaming), contact-household (infected saliva or discharge vesicles) and contact (with the direct touch), transplacental (passage of the virus through the placenta).
Symptoms of chickenpox
incubation period of varicella (from the moment of introduction, before the first signs of chickenpox) 11-23 days.During this period, the penetration of the pathogen through the mucosa of the upper respiratory tract, then multiplication and accumulation of the virus in the epithelial cells of the mucous membranes.
after maximum accumulation of the pathogen of chickenpox it spreads through the lymph and blood vessels, causing the occurrence of the following periods - prodromal or rashes.
prodromal period of chickenpox - (this period may not be) there is only a small proportion of people and lasts for 1 day.Characterized Scarlatiniform rash, save the few hours of their disappearance, and further, the temperature rise to 37-38⁰S and intoxication.Often this period is a reaction to viremia.
period rash - varicella begins badly (or immediately after the prodromal period) and lasts for 3-4 days and Bole.In most cases, the boundary between time and is not at all.As well as the prodromal period, a response to viremia and is characterized by the following symptoms:
• an increase in regional lymph nodes (may not be),
• fever 37-39 ° C is maintained throughout the period of the rash and each new impetus to the rash is accompanied bytemperature rise,
• chickenpox rash appears on the 1 day of intoxication, with podsypaniyami 5 days - some already are, while others are just emerging.Therefore, the impression of a false polimrfizma (a variety of rashes in the same patient: the bubbles and stains, and brown at the same time).Favourite localization and phasing, like measles, is not (a rash may even be on the scalp - an important differential diagnostic sign, as in the mouth, genital mutilation of girls, conjunctiva / cornea, larynx, with subsequent ulceration and healing within 5days).Already 1 day red spot turns into a bubble, and a few days later a rash appears on the body surface as a "dew" with transparent content, which becomes turbid after 1-2 days, and more in 1-2 days vial dries up and turns into a crust, disappearsafter 1-3 weeks.
sick chickenpox ceases to be contagious, once stopped podsypaniya and formed a crust.The rash is accompanied by itching of varying intensity.With good antiseptic treatment of rashes, they do not leave behind a scar, but ignoring these rules of hygiene there is a secondary infection with bacteria from the surface of kozhis subsequent defeat germentativnogo layer and the formation of scars / scars, as in smallpox, but not as rough.
rash of chickenpox (varicella)
• recovery period lasts for 3 weeks from the end of the eruption, and is characterized by falling away crusts and the formation of life-long immunity.After falling away crusts are dark spots, but they are held in a few weeks.Scarring is not, if there was no secondary infection.
This classic pattern is typical for varicella in children with normal immunity.
There are some contingents of people for whom chickenpox occurs most difficult and high-risk of complications, malignant variants of the course.For this group of risk include: pregnant women not immunized (hazard to the fetus with possible disability), children in the first months of life of unvaccinated mothers, immunized adults (not grafted and not bolevshie).In these cases develop severe forms of chickenpox: hemorrhagic, gangrenous, bullosa (see complications.) .
The course of chickenpox among different age groups of children and adults
Chickenpox in pregnant
Intrauterine infection (perhaps those pregnant women who are not immunized - or is not ill or had not been vaccinated):
- infection at 4 months pregnant -pathology of the skin, bones - hypoplasia of limbs, central nervous system, organ of vision, urinary tract, bowel, intrauterine growth retardation, retarded psychomotor domain.And after the birth mortality rate is 25%.
- 6 month - embriofetopaty like at 4 month, does not occur, and only after the birth of the symptoms of herpes zoster.
- chickenpox infection from the beginning 9 months prenatal visit and during the first 12 days of life, leading to a heavy flow, accompanied by a lesion of the internal organs (lungs, heart, kidneys, intestines) with a further addition of a hemorrhagic syndrome.In this case, mortality reaches 50%
- If there reinfetsirovanie (ie re-infection have once already aching or graft women), a few days before giving birth (as shown above), then the baby will develop symptoms immediately after birth andchickenpox is easy to pass, because the antibodies from the mother will be transferred to the child still in utero, the placenta.
chickenpox infection of infants (first 3 months of life)
Logged rarely, because maternal antibodies still indulge in child through the placenta in utero, but if this does not occur, the following symptoms are observed:
• elongated prodromal period to 4 dayswith moderate / severe symptoms of intoxication;
• against high temperatures can join cerebral symptoms (visible pulsation fontanel will talk about the increased intracranial pressure, convulsive readiness and dr.proyavleniya);
• rash abundant and flows slowly phasing (ie, staining, then bubbles after scabs and pigmentation) and the period of eruption becomes protracted - to 9 days instead of 5;
• often bacterial complications.
features of varicella in adults
• A more pronounced symptoms of intoxication;
• The rash does not appear in the first day, and 2-3.Stages and himself during the rash becomes protracted.
• part of a secondary bacterial infection, the development of pneumonia and other complications.
• Itching expressed much stronger.
Adults varicella complications are more common (see below.)
1. Virological method - abjection of chickenpox vesicles and exfoliated skin lesions.But it takes time and is only used in cases of dispute.
2. Rapid method - IFA (immunofluorescence reaction), with the help of his conduct the detection of viral antibodies.
3. The serum - ELISA (enzyme-linked immunosorbent assay) - is aimed at the detection of specific IgM antibodies to the virus and G varicella;M appear still in the incubation period (c / o 4-7 days after infection) and lasts for 2 months, their presence speaks of the acute period;G -poyavlyayutsya 2-3 week and persist for life, they testify to the immunization, ie for protection.
