Chicken pox - causative agent, symptoms, treatment, prevention

The causative agent of chickenpox

Varicella zoster virus is one of many types of herpes virus. It was first discovered and studied in 1911. It was discovered that upon initial contact of the human body with it, chickenpox occurs. With repeated infections with the same virus, a person becomes ill with herpes zoster. The well-known “cold” on the lips is also caused by a herpes virus of the same type, but slightly different from the chickenpox virus.

The herpes virus is a tiny round particle measuring only 300 nanometers. It consists of a core, represented by a DNA molecule, and a shell. The main property of the chickenpox pathogen is its volatility and instability in the external environment. Under the influence of heat and light, it dies within 5-7 minutes, but this does not prevent the virus released by sneezing, breathing or coughing from spreading many meters around and settling in the body of another person, who in this case is affected by chickenpox.

Pathogen and causes

The causative agent of chickenpox is the Varicella Zoster virus (herpes virus type 3), belonging to the Herpesviridae family.

Morphologically, the viral particles of the varicella-zoster and herpes viruses are indistinguishable and have nothing in common with the smallpox viruses. The varicella zoster virus, like other viruses of the herpes group, is a DNA-containing virus and is sensitive to ether. The development of the virus begins in the nuclei of infected cells. The first visible stage of nuclear lesions is expressed in the accumulation of dense osmiophilic masses around the circumference of the nucleoli.

The first virus-like particles appear in the center of a fine-grained mass that is highly osmiophilic. They are surrounded by a membrane and have a rounded central body. From the nucleus they penetrate the nuclear membrane and cytoplasm. In the cytoplasm, viral particles are usually surrounded by a double membrane. The extracellular virus is always surrounded by a double membrane.

The chickenpox virus has a cytopathic effect, which can be detected no earlier than the 5-6th day from the moment of infection; it is focal in nature; In the foci of degeneration, round cells that refract light are formed.

The entry point for infection in chickenpox is the mucous membrane of the respiratory tract. Entering with wet droplets through the air, the virus is fixed by the cellular elements of the mucous membrane.

The incubation period lasts 14 days. In rare cases, fluctuations in the incubation period can range from 11 to 21 days. During the incubation period, the virus multiplies in the mucous membrane of the respiratory tract, penetrates into the blood and hematogenously spreads; an allergic condition occurs in the body. The patient becomes infectious to others in the last 1-2 days of incubation. At this time, enanthema develops on the mucous membrane of the respiratory tract (pharynx, larynx, trachea). The contents of the bubbles are dispersed by droplets, which is facilitated by increased secretory activity and increased irritability of the affected mucous membranes.

After the incubation period, a rash appears, spreading over almost the entire surface of the body.

In the first days of illness, the virus is found in the contents of the vesicles and in the blood of patients.

Bubbles that appear during the initial rash usually go through all stages of development. With subsequent rashes, the blisters become smaller and many of them do not fully develop. The initial reaction of the body is hyperergic (necrosis of the epidermis in the places where chickenpox blisters appear).

Fever and other general phenomena usually accompany a profuse mass rash, which can be observed at the beginning, during the course of the disease, or at the end of it.

Prevalence

There is no country in the world where people do not get chickenpox. In 80-85% of cases, the chickenpox virus affects children under seven years of age. Staying a child most of the day in the same room with a dozen peers, infrequent ventilation, crowding in children's groups, and close contact of children with each other contribute to infection, which occurs through airborne droplets. It is enough for one child to catch the virus and the entire kindergarten group becomes ill.

Children who do not attend kindergarten are at risk of contracting the chickenpox virus at school. Adults usually become infected from their children. This rarely happens, since an adult most likely already had chickenpox in childhood and has a strong immunity to it.

There is a clear seasonality of the chickenpox disease: more than 80% of infections occur in the cold season.

How does chickenpox begin in a child?

Rarely do any children manage to avoid the unpleasant itchy blisters that chickenpox generously bestows on children.
The attitude towards this disease is twofold - some mothers are afraid of it like fire, others are even glad that the child suffered from it in childhood and earned strong immunity (see photos of chickenpox in children below). A dangerous virus with the beautiful name Varicella-Zoster (VZV), discovered in 1958, affects people at any age, but chickenpox is more severe in adolescence and adulthood.

How does infection occur?

Chickenpox (varicella) is transmitted from a sick person to a healthy person by air (through the air from neighboring rooms, through ventilation holes), by airborne droplets (by sneezing and coughing) and transplacentally (from a sick mother to the fetus). Contact transmission of infection has not been proven. This means that you cannot become infected with chickenpox through objects, towels, or clean dishes. The chickenpox virus does not live on them. You also cannot become infected from a person who is immune to chickenpox if he has been in contact with someone who is sick. For example, a kindergarten teacher who had chickenpox as a child and was in contact with a sick child will not infect anyone at home. The chickenpox virus is not carried on hands or clothing.

After entering through the nose or mouth, particles of the varicella zoster virus penetrate into the cells of the mucous membrane of the upper respiratory tract and actively divide, reproducing similar particles - virions. This period lasts from 11 days to three weeks, and is called incubation.

The incubation period of chickenpox, like any infectious disease, means that the pathogen is in the body, but there are no clinical manifestations of the disease yet. During incubation, the virus is not transmitted; a sick person becomes infectious 1-2 days before the first element of the rash appears. From this moment, the height of the chickenpox disease begins.

