Chickenpox

Chickenpox

Definition:

Chickenpox (varicella) was once considered a rite of passage for most children. Before routine chickenpox vaccination, virtually everyone had been infected by the time they reached adulthood, sometimes with serious complications. Today, the number of cases and hospitalizations is down dramatically.

However, when chickenpox does occur, it's highly contagious among people who aren't immune. Most people think of chickenpox as a mild disease — and, for most, it is. Unfortunately, there's no way to know who will develop a severe case.
The chickenpox vaccine is a safe, effective way to prevent chickenpox and its possible complications.

Symptoms:

The signs and symptoms of chickenpox are:

• A red, itchy rash, initially resembling insect bites, on your face, scalp, chest and back
• Small, liquid-filled blisters that break open and crust over
• Fever
• Abdominal pain or loss of appetite
• Mild headache
• General feeling of unease and discomfort (malaise) or irritability
• A dry cough
• Headache

The chickenpox rash goes through these three phases:

• Raised pink or red bumps (papules), which break out in different spots over several days
• Fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking
• Crusts and scabs, which cover the broken blisters and take several more days to heal

New bumps continue to appear for several days. As a result, you may have all three stages of the rash — bumps, blisters, and scabbed lesions — at the same time on the second day of the rash. Once infected, you can spread the virus for up to 48 hours before the rash appears, and you remain contagious until all spots crust over.

The disease is generally mild in healthy children. In severe cases, the rash can spread to cover the entire body, and lesions may form in the throat, eyes and mucous membranes of the urethra, anus and vagina. New spots continue to appear for several days.

When to see a doctor
If you suspect that you or your child has chickenpox, consult your doctor. He or she usually can easily diagnose chickenpox by examining the rash and by noting the presence of accompanying symptoms. Your doctor can also prescribe medications to lessen the severity of chickenpox and treat complications, if necessary. Be sure to call ahead for an appointment, to avoid waiting and possibly infecting others in a crowded waiting room.
Also, be sure to let your doctor know if any of these complications occur:

• The rash spreads to one or both eyes.
• The rash gets very red, warm or tender, indicating a possible secondary bacterial skin infection.
• The rash is accompanied by dizziness, disorientation, rapid heartbeat, shortness of breath, tremors, loss of muscle coordination, worsening cough, vomiting, stiff neck or a fever higher than 103 F (39.4 C).
• Anyone in the household is immune deficient or younger than 6 months old.

Complications:

Chickenpox is normally a mild disease. But it can be serious and can lead to complications, especially in these high-risk groups:

• Newborns and infants whose mothers never had chickenpox or the vaccine
• Adults
• Pregnant women
• People whose immune systems are impaired by medication, such as chemotherapy, or another disease
• People who are taking steroid medications for another disease or condition, such as children with asthma
• People with the skin condition eczema

A common complication of chickenpox is a bacterial infection of the skin. Chickenpox may also lead to pneumonia or, rarely, an inflammation of the brain (encephalitis), both of which can be very serious.

Chickenpox and shingles
Anyone who had chickenpox is at risk of a latent illness called shingles. After a chickenpox infection, some of the varicella-zoster virus may remain in your nerve cells. Many years later, the virus can reactivate and resurface as shingles — a painful band of short-lived blisters. The virus is more likely to reappear in older adults and people with weakened immune systems.

Shingles can lead to its own complication — a condition in which the pain of shingles persists long after the blisters disappear. This complication, called postherpetic neuralgia, can be severe.
A shingles vaccine is available and is recommended for adults age 60 and older who have had chickenpox in the past.

Chickenpox and pregnancy
Other complications of chickenpox affect pregnant women. Chickenpox early in pregnancy can result in a variety of problems in a newborn, including low birth weight and birth defects, such as limb abnormalities. A greater threat to a baby occurs when the mother develops chickenpox in the week before birth. Then it can cause a serious, life-threatening infection in a newborn.
If you're pregnant and not immune to chickenpox, talk to your doctor about the risks to you and your unborn child.

Treatments and drugs:

In otherwise healthy children, chickenpox typically requires no medical treatment. Your doctor may prescribe an antihistamine to relieve itching. But for the most part, the disease is allowed to run its course.

For people who have a high risk of complications from chickenpox, doctors sometimes prescribe medications to shorten the duration of the infection and to help reduce the risk of complications.
If you or your child falls into a high-risk group, your doctor may suggest an antiviral drug such as acyclovir (Zovirax) or another drug called immune globulin intravenous (IGIV). These medications may lessen the severity of the disease when given within 24 hours after the rash first appears. Other antiviral drugs, such as valacyclovir (Valtrex) and famciclovir (Famvir), also may lessen the severity of the disease, but have been approved for use only in adults. In some cases, your doctor may recommend getting the chickenpox vaccine after exposure to the virus. This can prevent the disease or lessen its severity.

If complications do develop, your doctor will determine the appropriate treatment. Treatment for skin infections and pneumonia may be with antibiotics. Treatment for encephalitis is usually with antiviral drugs. Hospitalization may be necessary.
Don't give anyone with chickenpox — child or adult — any medicine containing aspirin because this combination has been associated with a condition called Reye's syndrome.