chickenpox (redirected from Combusken pox)

Chickenpox 

Definition

Chickenpox (also called varicella) is a common and extremely infectious childhood disease that also affects adults on occasion. It produces an itchy, blistery rash that typically lasts about a week and is sometimes accompanied by a fever or other symptoms. A single attack of chickenpox almost always brings lifelong immunity against the disease. Because the symptoms of chickenpox are easily recognized and in most cases merely unpleasant rather than dangerous, treatment can almost always be carried out at home. Severe complications can develop, however, and professional medical attention is essential in some circumstances.

Description

Before the varicella vaccine (Varivax) was released for use in 1995, nearly all of the four million children born each year in the United States contracted chickenpox, resulting in hospitalization in five of every 1,000 cases and 100 deaths. Chickenpox is caused by the varicella-zoster virus (a member of the herpes virus family), which is spread through the air or by direct contact with an infected person. Once someone has been infected with the virus, an incubation period of about 10-21 days passes before symptoms begin. The period during which infected people are able to spread the disease is believed to start one or two days before the rash breaks out and to continue until all the blisters have formed scabs, which usually happens four to 7 days after the rash breaks out but may be longer in adolescents and adults. For this reason, doctors recommend keeping children with chickenpox away from school for about a week. It is not necessary, however, to wait until all the scabs have fallen off.

Chickenpox has been a typical part of growing up for most children in the industrialized world (although this may change if the new varicella vaccine becomes more widely accepted). The disease can strike at any age, but by ages nine or 10 about 80-90% of American children have already been infected. U.S. children living in rural areas and many foreign-born children are less likely to be immune. Because almost every case of chickenpox, no matter how mild, leads to lifelong protection against further attacks, adults account for less than 5% of all cases in the United States. Study results reported by the Centers for Disease Control and Prevention (CDC) indicate that more than 90% of American adults are immune to the chickenpox virus. Adults, however, are much more likely than children to suffer dangerous complications. More than half of all chickenpox deaths occur among adults.

Causes and symptoms

A case of chickenpox usually starts without warning or with only a mild fever and a slight feeling of unwellness. Within a few hours or days small red spots begin to appear on the scalp, neck, or upper half of the trunk. After a further 12-24 hours the spots typically become itchy, fluid-filled bumps called vesicles, which continue to appear in crops for the next two to five days. In any area of skin, lesions of a variety of stages can be seen. These blisters can spread to cover much of the skin, and in some cases also may be found inside the mouth, nose, ears, vagina, or rectum. Some people develop only a few blisters, but in most cases the number reaches 250-500. The blisters soon begin to form scabs and fall off. Scarring usually does not occur unless the blisters have been scratched and become infected. Occasionally a minor and temporary darkening of the skin (called hyperpigmentation) is noticed around some of the blisters. The degree of itchiness can range from barely noticeable to extreme. Some chickenpox sufferers also have headaches, abdominal pain, or a fever. Full recovery usually takes five to 10 days after the first symptoms appear. Again, the most severe cases of the disease tend to be found among older children and adults.

Although for most people chickenpox is no more than a matter of a few days' discomfort, some groups are at risk for developing complications, the most common of which are bacterial infections of the blisters, pneumonia, dehydration, encephalitis, and hepatitis:

• Infants. Complications occur much more often among children less than one year old than among older children. The threat is greatest to newborns, who are more at risk of death from chickenpox than any other group. Under certain circumstances, children born to mothers who contract chickenpox just prior to delivery face an increased possibility of dangerous consequences, including brain damage and death. If the infection occurs during early pregnancy, there is a small (less than 5%) risk of congenital abnormalities.
• Immunocompromised children. Children whose immune systems have been weakened by a genetic disorder, disease, or medical treatment usually experience the most severe symptoms of any group. They have the second-highest rate of death from chickenpox.
• Adults and children 15 and older. Among this group, the typical symptoms of chickenpox tend to strike with greater force, and the risk of complications is much higher than among young children.

Immediate medical help should always be sought when anyone in these high-risk groups contracts the disease.

