A rash appears, starting as well-defined, small, red, clear spots.
Within 12 - 24 hours, these pimples develop into small fluid-filled blisters.
The blisters grow, merge, and become pus-filled.
Pain is common during the active infection.
Within about 7 - 10 days (as with chickenpox), the blisters form crusts and heal. In some cases it may take as long as a month before the skin clears completely. Healing takes even longer in patients who have impaired immune systems, and, in such cases, the blisters may last for months.
Zoster Sine Herpete. Sometimes pain develops without a rash, a condition known as zoster sine herpete. This usually occurs in elderly patients. Symptoms include burning or shooting pain, numbness, tingling, itching, headache, fever, chills, and nausea. An accurate early diagnosis of shingles in such cases is often difficult. Some evidence suggests that some cases of Bell's palsy (in which part of the face becomes paralyzed) might actually be an indication of zoster sine herpete.
Postherpetic Neuralgia. Postherpetic neuralgia (PHN) is pain that persists for longer than a month after the onset of herpes zoster. PHN occurs in about 10 - 20% of patients who have shingles.
A diagnosis may be difficult if herpes zoster takes a non-typical course in the face, such as with Bell's palsy or Ramsay Hunt syndrome, or if it affects the eye or causes fever and delirium.
Saturday, February 6, 2010
Typical Shingles (Herpes Zoster).prodrome,active infection,syndrome known as postherpetic neuralgia - (ZAP).
Shingles nearly always occurs in adults. It develops on one side of the body. Usually two, and sometimes three, identifiable symptom stages occur:
The first is known as the prodrome, a cluster of warning symptoms that appear before the outbreak of the infection.
The second stage comprises the symptoms of the active infection itself.
In many patients, a third syndrome known as postherpetic neuralgia later develops.
Pain is so common to all stages of herpes zoster that doctors often refer to all syndromes with a single term: Zoster-Associated Pain (ZAP).
Prodrome (Pain).
Pain is the primary early symptom for shingles, and it occurs in all patients. The pain most often occurs in the skin at the site of the re-activated virus. The pain may be experienced as sharp, aching, piercing, tearing, or similar to an electric shock.
The affected skin may itch, feel numb, and be unbearably sensitive to touch. Often the patient experiences a combination of these sensations along with pain.
In addition, some patients may have flu-like symptoms such as muscle aches. (Some people have fever, but it is uncommon.)
The prodrome stage lasts 1 - 5 days before the infection becomes active and the skin rash erupts. Occasionally, the pain can last weeks or even months before the rash erupts.
Active Shingles. The rash that marks the active infection follows the same track of inflamed nerves as the prodrome pain. Between 50 - 60% of cases occur on the trunk. The second most common site is the head, particularly on one side of the face. It may also erupt on the neck or lower back. If the face is affected, there is a danger that the infection can spread to the eye or mouth. A rash that follows the side of the nose is a warning that the cornea of the eye is in danger.
The first is known as the prodrome, a cluster of warning symptoms that appear before the outbreak of the infection.
The second stage comprises the symptoms of the active infection itself.
In many patients, a third syndrome known as postherpetic neuralgia later develops.
Pain is so common to all stages of herpes zoster that doctors often refer to all syndromes with a single term: Zoster-Associated Pain (ZAP).
Prodrome (Pain).
Pain is the primary early symptom for shingles, and it occurs in all patients. The pain most often occurs in the skin at the site of the re-activated virus. The pain may be experienced as sharp, aching, piercing, tearing, or similar to an electric shock.
The affected skin may itch, feel numb, and be unbearably sensitive to touch. Often the patient experiences a combination of these sensations along with pain.
In addition, some patients may have flu-like symptoms such as muscle aches. (Some people have fever, but it is uncommon.)
The prodrome stage lasts 1 - 5 days before the infection becomes active and the skin rash erupts. Occasionally, the pain can last weeks or even months before the rash erupts.
Active Shingles. The rash that marks the active infection follows the same track of inflamed nerves as the prodrome pain. Between 50 - 60% of cases occur on the trunk. The second most common site is the head, particularly on one side of the face. It may also erupt on the neck or lower back. If the face is affected, there is a danger that the infection can spread to the eye or mouth. A rash that follows the side of the nose is a warning that the cornea of the eye is in danger.
High-Risk Candidates for Complications of Chickenpox.
Elderly people. The older the patient, the higher the risk for complications from either chickenpox or shingles. Adults who smoke are at particularly higher risk for pneumonia from chickenpox.
Patients with Serious Illnesses. People with serious illnesses may be at risk for complications of the varicella-zoster virus. Patients with diseases, such as Hodgkin's disease, who receive bone marrow or stem cell transplants are at higher risk for herpes zoster and its complications.
Pregnant Women. Pregnant women who become infected with the varicella-zoster virus, whether in the form of chickenpox or shingles, are at increased risk for serious pneumonia.
The risk for the infant is lower or higher depending on when the mother became infected.
Chickenpox in the mother during early pregnancy poses a slightly increased risk for birth defects in the infant.
The highest risk for birth defects is about 2%, which usually occurs if the mother has chickenpox between the 13th and 20th week. Even in such cases, birth defects may only result in minor skin abnormalities. More serious defects include a smaller than normal head, eye problems, low birth weight, and mental retardation.
If women develop chickenpox (not shingles) within 5 days before and 2 days after delivery, their newborns are at risk for life-threatening varicella.
Newborns and Infants. Chickenpox in newborns is a life-threatening condition. Although chickenpox can still be very dangerous in older infants, most are protected by antibodies in breast milk from mothers who have had chickenpox. Children under age 1 who develop chickenpox are at higher risk for childhood shingles. All infants should have as little exposure as possible to people with chickenpox.
Patients with Serious Illnesses. People with serious illnesses may be at risk for complications of the varicella-zoster virus. Patients with diseases, such as Hodgkin's disease, who receive bone marrow or stem cell transplants are at higher risk for herpes zoster and its complications.
Pregnant Women. Pregnant women who become infected with the varicella-zoster virus, whether in the form of chickenpox or shingles, are at increased risk for serious pneumonia.
The risk for the infant is lower or higher depending on when the mother became infected.
Chickenpox in the mother during early pregnancy poses a slightly increased risk for birth defects in the infant.
The highest risk for birth defects is about 2%, which usually occurs if the mother has chickenpox between the 13th and 20th week. Even in such cases, birth defects may only result in minor skin abnormalities. More serious defects include a smaller than normal head, eye problems, low birth weight, and mental retardation.
If women develop chickenpox (not shingles) within 5 days before and 2 days after delivery, their newborns are at risk for life-threatening varicella.
Newborns and Infants. Chickenpox in newborns is a life-threatening condition. Although chickenpox can still be very dangerous in older infants, most are protected by antibodies in breast milk from mothers who have had chickenpox. Children under age 1 who develop chickenpox are at higher risk for childhood shingles. All infants should have as little exposure as possible to people with chickenpox.
Complications of Shingles (Herpes Zoster).The pain and discomfort of the active herpes zoster infection.Effects on Face and Ears.The following are ri
Pain. The pain and discomfort of the active herpes zoster infection is the primary symptom and complication of herpes zoster. The pain usually takes one of these forms:
Continuous burning or aching pain
Periodic piercing pain
Spasm similar to electric shock
Such experiences may also be more intense than even normal responses, defined in the following ways:
Allodynia is pain caused by factors, such as a light touch of clothing or a cold wind, which occurs from very little stimulation.
Hyperalgesia is a more intense painful response to a normally painful experience.
The pain tends to be more severe at night. Temperature changes can also affect pain. The pain may extend beyond the areas of the initial zoster attack. In most cases, it does not affect daily life. Rarely, however, the pain of herpes zoster affects sleep, mood, work, and overall quality of life. This can lead to fatigue, loss of appetite, depression, social withdrawal, and impaired daily functioning.
Itching. Many patients report itching (postherpetic itch) as the primary symptom, rather than pain. In rare cases, it can be disabling.
Postherpetic Neuralgia (PHN). Postherpetic neuralgia (PHN) is pain that persists for longer than a month after the onset of herpes. It is the most common severe complication of shingles. It is not clear why PHN occurs. Some theories for its development are:
The herpes zoster virus appears to produce persistent inflammation in the spinal cord that causes long-term damage, including nerve scarring.
Nerves that are injured in the initial attack may heal abnormally and provoke an exaggerated response in the brain that produces intense sensitivity or pain.
In people with herpes zoster, the risk of developing PHN ranges from 10 - 70%. In general, however, the risk is likely to be in the lower range. People with impaired immune systems do not seem to be at any higher risk for persistent PHN than those with normal immune systems.
The following are risk factors for PHN:
Age. PHN affects about 25% of herpes zoster patients over 60 years old. The older a person is, the longer PHN is likely to last. It rarely occurs in people under age 50.
Gender. Some studies suggest that women may be at slightly higher risk for PHN than men.
Severe or Complicated Shingles. People who had prodromal symptoms or a severe attack (numerous blisters and severe pain) during the initial shingles episode are also at high risk for PHN. The rate is also higher in people whose eyes have been affected by zoster.