4. Genetic method - the use of PCR (polymerase chain reaction) is aimed at the detection of virus DNA.
5. General clinical tests: OAK (↓ A ^, ↑ Lf, normal ESR).Immunological examination: ↓ T-lymphocytes, in violation of the cell unit, ↑ activity of NF and macrophages, ↑ CEC (circulating immune complexes).
actually listed methods of diagnosis used by physicians do not often, the diagnosis is often based on complaints and inspection, in which the estimated character rash that generally is not right, and tests prescribed in the case of complications.
Treatment of varicella
often by force of habit doctor having diagnosed chickenpox, does not appoint any treatment other than fever-reducing drugs and lubrication zelenkoj rash - at the stage of development of modern medicine, it is not entirely correct.So we can restrict drug kit only if chickenpox is mild, rashes little child eats well and feels well.In other cases, in children and in the treatment of varicella in adults etiotropic treatment aimed at the destruction of the virus, a must!Remember that varicella zoster virus after the disease remains in the body for life and can subsequently prove himself herpes zoster, therefore, the more effective the treatment will etiotropic, roughly speaking, the more the virus will die, the less likely to get health problems in the future.
1. Etiotropic treatment of varicella
- virucidal agents directed specifically against the herpes virus:
• Acyclovir Zovirax = = viroleks (2 years);
• valtsiklovir (from 12 years), famciclovir
• (to 17 years), izoprinozin;Also, use Acyclovir Ointment on rashes and conjunctivitis (eye disease).
- Immunomodulators: interferon viferon
- Immunostimulants: tsikloferon, anaferon
- Antibiotics are used for secondary bacterial complications, and the drug of choice are 3-generation cephalosporins.
In severe cases of chickenpox used intravenous immunoglobulins.All of the above drugs used in the age dosages. If ill child the first year of treatment only under the supervision of a physician with a possible hospitalization, because for infectious processes in young children occurs with a tendency to generalize, frequent and severe complications and high mortality !
2. pathogenetic treatment of varicella
- Bed rest 3-5 days (in complicated longer)
- Careful maintenance of the skin and mucous membranes:
• hygienic bath / shower, then do not rub the skin, and lightlypromaknut towel,
• zelyonkoj rash treatment to prevent secondary infection,
• processing of the mouth - rinse furacillin and / or sodium sulfatsilom or sodium gidrokorbanatom;
• conjunctivitis can be used acyclovir ointment to prevent bacterial complications - sulfacetamide 20% levomitsitinovaya ointment or tetracycline.
- rich alkaline drinking
- When heavy currents - immunomodulators stronger (timolin, timogen, IRS-19) and cytokine preparations (ronkeylikin)
- Multivitamins, probiotics (bifidum-laktobakterin, Linex), chelators (smectite), drugs for metabolic therapy indications (Riboxinum, kokarboksilaza), mucolytics / expectorants (ambroxol, bromhexine, a decoction of thyme, chest collection №1) and anti-inflammatory sprays when dry cough (Erespal), antiplatelet agents (aktovegil, cavinton etc.), antihistamines (in severe itching used topically - fenistil gistan or gel, or other antihistamine ointment; and the inside is used antihistamines suprastin, tavegil, etc.);antipyretics (ibuprofen, Nurofen, or physical cooling methods - wrap).
3. Symptomatic treatment is appointed from the ranks of groups of pathogenic agents or more serious complications - cardiac glycosides.
Treatment lasts an average of 2 weeks (including pharmacotherapy).
rehabilitation after chickenpox
• a month after recovery doctor examines been ill, on his appointment to immunological examination and transmission specialists,
• protective regime within 2 weeks after recovery (exemption from physical exertion),
• removal of preventivevaccinations at 2 months,
• appointment within a month: a multivitamin and / or vitamin-mineral complexes, metabolic therapy and herbal adaptogens.
Complications of chickenpox
Complications of chickenpox often associated with the addition of bacterial flora, besides it promotes immunosuppressive function of varicella-zoster virus, as a result of evolving: gingivitis, stomatitis, purulent mumps, conjunctivitis, keratitis, otitis, sepsis, pneumonia, glomerulonephritis,encephalitis, myelitis, nephritis, myocarditis, keratitis, Reye's syndrome, arthritis, laryngitis.
But the most threatening complication is hemorrhagic form flow varicella , in which the vesicles are filled with hemorrhagic content (blood) = "bloody dew", multiple hemorrhages in the skin / mucous / nosebleeds / hemoptysis / digestive tract and other organs.
gangrenosum form characterized by the appearance of large flaccid blisters, necrosis area, scab.After the defection of bubbles formed ulcers, which rapidly infected, causing often develop septicemia and death occur in the near future.But severe complications develop on the background of immunodeficiencies, reception of glucocorticosteroids (GCS) or hormones.
Reye's syndrome can also result in death.The syndrome is based on fatty liver with the development of hypoglycemia, a significant increase in levels of transaminases, coagulopathy, an increase in the ammonia content and the level of fatty acids, the formation of toxic metabolites that cause direct damage to neurons, demyelination, cerebral edema.Symptoms of the syndrome - nausea, vomiting, delirium, seizures, coma, with the development.Because of the risk of Reye's syndrome should not be given aspirin to children under 11 years in all viral infections, including chickenpox, in which the risk of this complication so elevated.Reye's syndrome is found only at the age of 15 years.
If any symptoms of atypical varicella flow immediately call a doctor.
therapists Shabanova IE