Diagnosis

Where children are concerned, especially those with recent exposure to the disease, diagnosis can usually be made at home, by a school nurse, or by a doctor over the telephone if the child's parent or caregiver is unsure that the disease is chickenpox.

A doctor should be called immediately if:

• The child's fever goes above 102 °F (38.9 °C) or takes more than four days to disappear.
• The child's blisters appear infected. Signs of infection include leakage of pus from the blisters or excessive redness, warmth, tenderness, or swelling around the blisters.
• The child seems nervous, confused, unresponsive, or unusually sleepy; complains of a stiff neck or severe headache; shows signs of poor balance or has trouble walking; finds bright lights hard to look at; is having breathing problems or is coughing a lot; is complaining of chest pain; is vomiting repeatedly; or is having convulsions. These may be signs of Reye's syndrome or encephalitis, two rare but potentially dangerous conditions.

Treatment

With children, treatment usually takes place in the home and focuses on reducing discomfort and fever. Because chickenpox is a viral disease, antibiotics are ineffective against it.

Applying wet compresses or bathing the child in cool or lukewarm water once a day can help the itch. Adding four to eight ounces of baking soda or one or two cups of oatmeal to the bath is a good idea (oatmeal bath packets are sold by pharmacies). Only mild soap should be used in the bath. Patting, not rubbing, is recommended for drying the child off, to prevent irritating the blisters. Calamine lotion (and some other kinds of lotions) also help to reduce itchiness. Because scratching can cause blisters to become infected and lead to scarring, the child's nails should be cut short. Of course, older children need to be warned not to scratch. For babies, light mittens or socks on the hands can help guard against scratching.

If mouth blisters make eating or drinking an unpleasant experience, cold drinks and soft, bland foods can ease the child's discomfort. Painful genital blisters can be treated with an anesthetic cream recommended by a doctor or pharmacist. Antibiotics often are prescribed if blisters become infected.

Fever and discomfort can be reduced by acetaminophen or another medication that does not contain aspirin. Aspirin and any medications that contain aspirin or other salicylates must not be used with chickenpox, for they appear to increase the chances of developing Reye's syndrome. The best idea is to consult a doctor or pharmacist if unsure about which medications are safe.

Immunocompromised chickenpox sufferers are sometimes given an antiviral drug called acyclovir (Zovirax). Studies have shown that Zovirax also lessens the symptoms of otherwise healthy children and adults who contract chickenpox, but the suggestion that it should be used to treat the disease among the general population, especially in children, is controversial.

Alternative treatment

Alternative practitioners seek to lessen the discomfort and fever caused by chickenpox. Like other practitioners, they suggest cool or lukewarm baths. Rolled oats (Avena sativa) in the bath water help relieve itching. (Oats should be placed in a sock, that is turned in the bath water to release the milky antiitch properties.) Other recommended remedies for itching include applying aloe vera, witch hazel, or herbal preparations of rosemary (Rosmarinus officinalis) and calendula (Calendual officinalis) to the blisters. Homeopathic remedies are selected on a case by case basis. Some common remedy choices are tartar emetic (antimonium tartaricum), windflower (pulsatilla), poison ivy (Rhus toxicodendron), and sulphur.

Prognosis

Most cases of chickenpox run their course within a week without causing lasting harm. However, there is one long-term consequence of chickenpox that strikes about 20% of the population, particularly people 50 and older. Like all herpes viruses, the varicellazoster virus never leaves the body after an episode of chickenpox, but lies dormant in the nerve cells, where it may be reactivated years later by disease or age-related weakening of the immune system. The result is shingles (also called herpes zoster), a painful nerve inflammation, accompanied by a rash, that usually affects the trunk or the face for 10 days or more. Especially in the elderly, pain, called postherpetic neuralgia, may persist at the site of the shingles for months or years. Two relatively newer drugs for treatment of shingles have become available. Both valacy-clovir (Valtrex) and famciclovir (Famvir) stop the replication of herpes zoster when administered within 72 hours of appearance of the rash. The effectiveness of these two drugs in immunocompromised patients has not been established, and Famvir was not recommended for patients under 18 years.