In most cases, PHN resolves within 3 months. Some doctors define persistent pain after a herpes zoster attack as subacute herpetic neuralgia if it lasts between 1 - 3 months and as PHN only if it lasts beyond 3 months. Studies report that only about 10% of patients experience pain after a year. Unfortunately, when PHN is severe and treatments have not been very effective, the persistent pain and abnormal sensations can be profoundly frustrating and depressing for patients.
Secondary Infection in the Blisters. If the blistered area is not kept clean and free from irritation, it may become infected with group A Streptococcus or Staphylococcus bacteria. If the infection is severe, scarring can occur.
Guillain-Barre Syndrome. Guillain-Barre syndrome is caused by inflammation of the nerves and has been associated with a number of viruses, including herpes zoster. The arms and legs become weak, painful, and, sometimes, even paralyzed. The trunk and face may be affected. Symptoms vary from mild to severe enough to require hospitalization. The disorder resolves in a few weeks to months. Other herpes viruses (cytomegalovirus and Epstein-Barr), or bacteria (Campylobacter) may have a stronger association with this syndrome than herpes zoster.
Effects on Face and Ears.
Ramsay Hunt Syndrome. Ramsay Hunt syndrome occurs when herpes zoster causes facial paralysis and rash on the ear (herpes zoster oticus) or in the mouth. Symptoms include severe ear pain and hearing loss, ringing in the ear, loss of taste, nausea, vomiting, and dizziness. Ramsay Hunt syndrome may also cause a mild inflammation in the brain. The dizziness may last for a few days, or even weeks, but usually resolves. Severity of hearing loss varies from partial to total; however, this too usually always goes away. Facial paralysis, on the other hand, may be permanent.
Bell's Palsy. Bell's palsy is partial paralysis of the face. There is some indication that this syndrome may suggest a reactivation of herpes zoster, even if no rash appears.
Sometimes, it is difficult to distinguish between Bell's palsy and Ramsay Hunt syndrome, particularly in the early stages. In general, Ramsay Hunt syndrome tends to be more severe than Bell's palsy.
Effects on the Brain. Inflammation of the membrane around the brain (meningitis) or in the brain itself (encephalitis) is a rare complication in people with herpes zoster. The encephalitis is generally mild and resolves in a short period. In rare cases, particularly in patients with impaired immune systems, it can be severe and even life threatening.
Continuous burning or aching pain
Periodic piercing pain
Spasm similar to electric shock
Such experiences may also be more intense than even normal responses, defined in the following ways:
Allodynia is pain caused by factors, such as a light touch of clothing or a cold wind, which occurs from very little stimulation.
Hyperalgesia is a more intense painful response to a normally painful experience.
The pain tends to be more severe at night. Temperature changes can also affect pain. The pain may extend beyond the areas of the initial zoster attack. In most cases, it does not affect daily life. Rarely, however, the pain of herpes zoster affects sleep, mood, work, and overall quality of life. This can lead to fatigue, loss of appetite, depression, social withdrawal, and impaired daily functioning.
Itching. Many patients report itching (postherpetic itch) as the primary symptom, rather than pain. In rare cases, it can be disabling.
Postherpetic Neuralgia (PHN). Postherpetic neuralgia (PHN) is pain that persists for longer than a month after the onset of herpes. It is the most common severe complication of shingles. It is not clear why PHN occurs. Some theories for its development are:
The herpes zoster virus appears to produce persistent inflammation in the spinal cord that causes long-term damage, including nerve scarring.
Nerves that are injured in the initial attack may heal abnormally and provoke an exaggerated response in the brain that produces intense sensitivity or pain.
In people with herpes zoster, the risk of developing PHN ranges from 10 - 70%. In general, however, the risk is likely to be in the lower range. People with impaired immune systems do not seem to be at any higher risk for persistent PHN than those with normal immune systems.
The following are risk factors for PHN:
Age. PHN affects about 25% of herpes zoster patients over 60 years old. The older a person is, the longer PHN is likely to last. It rarely occurs in people under age 50.
Gender. Some studies suggest that women may be at slightly higher risk for PHN than men.
Severe or Complicated Shingles. People who had prodromal symptoms or a severe attack (numerous blisters and severe pain) during the initial shingles episode are also at high risk for PHN. The rate is also higher in people whose eyes have been affected by zoster.
In most cases, PHN resolves within 3 months. Some doctors define persistent pain after a herpes zoster attack as subacute herpetic neuralgia if it lasts between 1 - 3 months and as PHN only if it lasts beyond 3 months. Studies report that only about 10% of patients experience pain after a year. Unfortunately, when PHN is severe and treatments have not been very effective, the persistent pain and abnormal sensations can be profoundly frustrating and depressing for patients.
Secondary Infection in the Blisters. If the blistered area is not kept clean and free from irritation, it may become infected with group A Streptococcus or Staphylococcus bacteria. If the infection is severe, scarring can occur.
Guillain-Barre Syndrome. Guillain-Barre syndrome is caused by inflammation of the nerves and has been associated with a number of viruses, including herpes zoster. The arms and legs become weak, painful, and, sometimes, even paralyzed. The trunk and face may be affected. Symptoms vary from mild to severe enough to require hospitalization. The disorder resolves in a few weeks to months. Other herpes viruses (cytomegalovirus and Epstein-Barr), or bacteria (Campylobacter) may have a stronger association with this syndrome than herpes zoster.
Effects on Face and Ears.
Ramsay Hunt Syndrome. Ramsay Hunt syndrome occurs when herpes zoster causes facial paralysis and rash on the ear (herpes zoster oticus) or in the mouth. Symptoms include severe ear pain and hearing loss, ringing in the ear, loss of taste, nausea, vomiting, and dizziness. Ramsay Hunt syndrome may also cause a mild inflammation in the brain. The dizziness may last for a few days, or even weeks, but usually resolves. Severity of hearing loss varies from partial to total; however, this too usually always goes away. Facial paralysis, on the other hand, may be permanent.
Bell's Palsy. Bell's palsy is partial paralysis of the face. There is some indication that this syndrome may suggest a reactivation of herpes zoster, even if no rash appears.
Sometimes, it is difficult to distinguish between Bell's palsy and Ramsay Hunt syndrome, particularly in the early stages. In general, Ramsay Hunt syndrome tends to be more severe than Bell's palsy.
Effects on the Brain. Inflammation of the membrane around the brain (meningitis) or in the brain itself (encephalitis) is a rare complication in people with herpes zoster. The encephalitis is generally mild and resolves in a short period. In rare cases, particularly in patients with impaired immune systems, it can be severe and even life threatening.
Reye Syndrome.Other Rare Complications of Chickenpox
Reye Syndrome. Reye syndrome, a disorder that causes sudden and dangerous liver and brain damage, is a side effect of aspirin therapy in children who have chickenpox or influenza. The disease can lead to coma and is life threatening. Symptoms include rash, vomiting, and confusion beginning about a week after the onset of the disease. Because of the strong warnings against children taking aspirin, this condition is, fortunately, very rare. Children should never be given aspirin when they have a viral infection or fever. Acetaminophen (Tylenol) is the preferred drug for fever or pain in patients younger than age 18 years.
Other Rare Complications of Chickenpox. Other extremely rare complications of varicella include problems in blood clotting and inflammation of the nerves in the hands and feet. Inflammation can also occur in other areas of the body, such as the heart, testicles, liver, joints, or kidney.
Other Rare Complications of Chickenpox. Other extremely rare complications of varicella include problems in blood clotting and inflammation of the nerves in the hands and feet. Inflammation can also occur in other areas of the body, such as the heart, testicles, liver, joints, or kidney.
Disseminated Varicella
Disseminated Varicella. Disseminated varicella, which develops when the virus spreads to organs in the body, is extremely serious and is a major problem for patients with compromised immune systems. An immune system may become compromised as a result of diseases such as AIDS, inherited conditions, or certain drugs. For example, disseminated varicella occurs in up to 35% of children with chickenpox who are undergoing cancer chemotherapy. In such cases, mortality rates are between 7 - 30%.
Effects During Pregnancy
Effects During Pregnancy. The risk for chickenpox in a pregnant woman is very low (1 - 7 cases in 10,000). However, chickenpox places the woman at risk for life-threatening pneumonia. Infection in the pregnant woman in the first trimester also poses a 1 - 2% chance for infecting the developing fetus, which is an extremely serious condition. (Herpes zoster is even rarer in pregnant women, and there is almost no risk for the unborn child in such cases.)
Effects on the Brain and Central Nervous System.
Inflammation in the Brain. Encephalitis and meningitis, infections or inflammation in the central nervous systems, have occurred in a few varicella patients, both children and adults. This condition can be very dangerous, causing coma and even death. Fortunately, it is extremely rare. Symptoms vary. The patient may become over-agitated or may exhibit loss of coordination and poor balance.
Stroke. Although stroke in children is extremely rare, a condition called cerebral vasculitis, in which blood vessels in the brain become inflamed, has been associated with varicella-zoster. Varicella may be a factor in some cases of stroke in young adults.
