Chickenpox (Varicella); prevention, clinical features, management and complications

Introduction

It is an acute, highly communicable viral disease common in childhood and young adulthood. It is characterized by a sudden onset fever, malaise and skin eruption that is maculopapular for a few hours and vesicular for three to four days, leaving a granular scar.

Causative organism: varicella zoster virus.

Incubation period: 2-3 weeks

Method of transmission: direct and indirect contact with droplet form respiratory passage or other body fluids.

Pathophysiology

When the organism enters the body by the way of the respiratory mucous membranes, it produces systemic disease and skin lesions. They are generally more abundant on covered areas of the body, but they may appear everywhere including the scalp, conjunctivae and respiratory tract.

Lesions have been found in the lungs, liver, spleen, adrenal glands and pancreas. The disease is severe in those with deficiencies in cell-mediated immunity. The vesicles are restricted to the skin areas supply by sensory nerves of a single or associated group of dorsal root ganglia.

Clinical Features

  • Mild headache, fever and malaise may be present during the 3rd week after exposure.
  • Symptoms are usually not notice in young children. It is more likely to present in children over ten years, and it usually severe in adults.
  • The upper trunk is the most frequent site for the lesions.
  • Laryngeal or tracheal vesicle may cause severe dyspnoea.
  • Lesions erupt in successive crops.
  • Itching

Diagnosis

  1. Mainly based on the clinical presentation
  2. Tissues culture of vesicular fluid from lesion

Medical Management

  • This required symptomatic treatment.
  • Zovirax – by slow IV injection
  • Oral analgesic for pain
  • 3% acyclovir eye ointment

Nursing Management

  1. General nursing care of infectious disease.
  2. Observe strict isolation of hospitalized patients until all lesions are crusted.
  3. If he is a child who may scratch the lesions, the arms may have to be splinted.
  4. Bed rest/enough sleep.
  5. Nutrition; give well balance diet with liberal amounts of fluids.
  6. Personal hygiene; bath or encourage patient to bath regularly to remove exudates.
  7. Apply calamine lotion to relieve itching.
  8. Keep patient finger nails short and caution against scratching lesions to prevent spread of exudates and potential scaring and introduction of bacteria into lesions.

Prevention

  • Immunization.
  • Isolation of infected persons from other people.
  • Contact tracing and early treatment.

Complications

  • Conjunctiva ulcers.
  • Viral pneumonia.
  • Meningitis.
  • Secondary bacterial infection.

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