Prevention

A substance known as varicella-zoster immune globulin (VZIG), which reduces the severity of chickenpox symptoms, is available to treat immunocompromised children and others at high risk of developing complications. It is administered by injection within 96 hours of known or suspected exposure to the disease and is not useful after that. VZIG is produced as a gamma globulin from blood of recently infected individuals.

Key terms

Acetaminophen — A drug for relieving pain and fever. Tylenol is the most common example.

Acyclovir — An antiviral drug used for combating chickenpox and other herpes viruses. Sold under the name Zovirax.

Dehydration — Excessive water loss by the body.

Encephalitis — A disease that inflames the brain.

Hepatitis — A disease that inflames the liver.

Immune system — A biochemical complex that protects the body against pathogenic organisms and other foreign bodies.

Immunocompromised — Having a damaged immune system.

Pneumonia — A disease that inflames the lungs.

Pus — A thick yellowish or greenish fluid containing inflammatory cells. Usually caused by bacterial infection.

Reye's syndrome — A rare but often fatal disease that involves the brain, liver, and kidneys.

Salicylates — Substances containing salicylic acid, which are used for relieving pain and fever. Aspirin is the most common example.

Shingles — A disease (also called herpes zoster) that causes a rash and a very painful nerve inflammation. An attack of chickenpox will eventually give rise to shingles in about 20% of the population.

Trunk — That part of the body that does not include the head, arms, and legs.

Varicella-zoster immune globulin (VZIG) — A substance that can reduce the severity of chickenpox symptoms.

Varicella-zoster virus — The virus that causes chickenpox and shingles.

Varivax — A vaccine for the prevention of chickenpox.

Virus — A tiny particle that can cause infections by duplicating itself inside a cell using the cell's own software. Antibiotics are ineffective against viruses, though antiviral drugs exist for some viruses, including chickenpox.

A vaccine for chickenpox became available in the United States in 1995 under the name Varivax. Varivax is a live, attenuated (weakened) virus vaccine. It has been proven to be 85% effective for preventing all cases of chickenpox and close to 100% effective in preventing severe cases. Side effects are normally limited to occasional soreness or redness at the injection site. CDC guidelines state that the vaccine should be given to all children (with the exception of certain high-risk groups) at 12-18 months of age, preferably when they receive their measles-mumps-rubella vaccine. For older children, up to age 12, the CDC recommends vaccination when a reliable determination that the child in question has already had chickenpox cannot be made. Vaccination also is recommended for any older child or adult considered susceptible to the disease, particularly those, such as health care workers and women of childbearing age, who face a greater likelihood of severe illness or transmitting infection. A single dose of the vaccine was once thought sufficient for children up to age 12; older children and adults received a second dose four to eight weeks later. However, an outbreak at a daycare center in 2000 brought concern in the medical community about a second vaccination for younger children, since many of the affected children had been vaccinated. Researchers began recommending a second vaccination in 2002. In 1997 the cost of two adult doses of the vaccine in the United States was about $80. Although this cost was not always covered by health insurance plans, children up to age 18 without access to the appropriate coverage could be vaccinated free of charge through the federal Vaccines for Children program. Varivax is not given to patients who already have overt signs of the disease. It was once thought unsafe for children with chronic kidney disease, but a 2003 report said the vaccination was safe in these children. The finding is important, since even chickenpox can be a serious complication in children who must undergo a kidney transplant.

The vaccine also is not recommended for pregnant women, and women should delay pregnancy for three months following a complete vaccination. The vaccine is useful when given early after exposure to chickenpox and, if given in the midst of the incubation period, it can be preventative. The Infectious Diseases Society of America stated in 2000 that immunization is recommended for all adults who have never had chickenpox.