Stroke. Although stroke in children is extremely rare, a condition called cerebral vasculitis, in which blood vessels in the brain become inflamed, has been associated with varicella-zoster. Varicella may be a factor in some cases of stroke in young adults.
.Chickenpox (varicella) - complications.Specific Complications of Chickenpox (Varicella).
Chickenpox (varicella) rarely causes complications, but it is not always harmless. It can cause hospitalization and, in rare cases, death. Fortunately, since the introduction of the vaccine in 1995, hospitalizations have declined by nearly 90%, and there have been few fatal cases of chickenpox.
Adults have the greatest risk for dying from chickenpox, with infants having the next highest risk. Males (both boys and men) have a higher risk for a severe case of chickenpox than females. Children who catch chickenpox from family members are likely to have a more severe case than if they caught it outside the home. The older the child, the higher the risk for a more severe case. But even in such circumstances, chickenpox is rarely serious in children. Other factors put individuals at specifically higher risk for complications of chickenpox.
Recurrence of Chickenpox and Reactivation as Shingles
Recurrence of Chickenpox. Recurrence of chickenpox is possible, but uncommon. One episode of chickenpox usually means lifelong immunity against a second attack. However, people who have had mild infections may be at greater risk for a breakthrough infection later on.
Reactivation of the Virus as Shingles (Herpes Zoster). The major long-term complication of varicella is the later reactivation of the herpes zoster virus and the development of shingles. Shingles occurs in about 20% of people who have had chickenpox.
Specific Complications of Chickenpox (Varicella)
Aside from itching, the complications described below are very rare.
Itching. Itching, the most common complication of the varicella infection, can be very distressing, particularly for small children. Certain home remedies are available that can alleviate the discomfort. [See: "Treatment for Chickenpox" section below.]
Secondary Infection and Scarring. Small scars may remain after the scabs have fallen off, but they usually clear up within a few months. In some cases, a secondary infection may develop at sites which the patient has scratched. The infection is usually caused by the bacteria Staphylococcus aureus or Streptococcus pyogenes. Permanent scarring may occur as a result. Children with chickenpox are at much higher risk for this complication than adults are, possibly because they are more likely to scratch.
Ear Infections. Some children are at higher risk for ear infections from chickenpox. Hearing loss is a very rare result of this complication.
A middle ear infection is also known as otitis media. It is one of the most common of childhood infections. With this illness, the middle ear becomes red, swollen, and inflamed because of bacteria trapped in the eustachian tube.
Bacterial Superinfection. Bacterial superinfection of the skin caused by group A streptococcus is the most common serious complication of chickenpox (but it is still rare). The infection is usually mild, but if it spreads in deep muscle, fat, or in the blood, it can be life threatening. Infection can cause serious conditions, such as necrotizing fasciitis (the so-called flesh-eating bacteria) and toxic shock syndrome (TSS).
Symptoms include:
A persistent or recurrent high fever
Redness, pain, and swelling in the skin and the tissue beneath
Pneumonia. Pneumonia is suspected if coughing and abnormally rapid breathing develop in patients who have chickenpox. Adults and adolescents with chickenpox are at some risk for serious pneumonia. Pregnant women, smokers, and those with serious medical conditions are at higher risk for pneumonia if they have chickenpox. Oxygen and intravenous acyclovir are key treatments for this condition. Pneumonia that is caused by varicella can result in lung scarring, which may impair oxygen exchange over the following weeks, or even months.
Bacterial Superinfection. Bacterial superinfection of the skin caused by group A streptococcus is the most common serious complication of chickenpox (but it is still rare). The infection is usually mild, but if it spreads in deep muscle, fat, or in the blood, it can be life threatening. Infection can cause serious conditions, such as necrotizing fasciitis (the so-called flesh-eating bacteria) and toxic shock syndrome (TSS).
Adults have the greatest risk for dying from chickenpox, with infants having the next highest risk. Males (both boys and men) have a higher risk for a severe case of chickenpox than females. Children who catch chickenpox from family members are likely to have a more severe case than if they caught it outside the home. The older the child, the higher the risk for a more severe case. But even in such circumstances, chickenpox is rarely serious in children. Other factors put individuals at specifically higher risk for complications of chickenpox.
Recurrence of Chickenpox and Reactivation as Shingles
Recurrence of Chickenpox. Recurrence of chickenpox is possible, but uncommon. One episode of chickenpox usually means lifelong immunity against a second attack. However, people who have had mild infections may be at greater risk for a breakthrough infection later on.
Reactivation of the Virus as Shingles (Herpes Zoster). The major long-term complication of varicella is the later reactivation of the herpes zoster virus and the development of shingles. Shingles occurs in about 20% of people who have had chickenpox.
Specific Complications of Chickenpox (Varicella)
Aside from itching, the complications described below are very rare.
Itching. Itching, the most common complication of the varicella infection, can be very distressing, particularly for small children. Certain home remedies are available that can alleviate the discomfort. [See: "Treatment for Chickenpox" section below.]
Secondary Infection and Scarring. Small scars may remain after the scabs have fallen off, but they usually clear up within a few months. In some cases, a secondary infection may develop at sites which the patient has scratched. The infection is usually caused by the bacteria Staphylococcus aureus or Streptococcus pyogenes. Permanent scarring may occur as a result. Children with chickenpox are at much higher risk for this complication than adults are, possibly because they are more likely to scratch.
Ear Infections. Some children are at higher risk for ear infections from chickenpox. Hearing loss is a very rare result of this complication.
A middle ear infection is also known as otitis media. It is one of the most common of childhood infections. With this illness, the middle ear becomes red, swollen, and inflamed because of bacteria trapped in the eustachian tube.
Bacterial Superinfection. Bacterial superinfection of the skin caused by group A streptococcus is the most common serious complication of chickenpox (but it is still rare). The infection is usually mild, but if it spreads in deep muscle, fat, or in the blood, it can be life threatening. Infection can cause serious conditions, such as necrotizing fasciitis (the so-called flesh-eating bacteria) and toxic shock syndrome (TSS).
Symptoms include:
A persistent or recurrent high fever
Redness, pain, and swelling in the skin and the tissue beneath
Pneumonia. Pneumonia is suspected if coughing and abnormally rapid breathing develop in patients who have chickenpox. Adults and adolescents with chickenpox are at some risk for serious pneumonia. Pregnant women, smokers, and those with serious medical conditions are at higher risk for pneumonia if they have chickenpox. Oxygen and intravenous acyclovir are key treatments for this condition. Pneumonia that is caused by varicella can result in lung scarring, which may impair oxygen exchange over the following weeks, or even months.
Bacterial Superinfection. Bacterial superinfection of the skin caused by group A streptococcus is the most common serious complication of chickenpox (but it is still rare). The infection is usually mild, but if it spreads in deep muscle, fat, or in the blood, it can be life threatening. Infection can cause serious conditions, such as necrotizing fasciitis (the so-called flesh-eating bacteria) and toxic shock syndrome (TSS).
Risk Factors .The risk for herpes zoster.Risk Factors for Shingles (Herpes Zoster)
The varicella-zoster virus is responsible for both chickenpox and herpes zoster, but its method of infection is different in both diseases.
Both the active varicella and zoster form of the virus can cause chickenpox.
The shingles virus in its latent (inactive) form is never contagious.
Catching Chickenpox. Most people get chickenpox from exposure to other people with chickenpox. It is most often spread through sneezing, coughing, and breathing. It is so contagious that few nonimmunized people escape this common disease when they are exposed to someone else with the disease.
People can also catch chickenpox from direct exposure to a shingles rash if they have not been immunized by vaccination or a previous bout of chickenpox. In such cases, transmission happens during the active phase when blisters have erupted but not formed dry crusts. Herpes zoster spreads only from the rash. A person with shingles cannot transmit the virus by breathing or coughing.
Developing Shingles. Shingles itself can develop only from a reactivation of the varicella-zoster virus in a person who has previously had chickenpox. In other words, shingles itself is never transmitted from one person to another either in the air or through direct exposure to the blisters.
Risk Factors for Chickenpox (Varicella)
Between 75 - 90% of chickenpox cases occur in children under 10 years of age. Before the introduction of the vaccine, about 4 million cases of chickenpox were reported in the U.S. each year. Since a varicella vaccine became available in the U.S. in 1995, however, the incidence of disease and hospitalizations due to chickenpox has declined by nearly 90%.
The disease usually occurs in late winter and early spring months. It can also be transmitted from direct contact with the open sores. (Clothing, bedding, and other such objects do not usually spread the disease.)
A patient with chickenpox can transmit the disease from about 2 days before the appearance of the spots until the end of the blister stage. This period lasts about 5 - 7 days. Once dry scabs form, the disease is unlikely to spread.
Most schools allow children with chickenpox back 10 days after onset. Some require children to stay home until the skin has completely cleared, although this is not necessary to prevent transmission.
Risk Factors for Shingles (Herpes Zoster)
About 500,000 cases of shingles occur each year in the U.S. Anyone who has had chickenpox has risk for shingles later in life, which means that 90% of adults in the U.S. are at risk for shingles. Shingles occurs, however, in 10 - 20% of these adults over the course of their lives, so certain factors must exist to increase the risk for such outbreaks.
