Varicella Zoster

Question 1

Names of primary infection and reactivation of varicella zoster

Answer 1

Varicella (chickenpox)

Zoster (shingles)

Question 2

Chickenpox peak incidence

Answer 2

4-10 years

Question 3

Shingles peak incidence

Answer 3

> 50 years

Question 4

% of adults VZV IgG positive

Answer 4

90%

Question 5

Prodromal malaise
Mild pyrexia
Generalised itchy, vesicular rash
- presentation of?

Answer 5

Chickenpox

Question 6

Timeline of contagiousness of chickenpox

Answer 6

Contagious from 48h before the rash and until all vesicles have crusted over (within 7-10 days)

Question 7

May occur due to stress
Tingling in a dermatomal distribution
Followed by painful skin lesions
- presentation of?

Answer 7

Shingles

- recovery in 10-14 days

Question 8

Chickenpox and shingles rash type

Answer 8

Maculopapular rashes

Question 9

Chickenpox/shingles rash spread pattern

Answer 9

Appears centrally (face, scalp, torso)
Spreads to extremities

Question 10

Chickenpox/shingles investigations to consider

Answer 10

None
- clinical diagnoses
PCR
Viral culture
ELISA (rare)

Question 11

Management of chickenpox in children

Answer 11

Treat symptoms

• calamine lotion (itch)
• analgesia
• antihistamines

Question 12

Management of chickenpox in adults

Answer 12

Consider aciclovir (or others) if within 24hrs of rash onset, otherwise the same as children

Question 13

Management of shingles?

Answer 13

1st line - valaciclovir or famciclovir
2nd line - acyclovir
- give if within 72hrs of appearance of rash for 7 days

Question 14

Prevention method in immunosuppressed and pregnant women exposed to varicella zoster

Answer 14

VZIG - varicella zoster immunoglobulin

Question 15

Complications of varicella

Answer 15

Varicella

• bacterial sepsis
• pneumonia
• encephalitis
• haemorrhagic complications
• reactivation to shingles/herpes zoster

Question 16

Complications of zoster

Answer 16

Postherpetic neuralgia

Meningoencephalitis
Myelitis
Cranial nerve palsies
Vasculopathy
GI ulcers
Pancreatitis/Hepatitis
- complications can occur without rash