After reproduction, the chickenpox virus penetrates the lymphatic vessels and is sent to nearby lymph nodes (submandibular, cervical, occipital). This is where virions accumulate. This corresponds to the prodromal period. Then, from the 4-5th day of illness, a period of viremia begins - the spread of virus particles through the bloodstream into the epithelial cells of the skin and to the nerve ganglia. The circulation of the chickenpox virus in the blood is short-term (this is typical for all infectious diseases) and is accompanied by a deterioration in the general condition of the patient, a rise in temperature, weakness, and chills.

The herpes virus has a tropism (compatibility, affinity, preference) for epithelial cells of the skin and internal organs and for nervous tissue. With the blood flow, it enters the cells of the surface layer of the skin, where rashes appear, going through several successive stages. Some of the virions rush to the ganglia (nodes) of the trigeminal nerves (nerves innervating the face, upper part of the forehead, jaw). This is a favorite habitat for herpes viruses. Here, in the ganglia of the trigeminal nerve, viruses can exist in a latent (dormant) state for many years, without in any way interfering with a person’s living a normal life. With a decrease in immunity, various diseases, or cold, they “wake up” and the person becomes ill with herpes zoster.

In severe forms of chickenpox, the virus affects the epithelial tissues (surface) of internal organs - the liver, spleen and others. In the case of ordinary chickenpox, the virus is limited to the skin.

After entering the skin, virions destroy epidermal cells during their life processes, forming a typical element of a chickenpox rash - a vesicle (vesicle). Inside the bubble there is a large concentration of herpes viruses, so a person is infectious until all the bubbles have passed, and for another three days after the last one has dried.

Thus, quarantine for a person in contact with a patient with chickenpox lasts 21 days. After this period, a conclusion can be drawn as to whether infection has occurred. If so, then isolating such a patient can stop the further spread of chickenpox.

Symptoms

The incubation period is usually 14-16 (10-21) days. After chickenpox, the virus remains in the sensory nerve ganglia, where it can later reactivate and cause herpes zoster. Symptoms of chickenpox appear as an itchy, vesicular rash, usually starting on the face and upper torso and initially accompanied by fever and general malaise. The presence of a vesicular rash on the scalp is a characteristic symptom of chickenpox. The elements of the rash look like small (several millimeters in diameter) blisters rising above the reddened surface of the skin, filled with a clear liquid (which contains the chickenpox virus). As the rash gradually spreads to the body and limbs, the first blisters (vesicles) dry out. Usually all crusts disappear after 7-10 days.

Complications after an illness

Although varicella (chickenpox) is a relatively benign childhood disease and is rarely considered a significant public health problem, the course of the disease can sometimes be complicated by pneumonia or encephalitis caused by the VZV virus, which can lead to lasting effects or death. The most dangerous are bullous, hemorrhagic or gangrenous forms of chickenpox. Disfiguring scars may result from secondary infection of the vesicles; in addition, necrotizing fasciitis or sepsis may occur as a result of such infection.

Complications of chickenpox are recorded with a frequency of 5-6%, they serve as a reason for hospitalization in 0.3-0.5% of patients. Of the total number of cases, this is several thousand per year. 30% of complications are neurological, 20% are pneumonia and bronchitis, 45% are local complications (for example, streptaderma), accompanied by the formation of scars on the skin.

Other serious manifestations include pneumonia (more common in adults), rarely congenital varicella syndrome (caused by chickenpox contracted during the first 20 weeks of pregnancy) and perinatal varicella in newborns whose mothers develop chickenpox between 5 days before and 48 hours after. childbirth In patients with immunodeficiencies, including HIV infection, chickenpox is severe. Severe chickenpox and death may also occur in children taking steroid hormones for asthma. In general, complications and deaths from chickenpox are more common in adults than in children.

In 10-20% of those who have recovered from the disease, the varicella zoster virus remains in the nerve ganglia for life and subsequently causes another disease that can manifest itself at an older age - herpes zoster or herpes zoster. Herpes zoster is characterized by prolonged and painful neuralgic pain, and also has a number of complications in the form of damage to the nervous system and internal organs - paralysis, visual impairment. People with herpes zoster can be a source of chickenpox infection.

Classification of chickenpox

According to its form, chickenpox is divided into:

I. Typical chickenpox (with predominant damage by the virus to the skin and mucous membranes of the oral cavity), which, according to the severity of the manifestations of the infectious process, is divided into:

Easy
Moderate
Heavy

II. Atypical chickenpox, including varieties:

A rudimentary form of chickenpox. Occurs in young children if, after contact with a patient with chickenpox, gamma globulin, an immune drug containing antibodies to many viruses, was immediately administered. Then the clinical picture of chickenpox is blurred, the child’s well-being does not suffer, skin rashes are limited to a few vesicles, and the virus is stopped.
Visceral or generalized form of chickenpox. Children, often newborns, with severe chronic diseases that weaken the immune system, or taking drugs that suppress it, become ill. The visceral form occurs with severe symptoms of intoxication caused by the virus, fever, and involvement of internal organs in the process: lungs, intestines, liver. Possible death of the baby.
Hemorrhagic form of chickenpox. In adults and children with congenital diseases of the hemostatic system responsible for blood clotting, in children with leukemia (blood cancer). With this form of chickenpox, the contents of the rash blisters become bloody - hemorrhagic - on the 2nd-3rd day of the disease. The blisters burst and bleed, nasal and stomach bleeding occur)
The gangrenous form of chickenpox is often a continuation of the hemorrhagic form and can occur in children weakened by serious illnesses. The formation of areas of necrosis (death) of the skin around the vesicles is characteristic; deep ulcerative defects are formed in place of the opened vesicles, merging with each other. A bacterial infection occurs, aggravating the process. Prognosis – unfavorable

Along the way, chickenpox happens:

complicated chicken pox;
uncomplicated chickenpox.