The Aging Process. The risk for herpes zoster increases as people age, and the overall number of cases will undoubtedly increase as the baby boomer generation gets older. One study estimated that a person who reaches age 85 has a 50% chance of having herpes zoster. The risk for postherpetic neuralgia (PHN) is also highest in older people with the infection and increases dramatically after age 50. PHN is persistent pain and is the most feared complication of shingles.
Immunosuppression. People whose immune systems are impaired from diseases such as AIDS or childhood cancer have a risk for herpes zoster that is much higher than those with healthy immune systems. Herpes zoster in people who are HIV-positive may be a sign of full-blown AIDS. Certain drugs used for HIV, called protease inhibitors, may also increase the risk for herpes zoster.
Cancer. Cancer places people at risk for herpes zoster. At highest risk are those with Hodgkin's disease (13 - 15% of these patients develop shingles). About 7 - 9% of patients with lymphomas, and 1 - 3% of patients with other cancers, have herpes zoster. Chemotherapy itself increases the risk for herpes zoster.
Immunosuppressant Drugs. Patients who take certain drugs that suppress the immune system are at risk for shingles (as well as other infections). They include:
Azathioprine (Imuran)
Chlorambucil (Leukeran)
Cyclophosphamide (Cytoxan)
Cyclosporine (Sandimmune, Neoral)
Cladribine (Leustatin)
Infliximab (Remicade)
Adalimumab (Humira)
These drugs are used for patients who have undergone organ transplantation and are also used for severe autoimmune diseases caused by the inflammatory process. Such disorders include rheumatoid arthritis, systemic lupus erythematosus, diabetes, multiple sclerosis, Crohn's disease, and ulcerative colitis.
Risk Factors for Shingles in Children. Although most common in adults, shingles occasionally develops in children. Children with immune deficiencies are at highest risk. Children with no immune problems but who had chickenpox before they were 1 year old also have a higher risk for shingles.
Risk for Recurrence of Shingles. Shingles can recur, but the risk is low (1 - 5%). Evidence suggests that a first zoster episode boosts the immune system to ward off another attack.
Both the active varicella and zoster form of the virus can cause chickenpox.
The shingles virus in its latent (inactive) form is never contagious.
Catching Chickenpox. Most people get chickenpox from exposure to other people with chickenpox. It is most often spread through sneezing, coughing, and breathing. It is so contagious that few nonimmunized people escape this common disease when they are exposed to someone else with the disease.
People can also catch chickenpox from direct exposure to a shingles rash if they have not been immunized by vaccination or a previous bout of chickenpox. In such cases, transmission happens during the active phase when blisters have erupted but not formed dry crusts. Herpes zoster spreads only from the rash. A person with shingles cannot transmit the virus by breathing or coughing.
Developing Shingles. Shingles itself can develop only from a reactivation of the varicella-zoster virus in a person who has previously had chickenpox. In other words, shingles itself is never transmitted from one person to another either in the air or through direct exposure to the blisters.
Risk Factors for Chickenpox (Varicella)
Between 75 - 90% of chickenpox cases occur in children under 10 years of age. Before the introduction of the vaccine, about 4 million cases of chickenpox were reported in the U.S. each year. Since a varicella vaccine became available in the U.S. in 1995, however, the incidence of disease and hospitalizations due to chickenpox has declined by nearly 90%.
The disease usually occurs in late winter and early spring months. It can also be transmitted from direct contact with the open sores. (Clothing, bedding, and other such objects do not usually spread the disease.)
A patient with chickenpox can transmit the disease from about 2 days before the appearance of the spots until the end of the blister stage. This period lasts about 5 - 7 days. Once dry scabs form, the disease is unlikely to spread.
Most schools allow children with chickenpox back 10 days after onset. Some require children to stay home until the skin has completely cleared, although this is not necessary to prevent transmission.
Risk Factors for Shingles (Herpes Zoster)
About 500,000 cases of shingles occur each year in the U.S. Anyone who has had chickenpox has risk for shingles later in life, which means that 90% of adults in the U.S. are at risk for shingles. Shingles occurs, however, in 10 - 20% of these adults over the course of their lives, so certain factors must exist to increase the risk for such outbreaks.
The Aging Process. The risk for herpes zoster increases as people age, and the overall number of cases will undoubtedly increase as the baby boomer generation gets older. One study estimated that a person who reaches age 85 has a 50% chance of having herpes zoster. The risk for postherpetic neuralgia (PHN) is also highest in older people with the infection and increases dramatically after age 50. PHN is persistent pain and is the most feared complication of shingles.
Immunosuppression. People whose immune systems are impaired from diseases such as AIDS or childhood cancer have a risk for herpes zoster that is much higher than those with healthy immune systems. Herpes zoster in people who are HIV-positive may be a sign of full-blown AIDS. Certain drugs used for HIV, called protease inhibitors, may also increase the risk for herpes zoster.
Cancer. Cancer places people at risk for herpes zoster. At highest risk are those with Hodgkin's disease (13 - 15% of these patients develop shingles). About 7 - 9% of patients with lymphomas, and 1 - 3% of patients with other cancers, have herpes zoster. Chemotherapy itself increases the risk for herpes zoster.
Immunosuppressant Drugs. Patients who take certain drugs that suppress the immune system are at risk for shingles (as well as other infections). They include:
Azathioprine (Imuran)
Chlorambucil (Leukeran)
Cyclophosphamide (Cytoxan)
Cyclosporine (Sandimmune, Neoral)
Cladribine (Leustatin)
Infliximab (Remicade)
Adalimumab (Humira)
These drugs are used for patients who have undergone organ transplantation and are also used for severe autoimmune diseases caused by the inflammatory process. Such disorders include rheumatoid arthritis, systemic lupus erythematosus, diabetes, multiple sclerosis, Crohn's disease, and ulcerative colitis.
Risk Factors for Shingles in Children. Although most common in adults, shingles occasionally develops in children. Children with immune deficiencies are at highest risk. Children with no immune problems but who had chickenpox before they were 1 year old also have a higher risk for shingles.
Risk for Recurrence of Shingles. Shingles can recur, but the risk is low (1 - 5%). Evidence suggests that a first zoster episode boosts the immune system to ward off another attack.
virus of the Herpes family .known as varicella-zoster virus (VZV).Other Herpes Viruses
Shingles and chickenpox were once considered separate disorders. Researchers now know that they are both caused by a single virus of the herpes family, known as varicella-zoster virus (VZV). The word herpes is derived from the Greek word "herpein," which means "to creep," a reference to a characteristic pattern of skin eruptions. VZV is still referred to by separate terms:
Varicella: The primary infection that causes chickenpox
Herpes zoster: The reactivation of the virus that causes shingles
Varicella (Chickenpox). When patients with chickenpox cough or sneeze, they expel tiny droplets that carry the virus. If a person who has never had chickenpox or never been vaccinated inhales these particles, the virus enters the lungs. From here it passes into the bloodstream. When it is carried to the skin it produces the typical rash of chickenpox.
Chickenpox is caused by the varicella-zoster virus, a member of the herpes virus family. The same virus also causes herpes zoster, or shingles, in adults. Chickenpox is extremely contagious, and can be spread by direct contact, droplet transmission, and airborne transmission. Symptoms range from fever, headache, stomach ache, or loss of appetite before breaking out in the classic pox rash. The rash can consist of several hundred small, itchy, fluid-filled blisters over red spots on the skin. The blisters often appear first on the face, trunk, or scalp and then spread to other parts of the body
Herpes Zoster (Shingles). The varicella virus also travels to nerve cells called dorsal root ganglia. These are bundles of nerves that transmit sensory information from the skin to the brain. Here, the virus can hide from the immune system for years, often for a lifetime. This inactivity is called latency.
If the virus becomes active after being latent, it causes the disorder known as shingles. The virus in this later form is referred to as herpes zoster. The virus spreads in the ganglion and to the nerves connecting to it. Nerves most often affected are those in the face or the trunk. The virus can also spread to the spinal cord and into the bloodstream.
It is not clear why the varicella virus reactivates in some people but not in others. In many cases, the immune system has become impaired or suppressed from certain conditions such as AIDS, other immunodeficient diseases, or certain cancers or drugs that suppress the immune system. Aging itself increases the risk for shingles.
Other Herpes Viruses
The varicella-zoster virus belongs to a group of herpes viruses that includes eight human viruses (it also includes animal viruses). Herpes viruses are similar in shape and size and reproduce within the structure of a cell. The particular cell depends upon the specific virus. Human herpes viruses include herpes simplex virus 1 (HSV-1), which causes cold sores, and herpes simplex virus 2 (HSV-2), which causes genital herpes. Cytomegalovirus (CMV), which causes mononucleosis and retinitis, and Epstein-Barre Virus (EBV), another cause of mononucleosis, are also human herpes viruses.
All herpes viruses share some common properties, including a pattern of active symptoms followed by latent inactive periods that can last for months, years, or even a lifetime.
