Varicella Zoster Flashcards

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1
Q

Define Varicella Zoster?

A

Primary infection is called varicella (chickenpox)

Reactivation of the dormant virus (found in dorsal root ganglia) causes zoster (shingles)

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2
Q

What is Varicella Zoster also known as?

A

Herpes Zoster

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3
Q

What is the aetiology of Varicella Zoster?

A

VZV is a herpes ds-DNA virus
Highly contagious
Transmission by aerosol inhalation or direct contact with vesicular secretions

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4
Q

What is the epidemiology of Varicella Zoster?

A

Chicken pox peak incidence: 4-10 yrs
Shingles peak incidence: > 50 yrs
90% of adults are VZV IgG positive

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5
Q

What are the presenting symptoms of Chickenpox?

A

Prodromal Malaise
Mild Pyrexia
Sudden apperance of intensely itchy spreading rash mainly affecting face and trunk
Vesicles weep and crust over
New vesicles appear
Contagious from 48 hrs before the rash until after the vesicles have all crusted over (7-10 days)

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6
Q

What are the presenting symptoms of Shingles?

A

May occur after a period of stress
Tingling/hyperaesthesia in a dermatomal distribution
Painful skin lesions
Recovery: 10-14 days

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7
Q

Why is it a Dermatomal Distribution for Shingles tingling?

A

Dermatomal because the rash remains dormant in the dorsal root ganglia and reactivation makes the virus travel down the sensory axon to produce a dermatomal shingles rash

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8
Q

What are the signs of Chickenpox on physical examination?

A

Maculopapular rash
Areas of weeping and crusting
Skin excorciation (from scratching)
Mild pyrexia

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9
Q

What are the signs of Shingles on physical examination?

A

Vesicular maculopapular rash
Dermatomal Distribution
Skin Excoriation

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10
Q

What investigations would you do for Varicella Zoster?

A

Usually CLINICAL diagnoses
Vesicle fluid may be sent for electron microscopy viral PCR (RARELY necessary)
Chicken pox in an adult with previous history of varicella infection may require HIV testing

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11
Q

What is the management plan for Chickenpox?

A

Children - treat symptoms

Adults - consider aciclovir

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12
Q

What is the management plan for Shingles?

A

Aciclovir
Valaciclovir
Famciclovir

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13
Q

What is the prevention for Varicella Zoster?

A

Varicella Zoster Ig (VZIG) - may be considered in immunosuppressed or pregnant

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14
Q

What are the possible complications for Chickenpox?

A
Secondary Infection
Scarring
Pneumonia
Encephalitis 
Congenital Varicella Syndrome
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15
Q

What is the possible complications of Shingles?

A
Postherpetic neuralgia 
Zoster ophthalmicus 
Ramsey-Hunt Syndrome
Sacral Zoster 
Motor Zoster
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16
Q

What is Zoster Ophthalmicus?

A

Rash in the ophthalmic division of the trigeminal nerve

17
Q

What is Ramsay-Hunt Syndrome?

A

Reactivation of VZV in the geniculate ganglion causing zoster of the eye and facial nerve palsy
Vesicles may be seen behind the pinna of the ear or in the ear canal

18
Q

What is the prognosis for patients with Varicella Zoster?

A

Depends on complications

Worse in pregnancy, elderly and immunoccompromised