Chickenpox and Shingles ☺️ Flashcards
Describe the difference between chickenpox and shingles
Chickenpox
-inhalation of airborne virus or contact with blister fluid
What is the pathophysiology of chickenpox
How does this link to shingles?
HZV enters via nose - primary viremia
- viral replication in regional lymph nodes
- spreads to spleen, liver
Secondary viremia
- virus spread to organs and skin
- spread to resp sites and skin leads to rash and contagious spread
Managed by humoral, cell mediated response
HZV from vesicles track along neurons to DRG or V establishing latent infection which can be reactivated
Inflammation of DRG and sensory nerves => damage => neuropathic pain
If reactivation occurs in CNV => damage of the cornea
Describe the epidemiology of
- chickenpox
- shingles
Chickenpox
- often in young children
- can occur in adults if on high dose steroids, malignancy, IC, pregnant or grew up in a temperate climate
Shingles
- increases with age
- can occur at younger ages if on high dose steroids, malignancy, IC
- v unlikely during pregnancy
Describe the signs and symptoms of
- chickenpox
- shingles
Describe the distribution of the rash
Both have flulike symptoms
Chickenpox
- itchy red papules that become blisters which crust over
- trunk and progresses to the face and limbs bilaterally
Shingles
- tingling, burning pain precedes rash
- painful grouped blisters
- normally unilateral and limited to 1 dermatome
How would you manage someone with chickenpox
- infection control
- conservatively
Infectious period is 2 days before rash appears - blisters have crusted over
- avoid contact with IC, pregnant, neonates
- stay away from school , nursery
Fluids
Smooth cotton fabrics to reduce skin irritation and to maintain a comfortable temperature
Short nails to minimise scratching
Paracetamol for fever and pain
What are the complications of chickenpox in children
Very unlikely
Skin bacterial infections
-high fever
-red and tender around chickenpox lesion
Neuro
-encephalitis, meningitis, acute cerebellar ataxia
What are the complications of chickenpox in adults, pregnancy and IC
More likely
- pneumonia especially in smokers and pregnant
- hepatitis
- encephalitis
Severe disseminated chickenpox with haemorrhagic complications more common in IC
What are the complications of chickenpox to the fetus and neonates
Fetus
- congenital varicella syndrome during first 28wks
- skin scarring in dermatomes
- eye, limb, neuro abnormalities
Neonates
- neonatal chickenpox during 4wks before delivery
- more likely to be severe if born within 7days of maternal rash onset
- increased risk of disseminated or haemorrhagic chickenpox
How would you manage chickenpox in
- IC
- pregnant women and neonates
IC
-aciclovir
Pregnant
- if exposed and has had chickenpox before, immunity is assumed
- VZIG if exposed to virus for the 1st time. Only effective if you don’t have a rash
- aciclovir within a day of the rash appearing (20wk+)
Neonates
- no treatment for fetus
- VZIG if born within 7 days of maternal rash or exposure
- aciclovir if they develop chickepox
How would you manage someone with shingles
- infection control
- conservatively
- medically
Infection control Avoid -no exposure to chickenpox -pregnant, IC, neonates -stay off work until blisters have crusted over
Conservatively
- avoid sharing clothes, towels
- wear loose fitting clothes to reduce irritation
- avoid use of creams and dressings
- keep rash clean and dry to reduce bacterial superinfection risk
Pain relief (escalation)
- paracetamol alone
- paracetamol+codeine/NSAID
- amitriptyline or duloxetine
Aciclovir
- IC
- consider it for 50+ to reduce incidence of PHN
What are the complications of shingles
-more likely in IC
Neuro
- PHN
- meningitis, encephalitis
HZ oticus (Ramsey Hunt) => CNVII
- facial paralysis
- hearing, vestibular issues
HZ opthalmicus => corneal inflammation
- Hutchinson’s sign
- visual symptoms and an unexplained red eye
Disseminated virus more likely in IC => pneumonia, encephalitis, hepatitis, DIC
Rare to get shingles again but occurs in IC
Can you prevent shingles?
- who can get it
- who can’t get it
- what does it do
Zostavax (one dose)
-70-79 (less effective in 80+)
CI if
- IC
- acutely unwell
- recent shingles or PHN => delay for a year
- use of oral antivirals => delay for 2 days after stopping antivirals
- anaphylactic reaction to components
Reduce incidence, severity of shingles and PHN