Varicella: The primary infection that causes chickenpox
Herpes zoster: The reactivation of the virus that causes shingles
Varicella (Chickenpox). When patients with chickenpox cough or sneeze, they expel tiny droplets that carry the virus. If a person who has never had chickenpox or never been vaccinated inhales these particles, the virus enters the lungs. From here it passes into the bloodstream. When it is carried to the skin it produces the typical rash of chickenpox.
Chickenpox is caused by the varicella-zoster virus, a member of the herpes virus family. The same virus also causes herpes zoster, or shingles, in adults. Chickenpox is extremely contagious, and can be spread by direct contact, droplet transmission, and airborne transmission. Symptoms range from fever, headache, stomach ache, or loss of appetite before breaking out in the classic pox rash. The rash can consist of several hundred small, itchy, fluid-filled blisters over red spots on the skin. The blisters often appear first on the face, trunk, or scalp and then spread to other parts of the body
Herpes Zoster (Shingles). The varicella virus also travels to nerve cells called dorsal root ganglia. These are bundles of nerves that transmit sensory information from the skin to the brain. Here, the virus can hide from the immune system for years, often for a lifetime. This inactivity is called latency.
If the virus becomes active after being latent, it causes the disorder known as shingles. The virus in this later form is referred to as herpes zoster. The virus spreads in the ganglion and to the nerves connecting to it. Nerves most often affected are those in the face or the trunk. The virus can also spread to the spinal cord and into the bloodstream.
It is not clear why the varicella virus reactivates in some people but not in others. In many cases, the immune system has become impaired or suppressed from certain conditions such as AIDS, other immunodeficient diseases, or certain cancers or drugs that suppress the immune system. Aging itself increases the risk for shingles.
Other Herpes Viruses
The varicella-zoster virus belongs to a group of herpes viruses that includes eight human viruses (it also includes animal viruses). Herpes viruses are similar in shape and size and reproduce within the structure of a cell. The particular cell depends upon the specific virus. Human herpes viruses include herpes simplex virus 1 (HSV-1), which causes cold sores, and herpes simplex virus 2 (HSV-2), which causes genital herpes. Cytomegalovirus (CMV), which causes mononucleosis and retinitis, and Epstein-Barre Virus (EBV), another cause of mononucleosis, are also human herpes viruses.
All herpes viruses share some common properties, including a pattern of active symptoms followed by latent inactive periods that can last for months, years, or even a lifetime.
Prevention
Doctors recommend that kids receive the chickenpox vaccine when they're 12 to 15 months old and a booster shot at 4 to 6 years old. The vaccine is about 70% to 85% effective at preventing mild infection, and more than 95% effective in preventing moderate to severe forms of the infection. Therefore, although some kids who are immunized still will get chickenpox, the symptoms are usually much milder than those of kids who haven't had the vaccine and become infected.
Healthy kids who have had chickenpox do not need the vaccine — they usually have lifelong protection against the illness.
Treatment
A virus causes chickenpox, so the doctor won't prescribe antibiotics. However, antibiotics may be required if the sores become infected by bacteria. This is pretty common among kids because they often scratch and pick at the blisters.
The antiviral medicine acyclovir may be prescribed for people with chickenpox who are at risk for complications. The drug, which can make the infection less severe, must be given within the first 24 hours after the rash appears. Acyclovir can have significant side effects, so it is only given when necessary. Your doctor can tell you if the medication is right for your child.
BackContinueDealing With DiscomfortTo help relieve the itchiness, fever, and discomfort of chickenpox:
Use cool wet compresses or give baths in cool or lukewarm water every 3 to 4 hours for the first few days. Oatmeal bath products, available at supermarkets and drugstores, can help to relieve itching. (Baths do not spread the rash.)Pat (don't rub) the body dry.Put calamine lotion on itchy areas (but don't use it on the face, especially near the eyes).Serve foods that are cold, soft, and bland because chickenpox in the mouth may make drinking or eating difficult. Avoid feeding your child anything highly acidic or especially salty, like orange juice or pretzels.Ask your doctor or pharmacist about pain-relieving creams to apply to sores in the genital area.Give your child acetaminophen regularly to help relieve pain if your child has mouth blisters.Ask the doctor about using over-the-counter medication for itching.Never use aspirin to reduce pain or fever in kids with chickenpox because aspirin has been associated with the serious disease Reye syndrome, which can lead to liver failure and even death.
As much as possible, discourage kids from scratching. This can be difficult for them, so consider putting mittens or socks on your child's hands to prevent scratching during sleep. In addition, trim fingernails and keep them clean to help lessen the effects of scratching, including broken blisters and infection.
Most chickenpox infections require no special medical treatment. But sometimes, there are problems. Call the doctor if your child:
has fever that lasts for more than 4 days or rises above 102° F (38.8° C)has a severe cough or trouble breathinghas an area of rash that leaks pus (thick, discolored fluid) or becomes red, warm, swollen, or sorehas a severe headacheis unusually drowsy or has trouble waking uphas trouble looking at bright lightshas difficulty walkingseems confusedseems very ill or is vomitinghas a stiff neckCall your doctor if you think your child has chickenpox and you have a question or are concerned about a possible complication. The doctor can guide you in watching for complications and in choosing medication to relieve itching.
If taking your child to the doctor, let the office know in advance that your child might have chickenpox. It's important to try to avoid exposing other kids in the office — for some of them, a chickenpox infection could cause severe complications.
Healthy kids who have had chickenpox do not need the vaccine — they usually have lifelong protection against the illness.
Treatment
A virus causes chickenpox, so the doctor won't prescribe antibiotics. However, antibiotics may be required if the sores become infected by bacteria. This is pretty common among kids because they often scratch and pick at the blisters.
The antiviral medicine acyclovir may be prescribed for people with chickenpox who are at risk for complications. The drug, which can make the infection less severe, must be given within the first 24 hours after the rash appears. Acyclovir can have significant side effects, so it is only given when necessary. Your doctor can tell you if the medication is right for your child.
BackContinueDealing With DiscomfortTo help relieve the itchiness, fever, and discomfort of chickenpox:
Use cool wet compresses or give baths in cool or lukewarm water every 3 to 4 hours for the first few days. Oatmeal bath products, available at supermarkets and drugstores, can help to relieve itching. (Baths do not spread the rash.)Pat (don't rub) the body dry.Put calamine lotion on itchy areas (but don't use it on the face, especially near the eyes).Serve foods that are cold, soft, and bland because chickenpox in the mouth may make drinking or eating difficult. Avoid feeding your child anything highly acidic or especially salty, like orange juice or pretzels.Ask your doctor or pharmacist about pain-relieving creams to apply to sores in the genital area.Give your child acetaminophen regularly to help relieve pain if your child has mouth blisters.Ask the doctor about using over-the-counter medication for itching.Never use aspirin to reduce pain or fever in kids with chickenpox because aspirin has been associated with the serious disease Reye syndrome, which can lead to liver failure and even death.
As much as possible, discourage kids from scratching. This can be difficult for them, so consider putting mittens or socks on your child's hands to prevent scratching during sleep. In addition, trim fingernails and keep them clean to help lessen the effects of scratching, including broken blisters and infection.
Most chickenpox infections require no special medical treatment. But sometimes, there are problems. Call the doctor if your child:
has fever that lasts for more than 4 days or rises above 102° F (38.8° C)has a severe cough or trouble breathinghas an area of rash that leaks pus (thick, discolored fluid) or becomes red, warm, swollen, or sorehas a severe headacheis unusually drowsy or has trouble waking uphas trouble looking at bright lightshas difficulty walkingseems confusedseems very ill or is vomitinghas a stiff neckCall your doctor if you think your child has chickenpox and you have a question or are concerned about a possible complication. The doctor can guide you in watching for complications and in choosing medication to relieve itching.
If taking your child to the doctor, let the office know in advance that your child might have chickenpox. It's important to try to avoid exposing other kids in the office — for some of them, a chickenpox infection could cause severe complications.
Chickenpox and Pregnancy. Pregnant woman has had chickenpox before the pregnancy
Chickenpox and Pregnancy
Pregnant women and anyone with immune system problems should not be near a person with chickenpox. If a pregnant woman who hasn't had chickenpox in the past contracts it (especially in the first 20 weeks of pregnancy), the fetus is at risk for birth defects and she is at risk for more health complications than if she'd been infected when she wasn't pregnant. If she develops chickenpox just before or after the child is born, the newborn is at risk for serious health complications. There is no risk to the developing baby if the woman develops shingles during the pregnancy.
If a pregnant woman has had chickenpox before the pregnancy, the baby will be protected from infection for the first few months of life, since the mother's immunity gets passed on to the baby through the placenta and breast milk.
Those at risk for severe disease or serious complications — such as newborns whose mothers had chickenpox at the time of delivery, patients with leukemia or immune deficiencies, and kids receiving drugs that suppress the immune system — may be given varicella zoster immune globulin after exposure to chickenpox to reduce its severity.
Pregnant women and anyone with immune system problems should not be near a person with chickenpox. If a pregnant woman who hasn't had chickenpox in the past contracts it (especially in the first 20 weeks of pregnancy), the fetus is at risk for birth defects and she is at risk for more health complications than if she'd been infected when she wasn't pregnant. If she develops chickenpox just before or after the child is born, the newborn is at risk for serious health complications. There is no risk to the developing baby if the woman develops shingles during the pregnancy.
