Varicella-Zoster Flashcards
What is primary varicella presentation?
chickenpox
What is the latent reactivation of varicella?
herpes zoster
How is varicella spread?
droplets and aerosols or contact with lesions
How does varicella present?
fever then rash after 2 days
How is the rash present in chicken pox?
pruritic, start on head and spread to trunk, vesicles and pustules
When does crusting take place in chicken pox?
crusting
When are chickenpox pt infectious?
2 days prior to rash and until all crusting
What is the key presentation of chicken pox?
dew drop on rose pedal
What are complications of chicken pox?
cellulitis due to group A strep or s. aureus
Hepatitis
Thrombocytopenia
Cerebellar ataxis
What happens in preg pt exposed to varicella in first trimester?
fetal varicella syndrome
What two different exposure causes of chicken pox?
exposure to chickenpox or zoster
How do you tx chicken pox?
acetaminophen for fever
oatmeal bath or lotion
Who do you tx with viral meds in chicken pox?
immunocompromised, children with chronic lung or skin, newborn mothers, pt w/ complications
What is the viral meds for chicken pox?
valcyclovir for 2-18 yo
How does the rash in zoster present?
feels before present, pain, burning, tingling
When does rash appear?
1-2 days after exposure
Does the rash cross the midline?
no, dermatomal pattern
When does zoster reach the crusting stage?
10 days after exposure, no longer contagious
What can herpes zoster cause?
herpes zoster ophthalmicus
How do you treat HZO?
refer!!!!!
What is a key sign in HZO?
Hutchinson’s sign - vesicle on nose
What is pain persiting long after herpes zoster resolved?
post-herpetic neuralgia
Who gets PHN?
over 50 yo
What is the complications of zoster (2 more)?
bacterial infection and meningitis
When is treatment best for zoster?
within 3 days of rash appeance
What are the drugs for acute HZ?
Valacyclovir 1000 mg PO tid
Famciclovir 500 mg PO tid
Acyclovir 800 mg PO 5x/d
FOR 7-10 days
What is the tx for extensive HZ?
acyclovir 10-14 days
What do you give for acyclovir resistant HZ?
hoscarnet 14-28 days
What can you combine with antivirals for HZ?
60 mg/day taper 21 days
Hydrocodone or oxy
How do you treat PHN?
gabapentin 300 mg qhs
pregabalin 75 mg qhs
Capsaicin, lidocaine patches