Course of the disease

Through the upper respiratory tract, the infection enters the body and causes a disease such as chickenpox. The periods of the disease make it possible to distinguish several main stages:

Symptoms of a typical form of chickenpox in children

Chickenpox is a childhood infection because 80% of people become infected with it in childhood, primary school and preschool. In almost 95% of cases, chickenpox in children occurs in a mild typical form and goes through several periods:

Incubation. Lasts from the moment of infection with the virus until the onset of the first symptoms (from 11 to 23 days). The child’s health does not suffer, there are no symptoms
Prodromal period. Lasts no more than 3-4 days. The child is worried about low-grade fever (up to 38C), weakness, lethargy, apathy, sleep and appetite disturbances. Sometimes redness of the throat, diarrhea, and vomiting appear. More often, the prodromal period of chickenpox in children occurs with unexpressed symptoms of intoxication or without them at all.
Rash period. It begins with a rise in body temperature to 38-38.5 C and the appearance of a rash on the face and head. Soon elements of the rash affect the entire body, except the palms and feet. At first, the rashes are not numerous (10-20 elements), but very quickly there are more of them (100-150).

The chickenpox rash element goes through three stages of development:

The stage of the spot is roseola.
The vesicular stage of the vesicle.
The drying stage followed by the formation of a crust.

Rashes in the first stage are round and oval spots, red and pink, with a clear outline, dense to the touch. Spot sizes are 2 – 5 mm. Within 24 hours, the spot turns into a blister filled with a clear or cloudy liquid. The bubbles (vesicles) are dense to the touch, similar to small drops of dew on the surface of the body. Sometimes they are surrounded by a pink corolla. The blisters contain live varicella-zoster herpes viruses, which can be detected under a light microscope. On day 2-3, the liquid in the bubble resolves, and in its place a brown crust forms, which soon dries out and falls off. If you do not peel off the crust, there will be no trace left in place of the element. Small light pigment spots at the site of the rash disappear after 2 months, they are almost invisible.

The chickenpox rash is characterized by a wave-like appearance, that is, each new portion of the elements “sprinkles” every 2-3 days and is accompanied by a short-term rise in temperature. Therefore, you can see elements of the rash at different stages of development simultaneously (spots, blisters, crusts are adjacent to each other). Other infections do not have this feature.

A rash on the mucous membrane of the mouth, palate, tongue, and larynx is called enanthema. It often accompanies skin rashes and may not manifest itself in any way. Sometimes there is discomfort when swallowing and increased salivation. Babies may be fussy and refuse to breastfeed. Occasionally, the cornea of the eyes and conjunctiva, the inner side of the eyelids, are affected. The rash is of particular concern here.

The chickenpox rash is very, unbearably itchy.

The rash in girls can occur on the mucous membrane of the labia, where the rashes are few and do not bother much.

The period of rashes in children lasts from 8 to 10 days. The cervical, submandibular and occipital lymph nodes become enlarged and may hurt.

Recovery period. It begins after the last wave of rashes. 3-5 days after the appearance of the last element of the rash, the person becomes non-infectious; when the crusts fall off, he is considered recovered.

Dr. Komarovsky – chickenpox in children

Dr. Komarovsky - how to treat chickenpox in children?

Chickenpox: stages of the disease

Chickenpox goes through 4 stages of development:

Stage I : Small red spots appear on the skin that are very itchy. When scratched, these spots increase in size:

Stage II : red spots turn into blisters filled with purulent fluid:

Stage III : blisters burst and ulcerative wounds form in their place:

Stage IV : a new wave of rashes begins, resulting in red spots, blistering neoplasms, and ulcerative wounds on the child’s body:

Features of chickenpox in adults

In adults, the disease is more severe and is fraught with complications. This is due to the fact that the child has antibodies to the chickenpox virus in his blood, received from the mother (if the mother has had it herself and is immune). Antibodies are special proteins produced in the body in response to the introduction of an infectious agent; they are specific to each pathogen. When the chickenpox virus enters the body, the corresponding antibody proteins combine with antigens (proteins) on the surface of viruses with which they are similar and inactivate (neutralize) them. Therefore, it is easier for a child’s body, which has antibodies to chickenpox, to overcome the disease.

The adult immune system does not have the means to combat the chickenpox virus. There are few or no specific antibodies received from the mother that can stop the virus. Many other antibodies and immune complexes accumulated throughout life circulate in the blood. This is why chickenpox is severe in adults.

During both the prodromal period and the rash stage, severe weakness and febrile temperature (38.5-39.0 C) are disturbing. There are more elements of the rash in adults and itching is more pronounced. On the mucous membranes of the oral cavity and labia in adult women, enanthema is very itchy.

