Varicella Zoster Virus

Question 1

What is the RF for chickenpox?

Answer 1

Children – NOT immunised - Immunocompromised

Question 2

What is the transmission like in chickenpoz?

Answer 2

Aerosolised droplets OR direct contact with lesion

Question 3

When is chickenpox infectious?

Answer 3

1. Incubation 14 days

2. Infectious 1-2 days BEFORE rash to all lesions crusted

Question 4

What is the lifecycle like in chickenpox?

Answer 4

1. In skin/mucous membranes, causes small blood vessel inflammation (vasculitis)
2. degeneration of epithelial cells
3. fluid-filled vesicles

Question 5

What is the RF for shingles?

Answer 5

Adults (>50) – immunocompromised – stress

Question 6

What is the timeline of shingles?

Answer 6

Prodrome 2-4 days before rash

Question 7

What is the patho of shingles?

Answer 7

1. reactivation of dormant VZV in ganglia
2. travels down axon
3. local skin inflammation

Question 8

What is the treatment of a less severe presentation of shingles?

Answer 8

1. Self-limiting
2. Calamine lotion
3. Paracetmol

Question 9

What antivrials can be used?

Answer 9

(oral): acyclovir, valaciclovir, famciclovir

Question 10

What are the features of chickenpox?

Answer 10

• Fever
• Malaise. headache
• Sore throat, cough
• Rash

Question 11

What is rash like in chickenpox?

Answer 11

1. pruritic, ‘dew drop on rose petal’, starts as macules
2. to vesicles
3. to rupture
4. to scab
   - affects mucous membranes (nasopharynx, conjunctiva, mouth, vulva)

Question 12

What are possible complications of chickenpox?

Answer 12

1. 2ndary bacterial infection

2. Congenital varicella syndrome = limb hypoplasia, paresis, microcephaly, ophthalmic lesions

Question 13

What are the symptoms of shingles?

Answer 13

1. Prodrome – tingling, localised pain
2. Rash – erythematous, maculopapular lesions
3. painful vesicles, Dermatomal & usually thoracic or lumbar
4. 4 weeks to disappear.

Question 14

What are complications of shingles?

Answer 14

1. Ramsay hunt – involvement of facial nerve leads hearing loss, facial weakness, pain in ear/face, vesicles in auditory canal.
2. Postherpetic neuralgia – pain >90 days
3. HZ ophthalmicus – skin Sx in distribution of ophthalmic branch of trigeminal nerve +/- ocular Sx. SIGHT threatening!

Question 15

What is the management of more severe VZV?

Answer 15

IV antivirals
IV IG
*Pregnancy = separation, prophylaxis

Question 16

What are more severe complications of chickenpox?

Answer 16

1. Meningitis, encephalitis
2. Varicella pneumonitis
3. *Congenital varicella syndrome