While there was initial concern regarding the vaccine's safety and effectiveness when first released, the vaccination is gaining acceptance as numerous states require it for admittance into daycare or public school. In 2000, 59% of toddlers in the United States were immunized; up from 43.2% in 1998. A study published in 2001 indicates that the varicella vaccine is highly effective when used in clinical practice. Although evidence has not ruled out a booster shot later in life, all research addressing the vaccine's effectiveness throughout its six-year use indicates that chickenpox may be the first human herpes virus to be wiped out. Although initial concerns questioned if the vaccination might make shingles more likely, studies are beginning to show the effectiveness of the vaccine in reducing cases of that disease.

Resources

Periodicals

Arvin, Ann M. "Varicella Vaccine-The First Six Years." New England Journal of Medicine March 2001.

"Chickenpox Vaccine OK for Pediatric Patients." Vaccine Weekly January 22, 2003: 25.

Henderson, C. W. "Chickenpox Immunization Confirmed Effective in Adults." Vaccine Weekly September 2000: 22.

"Study: Two Vaccines Work Best." Vaccine Weekly January 8, 2003: 14.

Organizations

Centers for Disease Control and Prevention. National Immunization Hotline. 1600 Clifton Rd. NE, Atlanta, GA 30333. (800) 232-2522 (English). (800) 232-0233 (Spanish). http://www.cdc.gov.

Other

ABCNEWS.com. "Varicella Vaccine: States Mandate Chickenpox Immunization." August 1, 2000. [cited May 3, 2001]. 〈http://abcnews.go.com/sections/living/DailyNews/chickenpox_vaccine0802.html〉.

Centers for Disease Control and Prevention. "Prevention of Varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP)." July 12, 1996. [cited December 12, 1997]. http://aepo-xdv-www.epo.cdc.gov/wonder/prevguid/m0042990/entire.htm.

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chickenpox /chick·en·pox/ (chik´en-poks) varicella; a highly contagious disease caused by human herpesvirus 3, characterized by vesicular eruptions appearing over a period of a few days to a week after an incubation period of 17–21 days; usually benign in children, but in infants and adults may be accompanied by severe symptoms.

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chick·en·pox or chicken pox (chkn-pks)

n.

An acute contagious disease, primarily of children, that is caused by the varicella-zoster virus and characterized by skin eruptions, slight fever, and malaise. Also called varicella.

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chickenpox

[chik′ənpoks′]

Etymology: AS, cicen + ME, pokke

an acute, highly contagious viral disease caused by a herpesvirus, varicella zoster virus. It occurs primarily in young children and is characterized by crops of pruritic vesicular eruptions on the skin. The disease is transmitted by direct contact with skin lesions or, more commonly, by droplets spread from the respiratory tract of infected persons, usually in the prodromal period or the early stages of the rash. The vesicular fluid and the scabs are infectious until entirely dry. Indirect transmission through uninfected persons or objects is rare. The diagnosis is usually made by physical examination and by the characteristic appearance of the disease. The virus may be identified by culture of the vesicle fluid. Also called varicella.

observations The incubation period averages 2 to 3 weeks, followed by slight fever, mild headache, malaise, and anorexia occurring about 24 to 36 hours before the rash begins. The prodromal period is usually mild in children but may be severe in adults. The rash, which is highly pruritic, begins as macules and progresses in 1 or 2 days to papules and, finally, to vesicles surrounding an erythematous base and containing clear fluid. Within 24 to 48 hours the vesicles turn cloudy and become umbilicated, are easily broken, and become encrusted. The lesions, which erupt in crops so that all three stages are present simultaneously, first appear on the back and chest and then spread to the face, neck, and limbs; they occur only rarely on the soles and palms. In severe cases, laryngeal or tracheal vesicles in the pharynx, larynx, and trachea may cause dyspnea and dysphagia. Prolonged fever, lymphadenopathy, and extreme irritability from pruritus are other symptoms. The symptoms last from a few days to 2 weeks.