There is swelling of the tonsils, pain in the pharynx, enlarged, painful lymph nodes of the neck, axillary, submandibular.

The duration of the disease is the same as in children.

Video - chickenpox in adults

Diagnosis: chicken pox. What to do next?

In the absence of aggravating factors, such as early age (less than 1 year), severe symptoms of poisoning (febrile temperature, refusal to eat and drink), symptoms of damage to the nervous system, as well as suspicion of an immunodeficiency state, home bed rest is usually prescribed, recommended for the entire period of rashes. If the disease is severe, high fever persists for more than a day, hospitalization is necessary.

If the patient receives medications (cytostatics or corticosteroids), the risk of bacterial infection is high, so hospitalization in the infectious diseases department is also indicated.

Quarantine for chickenpox

To fight the virus and restore strength, you must adhere to a special diet. A dairy-vegetable diet is prescribed, which is gentle mechanically and thermally. Especially in case of damage to the oral mucosa, so as not to further injure the elements of the rash and prevent the development of a bacterial infection. You should not force-feed your child. Your appetite will return on its own after some time.

Drinking plenty of water will bring relief from your condition . You can offer the patient compotes, neutral mineral water without gases, warm jelly in small portions, but often. This will help compensate for fluid loss at elevated temperatures and reduce symptoms of intoxication.

Drinking plenty of fluids will help relieve your condition.

It is important to pay attention to hygiene; it is recommended to change bed linen more often and regularly wet clean the patient’s room. The child is allowed to bathe if the temperature remains at normal values until all the crusts fall off.

Classification of chickenpox

Type	Severity	Flow
Typical	Lightweight	Smooth (without complications)
Atypical	Medium-heavy	The appearance of complications (adding bacterial infection or manifestation of chronic diseases)
Generalized (with damage to internal organs)	Heavy	The appearance of complications (adding bacterial infection or manifestation of chronic diseases)

Treatment

Depending on the child’s condition and the course of the disease, the doctor determines treatment tactics along with general recommendations for patient care. Antiviral drugs are not prescribed for mild and moderate forms of the disease. For severe disease, the following are recommended: acyclovir, vidarabine. But only a doctor can diagnose the form of the disease and calculate the dose of medication!

It is better to start treatment after examination by a doctor.

Mandatory symptomatic therapy includes:

antipyretics for fever, if the temperature rises above 38.5 degrees (approved antipyretic medications for children: ibuprofen and paracetamol);
It is recommended to treat the rash with aniline dyes (1-2% solution of brilliant green or methylene blue) twice a day, applying the product pointwise to each element of the rash, making sure not to damage the cap of the bottle;
It is recommended to rinse the oral cavity with herbal decoctions (chamomile, sage), use antiseptics (tantum verde, hexoral, miramistin, a weak solution of potassium permanganate, as well as a solution of hydrogen peroxide 3%) or solutions with an anti-inflammatory effect (tonsilgon);
severe itching and agitation of the child can be alleviated by prescribing antihistamines (including such as fenistil, zyrtec, etc.);
In cases of symptoms of a bacterial infection, it is recommended to prescribe antibiotics.

Video - How to treat chickenpox in adults

How to distinguish chickenpox from other infections?

There are many infectious diseases accompanied by rashes and symptoms of intoxication. Already at the stage of examining the patient and collecting anamnesis (data about the history of the disease), the doctor can accurately establish the diagnosis. Most infections have the same general symptoms: fever, weakness, nausea. The rash varies from disease to disease. It is by the nature of the skin rashes that the doctor diagnoses a particular disease and the virus that has affected the patient.

The chickenpox rash is polymorphic, that is, different elements are present on the body at the same time: in the stage of spots, blisters and crusts. This is due to the jerky addition of new portions of elements, accompanied by a rise in temperature. First, spots appear on the skin of the face and scalp under the hair. The rash is located randomly on the torso, on the skin of the palms and feet. Elements of different sizes, on average 2 - 5 mm, the skin between them is not changed. During the first day from the moment of appearance, red spots transform into bubbles with transparent or cloudy contents, sometimes with a pink halo around the edge. After a couple of days, the vesicles dry out and become covered with a brown crust. Soon it disappears. In place of the torn off crust, a scar or hole remains.

The chickenpox rash is very itchy, and scratching the skin is dangerous due to the risk of causing a bacterial infection. The rash lasts from 7 to 10 days.

The general condition of typical chickenpox does not suffer much.

The measles rash usually appears 3-5 days after the onset of the disease. A few days before skin rashes, small whitish spots with a pink halo around the circumference appear on the mucous membrane of the cheeks, gums, and tongue against the background of bright red, swollen mucosa - Filatov-Koplik spots.

This is a distinctive feature of measles. The elements of the rash are dense red spots protruding above the surface of the skin, resembling irregularly shaped nodules. Sometimes they merge with each other. A rash begins to appear behind the ears, on the nose, and neck.

The next day, the rash covers the shoulders and chest, moving to the back and stomach. By the third day, the entire limbs are covered with a nodular rash. After 4-5 days, the rash quickly begins to darken, acquire a brown color (pigmentation stage), and slightly peel off. Moreover, the rash darkens in the same sequence as it began - from top to bottom. After 1.5 weeks the rash goes away. The staged nature of the rash (the face, chest, back, abdomen, and limbs are affected in turn) is a distinctive feature of measles.