If a pregnant woman has had chickenpox before the pregnancy, the baby will be protected from infection for the first few months of life, since the mother's immunity gets passed on to the baby through the placenta and breast milk.
Those at risk for severe disease or serious complications — such as newborns whose mothers had chickenpox at the time of delivery, patients with leukemia or immune deficiencies, and kids receiving drugs that suppress the immune system — may be given varicella zoster immune globulin after exposure to chickenpox to reduce its severity.
The first signs of chicken pox,chicken pox- symptoms
The first signs of chicken pox set off very sudden and there are cases when the chicken pox patient will actually have no symptoms at all. A mild fever, some weakness and tiredness are the first chicken pox symptoms that you will feel, after the incubation period is over. Soon after this signs of chicken pox, a rash will start to appear on your skin. At first only some areas of your body will be affected by these tiny, red spots. The main target of chicken pox rash are at first the chest and back. Then, just in a couple of hours it will spread all over your body. Even places like the mouth and scalp will eventually be affected by chicken pox.
The next step that will happen in your child' s chicken pox case is that the rash will start to develop into blisters that are filled with fluid. Eventually, these chicken pox blisters will dry, form scabs and fall off. Children are more fortunate than adults when it come to chicken pox symptoms, as well as chicken pox complications caused by infection. If there is the case of infection in a child that suffers from chicken pox, rest assure that this will be a very mild case, with no side- effect. On the other hand, if an adult suffers from chicken pox, mainly because he/ she did not have this disease when being a child, things can get more complicated.
So, as you can see, chicken pox has few symptoms at the beginning of the disease. When the rash appears, and then the blisters, then things get more clear. However, you will not know if your child has been infected with chicken pox for more than two weeks, which is the incubation period of the chicken pox virus.
The next step that will happen in your child' s chicken pox case is that the rash will start to develop into blisters that are filled with fluid. Eventually, these chicken pox blisters will dry, form scabs and fall off. Children are more fortunate than adults when it come to chicken pox symptoms, as well as chicken pox complications caused by infection. If there is the case of infection in a child that suffers from chicken pox, rest assure that this will be a very mild case, with no side- effect. On the other hand, if an adult suffers from chicken pox, mainly because he/ she did not have this disease when being a child, things can get more complicated.
So, as you can see, chicken pox has few symptoms at the beginning of the disease. When the rash appears, and then the blisters, then things get more clear. However, you will not know if your child has been infected with chicken pox for more than two weeks, which is the incubation period of the chicken pox virus.
Tuesday, February 2, 2010
Сhild is vaccinated against chicken pox
Unless your child is vaccinated against chicken pox, it's almost guaranteed that at some point he or she will come down with this common childhood illness. Fortunately, chicken pox (or varicella) is short lived, lasting about a week. Chicken pox is spread through airborne droplets and is extremely contagious, occurring in about 85% of children under twelve. The good news is that while it is extremely contagious, once children have chicken pox they are immune for life.
How do you know your child has chicken pox? "The first thing the parent sees is the rash," explains infectious diseases specialist, Dr. Ron Gold. "The rash often starts on the face or body and then may spread out onto the arms or legs. It's a very typical rash that doesn't look like anything else. It's a little blister with redness around the base of it. Unfortunately for the child it bothers them more than other rashes because it's very itchy." Other symptoms include fever, runny nose, fatigue, and decreased appetite.
Acetaminophen may help a child feel more comfortable and reduce the fever. But never give a child A-S-A, such as aspirin, as there is a link between it and the sometimes fatal, Reye's syndrome. Dr. Gold suggests that baths can be of great help and that "some children prefer cool water to relieve the itching with starch in it. Some prefer it to be hot so it's worth experimenting."
As for complications, Gold says, "in young children, the most common complication is an infection from scratching the pox. You can't usually stop young ones from scratching, but you can keep their fingernails short so that they don't cause any damage."
Although rare, chicken pox can have more serious complications such as pneumonia and encephalitis. If you're concerned that your child's illness is taking a turn for the worse, contact your child's doctor, but do so by phone so as to avoid exposing those children and adults with low immune systems to the virus. And if your child is an adolescent when exposed contact your doctor, as serious illness is more common in older children and adults.
Finally, although not widely used, there is a chicken pox vaccine now available. For more information about it, talk to your child's doctor.
How do you know your child has chicken pox? "The first thing the parent sees is the rash," explains infectious diseases specialist, Dr. Ron Gold. "The rash often starts on the face or body and then may spread out onto the arms or legs. It's a very typical rash that doesn't look like anything else. It's a little blister with redness around the base of it. Unfortunately for the child it bothers them more than other rashes because it's very itchy." Other symptoms include fever, runny nose, fatigue, and decreased appetite.
Acetaminophen may help a child feel more comfortable and reduce the fever. But never give a child A-S-A, such as aspirin, as there is a link between it and the sometimes fatal, Reye's syndrome. Dr. Gold suggests that baths can be of great help and that "some children prefer cool water to relieve the itching with starch in it. Some prefer it to be hot so it's worth experimenting."
As for complications, Gold says, "in young children, the most common complication is an infection from scratching the pox. You can't usually stop young ones from scratching, but you can keep their fingernails short so that they don't cause any damage."
Although rare, chicken pox can have more serious complications such as pneumonia and encephalitis. If you're concerned that your child's illness is taking a turn for the worse, contact your child's doctor, but do so by phone so as to avoid exposing those children and adults with low immune systems to the virus. And if your child is an adolescent when exposed contact your doctor, as serious illness is more common in older children and adults.
Finally, although not widely used, there is a chicken pox vaccine now available. For more information about it, talk to your child's doctor.
History of Chickenpox.What Is Chickenpox?
Chickenpox is an infectious disease caused by the varicella zoster virus (VZV), a virus that is part of the herpes virus family. The illness results in a blister-like rash, itching, tiredness, and fever.
Before the introduction of the varicella vaccine in 1995, approximately 4 million cases of chickenpox were reported annually, including 4,000 to 9,000 hospitalizations and 100 deaths. Since the introduction of the vaccine, the number of cases has dropped dramatically.
What Are the Symptoms?
Symptoms of chickenpox can begin with 1 to 2 days of low-grade fever and tiredness. These early symptoms do not always occur before the chickenpox rash develops.
Early symptoms are followed by itchy blisters that first appear on the trunk, face, and scalp. These blisters can spread over the entire body, causing between 250 and 500 itchy blisters. The chickenpox rash can appear in three or more successive waves. Eventually, the blisters crust over.Chickenpox is believed to have been first described (discovered) by Giovanni Filippo during the 1500s in Italy. In the 1600s, an English physician named Richard Morton gave the name chickenpox to what he thought was a milder form of smallpox. It is believed that in the 1700s, William Heberden (another English physician), was the first physician to prove that chickenpox was actually different from smallpox.Treatment Options for Chickenpox
In most cases, chickenpox can be treated at home. Home treatment involves relieving symptoms as the body fights the virus. It is important to regularly look at the skin and to make sure that the blisters are not becoming infected. It is also important to monitor other symptoms, such as fever.
Before the introduction of the varicella vaccine in 1995, approximately 4 million cases of chickenpox were reported annually, including 4,000 to 9,000 hospitalizations and 100 deaths. Since the introduction of the vaccine, the number of cases has dropped dramatically.
What Are the Symptoms?
Symptoms of chickenpox can begin with 1 to 2 days of low-grade fever and tiredness. These early symptoms do not always occur before the chickenpox rash develops.
Early symptoms are followed by itchy blisters that first appear on the trunk, face, and scalp. These blisters can spread over the entire body, causing between 250 and 500 itchy blisters. The chickenpox rash can appear in three or more successive waves. Eventually, the blisters crust over.Chickenpox is believed to have been first described (discovered) by Giovanni Filippo during the 1500s in Italy. In the 1600s, an English physician named Richard Morton gave the name chickenpox to what he thought was a milder form of smallpox. It is believed that in the 1700s, William Heberden (another English physician), was the first physician to prove that chickenpox was actually different from smallpox.Treatment Options for Chickenpox
In most cases, chickenpox can be treated at home. Home treatment involves relieving symptoms as the body fights the virus. It is important to regularly look at the skin and to make sure that the blisters are not becoming infected. It is also important to monitor other symptoms, such as fever.
Chickenpox Twice
People often wonder whether it is possible to get chickenpox twice. The answer is yes, although this is rare. For most people, one infection is thought to develop lifelong immunity. Getting chickenpox twice is more common in people who are immunocompromised.
For most people, following chickenpox, the varicella zoster virus moves into nerves located in the spinal cord. Here, the virus rests and, in some cases, causes no symptoms again. In other cases, the varicella virus can reactivate, causing herpes zoster (shingles).
For most people, following chickenpox, the varicella zoster virus moves into nerves located in the spinal cord. Here, the virus rests and, in some cases, causes no symptoms again. In other cases, the varicella virus can reactivate, causing herpes zoster (shingles).
