Read and translate text

Text B. Chickenpox

Chickenpox is a common viral illness characterized by acute onset of generalized vesicular rash and fever. It is a common illness among kids, particularly those under age 12. More than 90% of unvaccinated contacts become infected. The incubation period of chickenpox ranges from 9 to 21 days. Infectious period begins 2 days before onset of clinical symptoms and lasts until all lesions have crusted. Peak incidence is in the springtime. Most patients will have lifelong immunity following an attack of chickenpox; protection from chickenpox following varicella vaccine is approximately 6 yr. Symptoms usually go away without treatment, but as the infection is highly contagious, an infected child should stay home until the symptoms are gone.

An itchy rash of spots that look like blisters can appear all over the body and may be accompanied by flu-like symptoms: fever (37,7º–38,8º C), chills, backache, generalized malaise, headache, abdominal pain, sore throat. Symptoms are generally more severe in adults. Initial lesions generally occur on the trunk (centripetal distribution) and occasionally on the face; these lesions consist primarily of 3- to 4-mm red papules with an irregular outline and a clear vesicle on the surface (dew drops on a rose petal appearance). Intense pruritus generally accompanies this stage. New lesion development generally ceases by the fourth day with subsequent crusting by the sixth day. Lesions generally spread to the face and the extremities (centrifugal spread). Patients generally present with lesions at different stages at the same time. Crusts generally fall off within 5 to 14 days. Fever is usually highest during the eruption of the vesicles; temperature generally returns to normal following disappearance of vesicles. Signs of potential complications (e.g., bacterial skin infections, neurologic complications, pneumonia, hepatitis) may be present on physical examination. Mild constitutional symptoms (e.g., anorexia, myalgias, headaches, restlessness) may be present (most common in adults). Excoriations may be present if scratching is prominent.

Diagnosis is usually made based on patient's history and clinical presentation. Laboratory evaluation is generally not necessary. CBC may reveal leukopenia and thrombocytopenia. Serum varicella titers (significant rise in serum varicella IgG antibody level), skin biopsy, or Tzanck smear are used only when diagnosis is in question. Use antipruritic lotions for symptomatic relief, avoid scratching to prevent excoriations and superficial skin infections, use a mild soap for bathing; hands should be washed often, particularly before eating and after using a bathroom.

Use acetaminophen for fever and myalgias; aspirin should be avoided because of the increased risk of Reye's syndrome. Pruritus from chickenpox can be controlled with antihistamines (e.g., hydroxyzine 25 mg q6h) and oral antipruritic lotions (e.g., calamine). Oral antibiotics are not routinely indicated and should be used only in patients with secondary infection and infected lesions (most common infective organisms are Streptococcus sp. and Staphylococcus sp.).

Pregnant women should not be near a person with chickenpox. There is a risk for the fetus to have birth defects. But if she has had chickenpox before pregnancy, the baby will be protected from infection for the 1^st few months of life, since the mother’s immunity gets passed on to the baby through placenta and breast milk.

(Taken from Ferri's Clinical Advisor 2008, 10th ed)