During the entire period of skin rashes, a patient with measles has an elevated temperature.

The patient's condition is serious, he suffers from a strong dry cough, runny nose, stomatitis, headache, and festering eyes. Colitis with bloody stools and vomiting may occur due to fever.

The rash with rubella is small-spotted. All elements are the same size, light red in color, do not merge with each other, do not itch or peel. The rash is not abundant and is located on the unchanged skin of the extensor surfaces of the arms and legs, around large joints, on the back, and buttocks. The first elements appear on the face. After 3-5 days, the rash disappears without a trace.

3-4 days before the rash, an enanthema appears on the oral mucosa, hard and soft palate, behind the cheeks, which differs from Filatov-Koplik spots in measles: rashes 3-4 mm in size, pink, not white.

Rubella is easily tolerated, the temperature does not exceed 37.5°C. There is minor cough, runny nose and conjunctivitis. A distinctive feature of rubella is enlarged, painful occipital lymph nodes, which can be easily felt by bending the patient’s head.

The rash with scarlet fever is pink, pinpointed. Appears on the cheeks, abdomen, lateral surfaces of the torso, flexor surfaces of the arms, legs, armpits and groin folds on reddened skin. In the folds of the skin, the rash is more abundant, the skin color becomes bright red. Some dots turn into bubbles with cloudy contents. There is no itching.

The rash does not last more than a week and leaves no traces. A distinctive feature of a scarlet fever rash is its appearance on reddened skin; on the face, elements appear on flushed cheeks, but does not affect the nasolabial triangle, which remains pale in color. The characteristic appearance of a scarlet fever patient: a puffy face with bright red cheeks, a pale, sharply defined nasolabial triangle, shiny eyes.

When the rash disappears, the patient begins to develop pityriasis-like peeling (the skin comes off in scales from the ears, torso, limbs and face). So-called lamellar peeling occurs on the palms and soles. It begins with the appearance of cracks. The skin comes off in layers. A distinctive feature of scarlet fever is a specific sore throat, which affects the tonsils, pharynx, and uvula. They turn intensely red (“fire in the pharynx”), but the redness is clearly demarcated and does not affect the hard palate.

The condition of this disease is moderate, intoxication goes away after 5-7 days. A rash with meningitis (inflammation of the soft meninges caused by meningococcus) occurs on the 1-2 day of the disease, covers the entire body, especially pronounced on the thighs and buttocks.

The elements are small hemorrhages of varying sizes (hemorrhages) from round to irregular stellate with a focus of necrosis in the center of the element. Where the rashes are abundant, the elements can merge with each other, forming large areas of necrosis (death of the skin), in place of which scars remain. The disease is severe, characterized by repeated vomiting that does not bring relief, high fever, lethargy, convulsions, and loss of consciousness. In infants, the hallmark of the disease is a high-pitched, monotonous cry.

In a mild form, meningococcal infection occurs like a common runny nose, does not have a rash and may go unnoticed.

A rash with herpes zoster (herpes) appears after 2-3 days of the prodromal period, characterized by a rise in temperature, pain and burning along the affected nerves. Most often, the elements of the rash in the form of reddish nodules measuring 2-6 mm are located in the projection of the intercostal nerves and in the lumbar region against the background of slightly reddened skin. The nodules very quickly become bubbles with transparent contents, then dry out to form a crust. They can merge. They disappear in 7-14 days, leaving slight pigmentation. Pain along the nerve fibers after an exacerbation of herpes often persists for up to 1-2 months, the general condition does not suffer significantly. If a person who does not have antibodies to the herpes virus comes into contact with the patient, he will get chickenpox.

The rash with streptoderma, caused by the introduction of a streptococcal infection into the skin, consists of small yellowish vesicles on exposed areas of the body, face, soles, and feet. The skin under the rash is hyperemic. More often the rash is located in the area of the nasolabial triangle, near the nostrils and lips. The bubbles are filled with a cloudy liquid, their size quickly increases to 1.5 cm, then they merge with each other. Then the bubbles burst and become covered with yellow crusts. The skin at the site of the rash is itchy. The elements of the rash are not numerous, located at a great distance from one another. This rash is called “impetigo”, it has polymorphism, but does not have a jerky appearance, as with chickenpox. The general condition of the patient with streptoderma is satisfactory; only in small children is a rise in body temperature possible.

Features of the rash in children with chickenpox

The first reddish spots resemble mosquito bites and appear on the body. However, the rash quickly gains new positions, spreading over the arms and legs, then moves to the face and scalp.

The appearance of skin rashes quickly changes - red dots turn into fluid-filled blisters, which burst after 8-10 hours and cause unbearable itching.

After a while they dry out and become crusty, but new ones appear, going through the same cycle. On any part of the body, you can simultaneously see all stages of the development of rashes, and each subsequent one causes a jump in temperature.

Bubbles, the number of which reaches several hundred and even thousands, can affect the mucous membranes of the mouth, genitals, eyes, and in severe cases even cover the soles and palms of the hands.

The period of rash lasts from 4 to 8 days, after which recovery begins. The yellow-brown crusts that appear in place of the bubbles disappear after about a week, leaving no trace.