The Chicken Pox Vaccine
Chicken pox is a common infection caused by the varicella virus. This gallery shows pictures of chicken pox lesions in various stages and on different types of skin.There is a risk of developing shingles after getting the chicken pox vaccination but that risk is very low. A recent study showed that children who received the vaccination later were at a higher risk of developing shingles.
The first chicken pox vaccine is normally given after a child's first birthday, and the second vaccination is given between 4 and 6 years old. The second vaccination can actually be given 3 months after the first.
The study also showed that children with asthma and developmental disorders were also at a higher risk of developing shingles.
Since wide-spread vaccination began in the mid-1990's, the incidence of chicken pox has decreased dramatically. Varivax is the live-virus vaccine that produces persistent immunity against chicken pox. The virus used for the vaccine is known as the Oka strain. It is an attenuated strain meaning it is much weaker than naturally occurring varicella. This weaker virus infects the cells and replicates in the bloodstream causing the immune system to develop antibodies to fight it off. In most cases this infection is subclinical, meaning it does not produce symptoms. If a vaccinated person gets chicken pox, the disease is mild 95% of the time. The length of time these antibodies stay effective is controversial, but it appears that vaccination does confer long-lasting immunity.
The side effects of the chicken pox vaccine are usually mild and include:
Low-grade fever
Mild discomfort at the vaccination site
A limited rash at the vaccination site (about 3-5 lesions)
Who Should Get the Chicken Pox Vaccine
The chicken pox vaccine is recommended for all children between the ages of 18 months and adolescence who have not yet had chicken pox. Studies have also shown that the vaccine can prevent chicken pox or reduce the severity of the illness if it is given with 3-5 days of exposure to an infected person. Some experts recommend that any healthy adult who does not have a known history of chicken pox infection be vaccinated. Some studies also show that the chicken pox vaccine may prevent or reduce the severity of shingles in adults over 55 years of age who had a childhood bout of chicken pox.
Who Should NOT Get the Chicken Pox Vaccine
Because the chicken pox vaccine contains a live virus it is not recommended for the people with the following:
Pregnant women
History of previous chicken pox infection
Compromised immune system
Exposure to the varicella virus less than 21 days previously
Allergy to neomycin
Transfusion of IgG or other blood products within the past 5 months
Administration of aspirin or aspirin-containing products within the past 6 weeks
Chicken Pox Vaccine Controversies
Certain aspects of vaccination for chicken pox are either unknown or are under study. The two controversial aspects are vaccination of infants and the need for booster shots. Currently there are no recommendations or studies on infants who develop chicken pox during the first year of life. In older patients booster shots may be needed to maintain adequate levels of antibodies to prevent shingles.
The first chicken pox vaccine is normally given after a child's first birthday, and the second vaccination is given between 4 and 6 years old. The second vaccination can actually be given 3 months after the first.
The study also showed that children with asthma and developmental disorders were also at a higher risk of developing shingles.
Since wide-spread vaccination began in the mid-1990's, the incidence of chicken pox has decreased dramatically. Varivax is the live-virus vaccine that produces persistent immunity against chicken pox. The virus used for the vaccine is known as the Oka strain. It is an attenuated strain meaning it is much weaker than naturally occurring varicella. This weaker virus infects the cells and replicates in the bloodstream causing the immune system to develop antibodies to fight it off. In most cases this infection is subclinical, meaning it does not produce symptoms. If a vaccinated person gets chicken pox, the disease is mild 95% of the time. The length of time these antibodies stay effective is controversial, but it appears that vaccination does confer long-lasting immunity.
The side effects of the chicken pox vaccine are usually mild and include:
Low-grade fever
Mild discomfort at the vaccination site
A limited rash at the vaccination site (about 3-5 lesions)
Who Should Get the Chicken Pox Vaccine
The chicken pox vaccine is recommended for all children between the ages of 18 months and adolescence who have not yet had chicken pox. Studies have also shown that the vaccine can prevent chicken pox or reduce the severity of the illness if it is given with 3-5 days of exposure to an infected person. Some experts recommend that any healthy adult who does not have a known history of chicken pox infection be vaccinated. Some studies also show that the chicken pox vaccine may prevent or reduce the severity of shingles in adults over 55 years of age who had a childhood bout of chicken pox.
Who Should NOT Get the Chicken Pox Vaccine
Because the chicken pox vaccine contains a live virus it is not recommended for the people with the following:
Pregnant women
History of previous chicken pox infection
Compromised immune system
Exposure to the varicella virus less than 21 days previously
Allergy to neomycin
Transfusion of IgG or other blood products within the past 5 months
Administration of aspirin or aspirin-containing products within the past 6 weeks
Chicken Pox Vaccine Controversies
Certain aspects of vaccination for chicken pox are either unknown or are under study. The two controversial aspects are vaccination of infants and the need for booster shots. Currently there are no recommendations or studies on infants who develop chicken pox during the first year of life. In older patients booster shots may be needed to maintain adequate levels of antibodies to prevent shingles.
Chicken Pox and its Stages
Chickenpox mostly affects children and is caused by the varicella-zoster virus. Later in life the same virus can cause Herpes Zoster. Humans are the only carriers of this virus.
Chicken Pox is also known as Varicella is an acute and highly contagious disease. People who have never had chickenpox can get infected just by being in a room with someone who has the disease. If one member in the family gets chickenpox, he usually will infect another family member unless precautions are taken.
A person who gets infected will take 14 to 21 days before the chickenpox rash starts appearing on him. Once infected the person can infect another person from up to 48 hours before the initial rash and remains infective until all the blisters have burst all the crusts have disappeared. The chickenpox from an infected person spreads by -
Airborne droplets that are spayed when they cough or sneeze
Direct contact with discharge from the blisters of the skiComing in contact with Herpes or Shingles infection The most common cause of infection is through the respiratory droplets that are inhaled by another person.
Everyone who has not had the disease is at risk of getting it; if they come in contact with an infected person. It affects all races and both sexes are equally prone to it.
This viral disease is characterized by dry itching (pruritus) and a skin rash with fluid-filled blisters that burst and form crusts. The onset of the chickenpox rash may be preceded by a day of mild fever and weakness. The infectious period lasts from about three days before the rash appears until all the blisters have formed scabs.
Chicken Pox and its Stages
Most children have been infected with the virus by the age of 10. After infection, lifelong immunity against recurrent infection is usually present.
The Varicella Zoster virus of chickenpox can also cause 'Herpes Zoster or Shingles.' Normally once the chickenpox infection settles down the virus rests in the roots of the ganglia next to the spinal cord and becomes dormant or inactive. However sometimes the virus may suddenly later in life decide to become active again and can cause the painful lesions of Shingles.
These pocks break out in many without any illness or previous sign: in others they are preceded by a little degree of chillness, lassitude, cough, disturbed sleep, wandering pains, loss of appetite, and feverishness for three days. On the first day of the eruption they are reddish. On the second day there is at the top of most of the a very small bladder, about the size of a millet-seed.
Chicken Pox is also known as Varicella is an acute and highly contagious disease. People who have never had chickenpox can get infected just by being in a room with someone who has the disease. If one member in the family gets chickenpox, he usually will infect another family member unless precautions are taken.
A person who gets infected will take 14 to 21 days before the chickenpox rash starts appearing on him. Once infected the person can infect another person from up to 48 hours before the initial rash and remains infective until all the blisters have burst all the crusts have disappeared. The chickenpox from an infected person spreads by -
Airborne droplets that are spayed when they cough or sneeze
Direct contact with discharge from the blisters of the skiComing in contact with Herpes or Shingles infection The most common cause of infection is through the respiratory droplets that are inhaled by another person.
Everyone who has not had the disease is at risk of getting it; if they come in contact with an infected person. It affects all races and both sexes are equally prone to it.
This viral disease is characterized by dry itching (pruritus) and a skin rash with fluid-filled blisters that burst and form crusts. The onset of the chickenpox rash may be preceded by a day of mild fever and weakness. The infectious period lasts from about three days before the rash appears until all the blisters have formed scabs.
Chicken Pox and its Stages
Most children have been infected with the virus by the age of 10. After infection, lifelong immunity against recurrent infection is usually present.
The Varicella Zoster virus of chickenpox can also cause 'Herpes Zoster or Shingles.' Normally once the chickenpox infection settles down the virus rests in the roots of the ganglia next to the spinal cord and becomes dormant or inactive. However sometimes the virus may suddenly later in life decide to become active again and can cause the painful lesions of Shingles.
These pocks break out in many without any illness or previous sign: in others they are preceded by a little degree of chillness, lassitude, cough, disturbed sleep, wandering pains, loss of appetite, and feverishness for three days. On the first day of the eruption they are reddish. On the second day there is at the top of most of the a very small bladder, about the size of a millet-seed.
Monday, February 1, 2010
Child is infected with chicken pox.
The most contagious time occurs when the person is manifesting the cold-like symptoms. This happens usually two to five days before the rash appears. As a result the time in which someone is most contagious occurs before the person even knows he has chicken pox. After the rash appears, the person is infectious for about five days or until all the lesions have begun crusting over.