interventions Routine treatment consists of bed rest; medications to reduce fever; applications of topical antipruritics, such as wet compresses, calamine lotion, or a paste made from baking soda and water; or oral antihistamines, given for the relief of itching. Infected vesicles may be treated with neomycin-bacitracin, and systemic antibiotics may be given if the secondary bacterial infection is extensive. People who are susceptible and at risk for severe disease when exposed to the infection may be passively protected with zoster immune globulin, varicella-zoster immune globulin, immune serum globulin, or zoster immune plasma. A vaccine for active immunization is available for individuals 12 months of age and older. Babies born to women in whom chickenpox develops within 5 days of delivery are especially likely to have a severe case of the disease. One attack of the disease usually confers permanent immunity, although recurring episodes of herpes zoster occur, especially in elderly or debilitated people, resulting from reactivation of the virus. Herpes zoster virus, like all herpesviruses, lies dormant in certain sensory nerve roots after primary infection.

nursing considerations Chickenpox in childhood is usually benign. Few cases require hospitalization. It may be serious or fatal in immunocompromised people, such as those infected with human immunodeficiency virus, those receiving chemotherapy or radiotherapy for malignant disease, those who have undergone organ transplantation, those with congenital or acquired defects in cell-mediated immunity, or those receiving high doses of steroids. Common complications are secondary bacterial infections, such as abscesses, cellulitis, pneumonia, and sepsis, and hemorrhagic varicella (tiny hemorrhages that may occur in the vesicles or surrounding skin). Less common complications are encephalitis, Reye's syndrome (associated with the use of aspirin), thrombocytopenia, and hepatitis.

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chickenpox,

n contagious childhood illness caused by the varicella zoster virus. Symptoms include infectious skin lesions that form crusts before receding, headache, and slight fever. Generally mild in children but may be severe in adults.

Chickenpox.

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chickenpox,

n See varicella.

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chickenpox

Varicella, human herpesvirus type 3 Acute HHV-3 infection, most common before age 10; 3.5 million cases & 50 children die/yr of chickenpox–US; 9000 are hospitalized Clinical 2-wk incubation, then a scarlatiform prodromal rash, low-grade fever, weakness, sore throat, cough, anorexia, malaise, crops of reddish papules that become intensely pruritic vesicles, which ↑ in number for 3-4 days; itching and excoriation may cause extensive (permanent) scarring Complications Otitis, pneumonia, 2º bacterial rashes and infections, encephalitis–5-15% mortality, 15% with permanent neurologic sequelae, ataxia, palsies, Reye syndrome, a potentially fatal complication, viral pneumonia–1:400 require hospitalization, thrombocytopenia, purpura fulminans, myocarditis, glomerulonephritis, hepatitis, myositis; after resolution of clinical disease, HHV-3 becomes latent, integrating its DNA into the dorsal root ganglion cells Management Acyclovir may shorten duration of disease. See Chickenpox vaccine, Shingles.

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Patient discussion about Combusken pox.

Q. Is chicken pox dangerous to my fetus? I am pregnant and have never had chicken pox before. My daughter is 2 years old and has not had chicken pox before and hasn't been vaccinated against it either. If she does catch chicken pox can this be dangerous to me or the fetus?

A. If a pregnant woman who hasn't had chickenpox in the past contracts it (especially in the first 20 weeks of pregnancy), the fetus is at risk for birth defects and she is at risk for more health complications than if she'd been infected when she wasn't pregnant. If she develops chickenpox just before or after the child is born, the newborn is at risk for serious health complications. Therefore, it is advised that you vaccinate your daughter against chicken pox so she will not catch it and then could not pass it on to you.

Q. How contagious is chicken pox? I just found out that a kid in my son's preschool has chicken pox. What are the chances my son got it too? He hasn't been vaccinated against it. He is 3 years old.

A. Chickenpox is very contagious — so there is a big chance your son caught it too. Most kids with a sibling who's been infected will get it as well, showing symptoms about 2 weeks after the first child does. Chickenpox causes a red, itchy rash on the skin that usually appears first on the abdomen or back and face, and then spreads to almost everywhere else on the body, including the scalp, mouth, nose, ears, and genitals.
Some kids have a fever, abdominal pain, sore throat, headache, or a vague sick feeling a day or 2 before the rash appears. These symptoms may last for a few days, and fever stays in the range of 100°–102° Fahrenheit (37.7°–38.8° Celsius), though in rare cases may be higher.