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50 Cards in this Set
- Front
- Back
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etiology ?? |
varicella zoster virus |
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varicella zoster virus
what ?? |
doubl-stranded DNA virus |
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forms/types of varicella zoster infections |
1-primary
2-laten infection
3-secondary / reactivation
4-congenital |
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primary varicella infection ??? |
chickenpox |
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secondary varicella / reactivation |
shingle / Herpes zoster |
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transmission methods ?? |
1-respiratory droplets
2-lesions / vesicles fluid |
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transmissions via vesicles fluid ?? |
high viral load
less transmission rate than resp. droplets |
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incupation period ?? |
10 - 21 day |
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age of infection ??? |
most infection 90 % at age less than < 10 yrs |
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prognosis ?? |
depends on : ___________________________ 1-age
2-immunity |
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bad prognosis ?? |
old age ( any > 12 yo)
immunocopromized |
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main method of Dx ? |
clinical : vesicular rash with different stages of maturation
in crops |
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definitive method of Dx ?? |
vesicular fluid culture |
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pathophysiology of 1ry infection |
1-replication at URT mucosa / Lymph N ((prodrom))
2-1ry viremia
3-2nd replication at liver / spleen
4- 2ry viremia
5-viral invasion of epidermis |
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proliferation at URT mucosa and regional LN
timing ?? |
1st (( 2-4 )) days |
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1ry viremia
timing ?? |
4-6 days |
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2ry proliferation at liver and spleen
timing |
6-14 day |
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2ry viremia timing ?? |
14-16 day |
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viral invasion of skin ??
vesicle pathophysiology |
virus will invades the endothelium of capillaries and epidermis
it will cause intra and inter cellular edema .....vesicles formation |
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clinical stages of disease
((history / symptomes )) |
1-prodrome
2-rash onset |
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the prodrome ?? |
not common in children
in adolescent / adults is common : _________________________________ 1-nause 2-maylgia 3-anorexia 4-headache
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stage of disease onset / rash
manifistation ?? |
1-itchy rash
2-malaise
3-fever |
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fever in chickenpox charachteristic ??? |
low-grade |
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infective period ?? |
1-2 days before the rash
4-5 days after onset // at time of crustation |
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rash
area of involvement ?? starts at ??
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at trunk / face |
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rash
palms / soles ??
mucousa / oral ?? |
yes it does involve palms/soles / oral mucosa |
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latent infection ?? |
after crustation of vesicles ..... virus will spread to local sensory nerves
and remain dormant at dorsal sensory ganglia till reactivation.......shingles |
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chickenpox rash stages ?? |
-red macules
-papules
-clear vesicle
-pustules
-central umbilication
-crustation |
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chickenpox at oropharynx presentation ?? |
shallow painful ulcer |
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most common complication of varicella |
2ry bacterial infection |
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possible complications of chickenpox |
1-secondary infection
2-disseminated varicella ( varicella pneumonia)))
3-CNS
4-heamorrhagic complications
5-congenital varicella |
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forms of varicella 2ry bacterial infections ?? organisms ?? |
1- staph & strep
2-impetigo / cellulitis / erysipelase
3-may result in scarring / sepsis |
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disseminated varicella
manifestation |
- varicella pneumonia
- myocarditis
-gangrene
-hepatitis
-Glomerularnephritis |
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CNS complications of varicella ??? |
-Ray syndrome
-Gullien- barie syndrome
-acute cerebellar ataxia
-encephalitis |
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what are the heamorrhagic complications of varicella ?? |
-rare
-unkown etilogy
-low plt and purpura
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congenital varicella
% if mother infected ??
time of pregnancy ?? |
1-2 %
early-mid pregnancy |
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congenital varicella presentation |
1-limbs aplasia
2-muscle atrophy
3-skin scarring
4-cortical atrophy
5-microceph
6-cataract
7-digital amputation |
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DDx of chickenpox ?? |
-pemphigoid
-dermatitis herpitiformis
-drug eruption
-erythema multiformis
-H.simplex
-impetigo
-insect bite
-smallpox
-syphillis |
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work up in chockenpox ?? |
- Tzank smear
-vesicular fluid Cx
-serology
-CXR |
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Tzank smear |
multinucleated giant cells |
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manegment |
1-symptomatic
2-role of antiviral |
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symptomatic Rx |
1-antihistamine
2-local creams / calamine lotion
3-acetaminophine |
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indications for Antiviral / acyclovir use |
1-immunosuppressseds
2-older than 12 Yo
3-complication /disseminated / pneumonia |
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acyclovir
oral vs Iv |
oral in adult immunocompetent as prophx for complications
IV for immunocopromized |
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oral acyclovir as prophx in pt > 12 yo
dose frequency duration |
800 mg X 4
for 5 days |
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immunocopromized IV dose frequency duration |
10-15 mg / Kg Q8 hrs
for 7 - 10 days |
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other antiviral |
1 |
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VZ immunoglobulin
post-exposure |
1 |
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vaccination |
1 |
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1 |
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