But this is only if the mother helped the baby survive a period of severe itching - she prevented scratching and infection from getting into the wound. Premature tearing of the cortical layer can lead to the appearance of a “pockmark” that can remain for life.

Five days after the last bubble appears, the baby is considered not contagious and can be taken out for a walk.

Diagnosis of chickenpox

The diagnosis of chickenpox is made when the patient is examined by a doctor at home. The skin rash characteristic of the disease and the indication of contact with a patient with chickenpox about three weeks ago leave no doubt about the correctness of the diagnosis.

In the laboratory, the disease is confirmed by the detection of herpes viruses in a smear of the liquid from the vesicle under a light or electron microscope. Serological diagnostic methods are used:

ELISA (immunofluorescent analysis);
RSK (compliment binding reaction).

Laboratory diagnostic methods are required for an atypical form of chickenpox or a blurred clinical picture of chickenpox. In children, in most cases, a visual examination is sufficient to make a diagnosis.

Prevention

Parents who decide to vaccinate their child use this method as a disease prevention measure. But vaccination does not provide a 100% guarantee that the child will not get sick: perhaps, if infected, the disease will occur in a milder form.

OKAVAX VACCINE

When vaccinated, a live vaccine is used, which contains a weakened virus. Children are vaccinated after one year according to the vaccination calendar. It is believed that the period after vaccination protects a child for approximately 10 years. In addition, vaccines are widely used:

1Belgium (VARILRIX);

2Japan (OKAWAX).

Vaccines such as VARIVAX and ZOSERVAX . Belgium produces a vaccine called MMRV . It is combined and the child is vaccinated simultaneously against infections such as measles, rubella, chickenpox, and mumps.

A woman can get vaccinated before a planned pregnancy. This happens if she has not previously suffered from this disease in childhood, that is, she does not have antibodies against the virus. In addition to vaccination, chickenpox can be prevented in an emergency. This should happen no later than 72 hours after contact with a sick person. If a woman is pregnant and needs emergency prophylaxis, Zostevir , which is an immunoglobulin, is administered.

Despite the fact that chickenpox is a relatively safe disease for healthy children, all doctor's recommendations must be followed.

VIDEO: Chickenpox – School of Dr. Komarovsky

Chickenpox – School of Dr. Komarovsky

Chickenpox in children: incubation period, first symptoms, treatment + 60 PHOTOS

Treatment

A patient with chickenpox does not need specific treatment. The patient's condition can be alleviated by the following measures:

Maintaining hygiene. The child must be bathed with soap, especially the perineal area and external genitalia to prevent secondary infection by bacteria.
Wearing cotton clothing to reduce sweating, which increases itching.
Keeping children's short-cut nails clean will minimize the risk of infection when scratching the skin.
Taking warm baths with a weak solution of potassium permanganate daily will help relieve itching.
Lubricating stains and bubbles with a solution of brilliant green (brilliant green) 1% or 2% potassium permanganate.
Rinsing the mouth with antiseptics (furacillin, potassium permanganate) in the presence of enanthema.
Limiting the diet from spicy, solid foods.
Antihistamines (fenistil, fenkarol, Erius, Zyrtec, Cetrin) in age-specific dosages help cope with itching in both adults and children.
Antiviral drugs (isoprinosine, Valtrex, acyclovir) are used in adults for severe chickenpox and complications. The typical, mild form of chickenpox in children does not require medication.
The addition of bacterial flora is an indication for the prescription of antibiotics.

The introduction of human immunoglobulin can alleviate the condition and increase nonspecific immunity.

When does the disease occur?

Due to its low resistance to external factors, the pathogen is not active all year round: low temperatures in winter and sunlight in summer easily deactivate the virus. Therefore, chickenpox is seasonal - local foci of the disease occur especially often in spring and autumn. Moreover, the peak of infection occurs from March to May.

Most of the population has antibodies to the virus that causes the disease, since many suffer from chickenpox in childhood. The same virus, present in small quantities in the body, causes a fever on the lip, the so-called “cold,” when the immune system is weakened.

Most often, children from 2 to 5 years old become ill - at this time the number of contacts of the child increases, he begins to attend kindergarten, where, in fact, infection occurs in most cases.

Chickenpox in children under one year of age is unlikely. Up to 6 months, the child is protected from the disease by the mother’s immune cells, transmitted to him during intrauterine development, so chickenpox practically does not occur in newborns. When breastfeeding, immunity to the disease is possible for longer, depending on the duration of feeding.

Adults who did not have chickenpox as children may develop chickenpox during their lifetime if they have not received the chickenpox vaccine.

Why is chickenpox dangerous for pregnant women?

A woman infected with the chickenpox virus during pregnancy passes it on to her fetus. The prognosis for the fetus depends directly on the period at which the infection occurred. When a pregnant woman who does not have immunity to the virus gets chickenpox in the first trimester, the pregnancy may end in miscarriage. Developmental defects in the child are possible. However, this disease is not an indication for termination of pregnancy. The woman is given the drug human immunoglobulin (a protein isolated from the blood of healthy people that contains antibodies to various infectious agents) to reduce the risk of infection of the fetus. Subsequently, it will be necessary to take tests to determine fetal pathologies, ultrasound screening and amniocentesis (sampling of amniotic fluid for analysis).