Humans are the only animals that get chicken pox. So the only way to catch it is by being around a person who is infected. The virus is spread through secretions and by tiny droplets, so sharing saliva, sneezing, and coughing are good ways to pass the virus from one person to another.
Children with immune problems can have significant problems if infected with chicken pox. These include those children infected with HIV, the virus that causes AIDS, those with cancer, those on steroids for other illnesses, and newborn babies.
There is not a lot that can be done to completely eliminate the symptoms once a child is infected with chicken pox. Most treatment is then aimed at trying to alleviate the pain, itch, and fever associated with chicken pox.
Humans are the only animals that get chicken pox. So the only way to catch it is by being around a person who is infected. The virus is spread through secretions and by tiny droplets, so sharing saliva, sneezing, and coughing are good ways to pass the virus from one person to another.
Children with immune problems can have significant problems if infected with chicken pox. These include those children infected with HIV, the virus that causes AIDS, those with cancer, those on steroids for other illnesses, and newborn babies.
There is not a lot that can be done to completely eliminate the symptoms once a child is infected with chicken pox. Most treatment is then aimed at trying to alleviate the pain, itch, and fever associated with chicken pox.
The "pocks" of chicken-pox.
Chicken-pox is also usually a mild disease which, however, may be quite alarming in the early stages because it may be mistaken for smallpox. Besides that, the early symptoms of headache and pain in the back are extremely severe, and make the patient and parents think that a far graver disease is present.
The "pocks" of chicken-pox are widely scattered on the body, and are more liable to be present on the chest and back and abdomen than they are on the hands, feet and head, which latter distribution is characteristic of smallpox. However, few patients with chicken-pox escape a few pocks on the face, and almost invariably these leave slight scars. In fact, chicken-pox is more liable to leave a depressed scar than smallpox, and so far as I know, there is no way to prevent this scarring.
So far as treatment is concerned, chicken-pox needs little consideration. The disease is self-limited and the treatment is of slight importance. The patient need be kept in bed only about 24 hours, and aside from a light catharsis, the only treatment required is usually local treatment of the pocks. These should be softened with vaseline or some similar substance, and by all odds the patient should be kept from scratching them when they are healing. It is very difficult to prevent this because itching is frequently marked and very distressing.
Calomine or zinc oxide lotion have been recommended to stop this. Scratching these pocks almost invariably results in scarring.
The quarantine for chicken-pox is not very rigidly enforced, and quite properly so. Most school authorities allow children with chicken-pox to return to school 24 hours after the pocks have healed.
The disease is one of the most contagious in the world, but so mild that attempts to prevent epidemics are hardly worth the trouble that they require. In fact, all such attempts are usually entirely fruitless.
The "pocks" of chicken-pox are widely scattered on the body, and are more liable to be present on the chest and back and abdomen than they are on the hands, feet and head, which latter distribution is characteristic of smallpox. However, few patients with chicken-pox escape a few pocks on the face, and almost invariably these leave slight scars. In fact, chicken-pox is more liable to leave a depressed scar than smallpox, and so far as I know, there is no way to prevent this scarring.
So far as treatment is concerned, chicken-pox needs little consideration. The disease is self-limited and the treatment is of slight importance. The patient need be kept in bed only about 24 hours, and aside from a light catharsis, the only treatment required is usually local treatment of the pocks. These should be softened with vaseline or some similar substance, and by all odds the patient should be kept from scratching them when they are healing. It is very difficult to prevent this because itching is frequently marked and very distressing.
Calomine or zinc oxide lotion have been recommended to stop this. Scratching these pocks almost invariably results in scarring.
The quarantine for chicken-pox is not very rigidly enforced, and quite properly so. Most school authorities allow children with chicken-pox to return to school 24 hours after the pocks have healed.
The disease is one of the most contagious in the world, but so mild that attempts to prevent epidemics are hardly worth the trouble that they require. In fact, all such attempts are usually entirely fruitless.
Prognosis.Prevention.
Most cases of chickenpox run their course within a week without causing lasting harm. However, there is one long-term consequence of chickenpox that strikes about 20% of the population, particularly people 50 and older. Like all herpes viruses, the varicellazoster virus never leaves the body after an episode of chickenpox, but lies dormant in the nerve cells, where it may be reactivated years later by disease or age-related weakening of the immune system. The result is shingles (also called herpes zoster), a painful nerve inflammation, accompanied by a rash, that usually affects the trunk or the face for 10 days or more. Especially in the elderly, pain, called postherpetic neuralgia, may persist at the site of the shingles for months or years. Two relatively newer drugs for treatment of shingles have become available. Both valacy-clovir (Valtrex) and famciclovir (Famvir) stop the replication of herpes zoster when administered within 72 hours of appearance of the rash. The effectiveness of these two drugs in immunocompromised patients has not been established, and Famvir was not recommended for patients under 18 years.
A substance known as varicella-zoster immune globulin (VZIG), which reduces the severity of chickenpox symptoms, is available to treat immunocompromised children and others at high risk of developing complications. It is administered by injection within 96 hours of known or suspected exposure to the disease and is not useful after that. VZIG is produced as a gamma globulin from blood of recently infected individuals.
A substance known as varicella-zoster immune globulin (VZIG), which reduces the severity of chickenpox symptoms, is available to treat immunocompromised children and others at high risk of developing complications. It is administered by injection within 96 hours of known or suspected exposure to the disease and is not useful after that. VZIG is produced as a gamma globulin from blood of recently infected individuals.
Alternative treatment,practitioners.
Alternative practitioners seek to lessen the discomfort and fever caused by chickenpox. Like other practitioners, they suggest cool or lukewarm baths. Rolled oats (Avena sativa) in the bath water help relieve itching. (Oats should be placed in a sock, that is turned in the bath water to release the milky antiitch properties.) Other recommended remedies for itching include applying aloe vera, witch hazel, or herbal preparations of rosemary (Rosmarinus officinalis) and calendula (Calendual officinalis) to the blisters. Homeopathic remedies are selected on a case by case basis. Some common remedy choices are tartar emetic (antimonium tartaricum), windflower (pulsatilla),
Treatment
With children, treatment usually takes place in the home and focuses on reducing discomfort and fever. Because chickenpox is a viral disease, antibiotics are ineffective against it.
Applying wet compresses or bathing the child in cool or lukewarm water once a day can help the itch. Adding four to eight ounces of baking soda or one or two cups of oatmeal to the bath is a good idea (oatmeal bath packets are sold by pharmacies). Only mild soap should be used in the bath. Patting, not rubbing, is recommended for drying the child off, to prevent irritating the blisters. Calamine lotion (and some other kinds of lotions) also help to reduce itchiness. Because scratching can cause blisters to become infected and lead to scarring, the child's nails should be cut short. Of course, older children need to be warned not to scratch. For babies, light mittens or socks on the hands can help guard against scratching.
If mouth blisters make eating or drinking an unpleasant experience, cold drinks and soft, bland foods can ease the child's discomfort. Painful genital blisters can be treated with an anesthetic cream recommended by a doctor or pharmacist. Antibiotics often are prescribed if blisters become infected.
Fever and discomfort can be reduced by acetaminophen or another medication that does not contain aspirin. Aspirin and any medications that contain aspirin or other salicylates must not be used with chickenpox, for they appear to increase the chances of developing Reye's syndrome. The best idea is to consult a doctor or pharmacist if unsure about which medications are safe.
Immunocompromised chickenpox sufferers are sometimes given an antiviral drug called acyclovir (Zovirax). Studies have shown that Zovirax also lessens the symptoms of otherwise healthy children and adults who contract chickenpox, but the suggestion that it should be used to treat the disease among the general population, especially in children, is controversial.
Applying wet compresses or bathing the child in cool or lukewarm water once a day can help the itch. Adding four to eight ounces of baking soda or one or two cups of oatmeal to the bath is a good idea (oatmeal bath packets are sold by pharmacies). Only mild soap should be used in the bath. Patting, not rubbing, is recommended for drying the child off, to prevent irritating the blisters. Calamine lotion (and some other kinds of lotions) also help to reduce itchiness. Because scratching can cause blisters to become infected and lead to scarring, the child's nails should be cut short. Of course, older children need to be warned not to scratch. For babies, light mittens or socks on the hands can help guard against scratching.
If mouth blisters make eating or drinking an unpleasant experience, cold drinks and soft, bland foods can ease the child's discomfort. Painful genital blisters can be treated with an anesthetic cream recommended by a doctor or pharmacist. Antibiotics often are prescribed if blisters become infected.
Fever and discomfort can be reduced by acetaminophen or another medication that does not contain aspirin. Aspirin and any medications that contain aspirin or other salicylates must not be used with chickenpox, for they appear to increase the chances of developing Reye's syndrome. The best idea is to consult a doctor or pharmacist if unsure about which medications are safe.
Immunocompromised chickenpox sufferers are sometimes given an antiviral drug called acyclovir (Zovirax). Studies have shown that Zovirax also lessens the symptoms of otherwise healthy children and adults who contract chickenpox, but the suggestion that it should be used to treat the disease among the general population, especially in children, is controversial.
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