It has been a long, long, long while since I posted anything to do with medicine. So here is a little sneak peak.
- Varicella Zoster Virus is a member of the herpes family and causes chicken pox.
- Chicken Pox is highly contagious
- Transmission is airborn and through contact to open skin wounds or transmitted through saliva.
- The incubation period is around 2 weeks – symptoms of a fever, skin rash or runny nose may occur during this time.
- People are infectious 1-2 days before the rash appears up until the lesions form a crust.
- It is usually a mild disease but can be a lot more sever in adults
- The rash is made up of different stages lesions on the skin, after a while the open wound will crust over.
- The chicken pox spots (lesions) will usually appear on the scalp or the trunk first and from there spread over the limbs, sometimes inside the mouth and vagina.
Chicken Pox is diagnosed through the visible characteristics and the clinical signs and symptoms. In Unsure cases a direct immunofluorescence, serology, culture or PCR on a scraping from a lesion may be required to confirm.
- Complications which may occur in adult cases are:
-secondary bacterial infection
- In women who are pregnant it can cause problems.
- Majority of cases are of children under ten.
- Chicken Pox Virus can remain in the body, and at a later stage, it can cause shingles. Shingles are usually brought on at a time of great stress or when the immune system is compromised.
- Shingles are infectious like chicken pox, and can be painful. When the virus is no longer dormant in the body clusters of painful lesions, this may be accompanied by a headache, fever and an overall sick feeling. Symptoms usually last 2-5 weeks, but the pain can persist up to a year.
How To Treat?
- Calamine Lotion, Baths and Analgesics are used to sooth and calm the itch and pain.
- For patients older than 12, Aciclovir is used for patients who are at increased risk of severe infection, it may also be used in patients with compromised immune systems like Famciclovir and valaciclovir to limit the spread.
- If the mentioned drugs above are given within a few days of diagnosis it can prevent it from coming back again.
- In pregnant women, neonates, premature babies or immunosuppressed people, Immune Gloulin should be given within 96 hours.
Do you Want an example?
Was That a Yes?
A registered nurse working in an HDU (High Dependency Unit) notified the Infection Control Nurse that her daughter had chickenpox. The daughter’s skin lesions had appeared five days prior to the notification. The staff member did not have a history of having had the disease and was in the second trimester of her second pregnancy. Blood tests on the RN for antibody to Varicella zoster virus (VZV) were negative. She was rostered off work and given varicella zoster specific immunoglobulin by her obstetrician. A few days later she developed chickenpox. She subsequently gave birth to a normal infant weighing 3050 g.
What the hell?
a. Why was the immunoglobulin injection not effective in preventing chickenpox in this case?
The Pregnant woman’s daughter had developed lesions 5 days prior to her notifying the hospital, by the time that the woman had the injection of Immune Globulin it was already too late to be affective as it should be given within 96 hours.
The GP would have recommended Varicella Zoster Immune Globulin since the woman was pregnant, not immune to chicken pox and had contact with her daughter while she was infectious. Immune Globulin doesn’t stop chicken Pox from developing, it is believed to makes the virus symptoms not as serious
b. What are the risks to the baby if chickenpox is contracted during pregnancy?
The risks to the baby can be a range of things depending on the treatment and the timing of catching chicken Pox.
According to the NHS, the National Health Service, In the United Kingdom, if Chicken pox is caught up to the 28th week of pregnancy the baby may die or develop Foetal Varicella Syndrome, which can damage the baby’s skin, eyes, limbs, brain, bladder or bowl. If chickenpox is caught between 28 weeks and 36 weeks, the Baby will be symptom free when it is born, but the virus will lie dormant until the first few years of life where it may become shingles. After 36 weeks the Baby may be infected and born with chickenpox.
c. What infection control issue does this raise for the other staff and patients? How can it
best be handled?
As a health care professional the pregnant woman should have had the Varicella vaccine before she got pregnant .
During the time that the woman still attended work, when she was interacting with her daughter who was infectious for 7 days (5 days of the rash and the two days before it appeared) before she alerted the hospital. This woman may have passed along the virus to the patients she works with,
d. How could this type of situation be avoided?
The pregnant woman could have had herself and her child vaccine against chicken pox and she could have notified the hospital immediately.
Reference List :
- National Health Service ,UK, Viewed on the 15/05/2013. Last update was : 22/10/2012 http://www.nhs.uk/chq/Pages/1109.aspx?CategoryID=54&SubCategoryID=137
- “Chicken Pox and Pregnancy ” Reproductive Care, Novia Scotia, Viewed 15/05, updated from June 2005 http://www.gov.pe.ca/photos/original/doh_repcar_varz.pdf.
- Bishop, Pand Lee, G. “Microbiology and Infection Control for health professionals ” 5th edition, 2013