In women who become infected with the chickenpox virus in the second trimester of pregnancy, when the placenta has formed, the danger to the fetus is minimal (2% or less). A healthy placenta protects its inhabitant from viral invasion. Immunoglobulin treatment is prescribed only in cases where the risk to the mother or child outweighs the risk of side effects from the administration of the substance.

The chickenpox virus is most dangerous for the fetus of a pregnant woman who becomes ill a few days before giving birth. In this case, the child does not have antibodies to chickenpox and becomes ill in the coming weeks after birth. The course of the disease is severe and death is possible. Immunoglobulin administered to the baby can alleviate the condition and avoid the death of the newborn.

Women who get chickenpox 1-2 weeks before giving birth have a chance to give birth to a child with a set of specific antibodies produced by her body and transferred through the placenta to the baby. In this case, chickenpox in a newborn is not so severe, so obstetricians can specifically delay spontaneous childbirth to allow the mother to pass on antibodies to the baby. His own immune system is still immature, and is not capable of producing them itself.

The disease occurs in a pregnant woman in the same way as in any adult, with the same symptoms. To get rid of itching, local remedies are prescribed, since many antipruritic drugs are contraindicated for them.

Chickenpox in HIV-infected patients

Chickenpox in HIV-positive people is not common, since the immunodeficiency virus is mainly contracted in adulthood, when chickenpox is already behind us.

The incubation period lasts a week. Throughout all periods of the disease, high fever with chills, muscle pain, weakness, and headache are a concern. There are many rashes, they last up to a month, and the person is contagious for a long time. A secondary bacterial infection is associated with the skin rash. The likelihood of complications – pneumonia, damage to internal organs – increases many times over.

Treatment of chickenpox in HIV-infected patients includes intravenous administration of large doses of acyclovir, a specific drug for herpes infection.

Allergy or chickenpox?

Sometimes parents who encounter a rash in their baby for the first time can confuse these diseases. How to distinguish allergic reactions from such a serious illness as chicken pox? The symptoms and treatment of these diseases are quite different, although both present with a rash.

With chickenpox, the first pimples appear on the scalp and face. Only then does the rash move and cover the entire body. Allergies are characterized by a clear localization of acne formation. When the spots become bubbles with liquid and are surrounded by reddened halos, characteristic of chickenpox, it is completely impossible to confuse.

There is one more feature you should know. Unlike allergies, chickenpox is characterized by a wave-like course. One stage of rash superimposes on another. Thus, pink spots, bubbles with liquid, and crusts appear on the body. Sometimes chicken pox is so intense that the rash leaves no “living” space on the body. This is particularly troubling.

Complications of chickenpox

Complications of chickenpox occur in people with weak immune defenses and in atypical forms of the disease. They can be caused either by the chickenpox virus itself or by a bacterial infection attached to the viral one.

The herpes virus in chickenpox can cause many diseases. Let's look at them in order.

1. Encephalitis - inflammation of the gray and white matter of the brain and its membranes. The cerebellum is often affected. A complication develops at the end of the period of rash. Symptoms of encephalitis appear as a result of inflammatory swelling of the brain tissue and are neurological in nature:

gait disturbance, staggering;
paralysis of limbs; may be one-sided;
tremor (shaking) of the hands and feet;
ataxia – loss of coordination of movements;
nystagmus – uncontrolled movements of the eyeballs;
slow speech
general cerebral symptoms: vomiting, headache, convulsions, lethargy, apathy, high fever.

Encephalitis can develop even with a mild course of typical chickenpox. Requires hospital treatment. The prognosis for life is favorable.

2. Paralysis of the optic nerve and facial nerves. May be characterized by numbness, lack of movement and sensitivity of the corresponding muscles. The complication goes away in 3-5 days.

3. Myelitis – inflammation of the spinal cord. A severe complication characterized by loss of functions of organs receiving innervation from certain segments of the spinal cord. Both the brain substance itself inside the spinal canal and the nerve roots and fibers extending from it become inflamed. Symptoms depend on the height of the lesion, the following are noted:

paralysis of arms and legs;
breathing disorder;
the functions of the pelvic organs are disrupted (delayed excretion of feces and urine or, conversely, incontinence);
Trophic disorders are characteristic: bedsores and non-healing ulcers on the skin.

It is treated inpatiently, the prognosis for life depends on the severity of the disease and the level of the spinal cord affected by the inflammatory process. The most severe is upper cervical myelitis, leading to complete paralysis of the body muscles and death from paralysis of the respiratory muscles.

4. Bacterial complications of chickenpox:

stomatitis (inflammation of the oral cavity, accompanied by pain when chewing, swelling of the mucous membrane);
laryngitis (rough cough, fever);
bronchitis, pneumonia (cough, shortness of breath, fever. Rare);
vulvovaginitis (inflammation of the labia and vaginal opening in girls);
balanoposthitis (inflammation of the foreskin and head of the penis in boys);
perineal phlegmon (purulent inflammation of the subcutaneous tissue);
dermatitis (with secondary bacterial infection of skin rash elements);
bursitis (inflammation of the intraarticular bursa. Characteristically severe);
thrombophlebitis (inflammation of the veins and the formation of blood clots. Rare).

Severe complications of chickenpox are treated in a hospital setting.

Complications

Complications from chickenpox are more common in infants or adults, because the virus is highly active in their bodies and causes more harm. The negative consequences of chickenpox include:

inflammation of nerve endings, disturbances in the functioning of the central nervous system;
the appearance of papules on the surface of the lungs, which makes breathing difficult and can cause pneumonia;
acute decrease in protective function, due to which the body becomes vulnerable to bacteria and fungi;
disruption of heart function, development of heart failure.

Complications often develop in cases where the parents of a sick child or the adults themselves ignore the first signs of chickenpox and allow prolonged fever.

Vaccination, chickenpox vaccination and prevention

Prevention of chickenpox comes down to interrupting the spread of the virus. A sick person in contact with a chickenpox patient is required to isolate for 21 days. If the exact date of contact is known, isolation lasts from 11 to 21 days, since in the first ten days from the moment of infection the person does not shed the virus.

A child who has had chickenpox is allowed to visit a child care facility 8 days after the last bubble appears.

If the chickenpox virus is detected in a child in the kindergarten, he must be isolated from other children and placed in a separate room. Afterwards, it is enough to ventilate and wash the room. Disinfection is not required, since the virus is unstable and will die within 10-15 minutes.

During an outbreak of chickenpox in a children's institution, a morning filter is necessary: the kindergarten health worker examines all children who come to the institution for skin rashes, red throat, and enlarged lymph nodes. The temperature is measured.

It has been known since ancient times that you only get chickenpox once in a lifetime, and it is better to get it in childhood, when it is mild. Therefore, many parents deliberately allow their child to come into contact with someone with chickenpox. Perhaps this action is justified, but in medical practice there are no recommendations regarding this.

Vaccinations and vaccinations against chickenpox

In Russia, the chickenpox vaccine has been used since 2008. Trademarks of imported vaccines have been patented: “Okavax” - produced in France and “Varilrix” - Belgium. Both vaccines contain live, attenuated varicella-zoster herpes viruses.

In Russia, vaccination against chickenpox is not mandatory. According to the national vaccination schedule against chickenpox, children from 2 years of age (acceptable from one year) and adults at any age should be vaccinated. It is mandatory to vaccinate all children from 2 years of age against chickenpox when traveling to places of public recreation and children's health.

The vaccine is contraindicated for pregnant women. You should get vaccinated 2-3 months before planning a pregnancy. If conception occurs immediately after vaccination, then there are no indications for termination of pregnancy.

The vaccine is recommended to be administered after contact with a patient with chickenpox for 72 hours; during incubation, a large number of antibodies to viruses will have time to form. The disease either will not develop, or will pass easily, without complications.

The vaccine is administered subcutaneously in the shoulder once to children from 2 to 13 years of age. Adults will require a second administration after 6-10 weeks.

Induration and redness may sometimes form on the skin at the injection site. After vaccination against chickenpox, delayed reactions may occur in 1-3 weeks in the form of a rash similar to chickenpox on the skin and mucous membranes. This is a normal phenomenon caused by immunological reactions in the body. After a few days, this chickenpox-like condition goes away on its own.

Before getting vaccinated against chickenpox, you should consult a doctor, as the vaccine has contraindications. It should not be done for any acute diseases, leukemia, AIDS, patients on hormone therapy, recent administration of human immunoglobulin, blood transfusions, or an allergic reaction to the drug neomycin.

Effectiveness of vaccination

Other than vaccination, there are no countermeasures to control the spread of chickenpox or the incidence of herpes zoster in susceptible populations. Varicella-zoster immune globulin and herpes medications are very expensive and are mainly used as prophylaxis after exposure to infection or to treat chickenpox in people at high risk of developing severe disease. Due to the extreme contagiousness of chickenpox, almost all children and young adults in the world are affected. Each year from 1990 to 1994, before the chickenpox vaccine was available, there were about 4 million cases of the disease in the United States. Of this number, approximately 10,000 patients required hospitalization and 100 patients died.

Varicella vaccines using the Oka strain of VZV have been on the market since 1994. Positive results regarding safety, effectiveness and cost-effectiveness analyzes supported the rationale for their introduction into childhood immunization programs in a number of industrialized countries. After following study populations for 20 years in Japan and 10 years in the United States, more than 90% of immunocompetent individuals vaccinated in childhood were still protected against varicella.

About 95% of children will produce antibodies in response to vaccination, and 70-90% will be protected from infection for at least 7-10 years after vaccination. According to Japanese researchers (Japan is the first country in which the vaccine was registered), immunity against chickenpox lasts 10-20 years. It is safe to say that the circulating virus promotes “re-vaccination” of vaccinated people, increasing the duration of immunity.

Research suggests that emergency vaccination may also be effective - when the vaccine is given within 96 hours (preferably 72 hours) of exposure to VZV, at least 90% protective efficacy can be expected. Treatment for chickenpox in persons who have received the vaccine is much easier than in those who have not been vaccinated.

Immunity after chickenpox

A person who has had chickenpox develops a stable, lifelong immunity, which will immediately stop the chickenpox virus after entering the body.

It is extremely rare for chickenpox to reoccur, mainly among people with an immunodeficiency state. After vaccination, immunity from chickenpox is acquired in 90% of cases. The chickenpox virus that has entered the body of a person who has had the disease will no longer cause chickenpox. In this case, another disease occurs - herpes zoster, characterized by stages of exacerbations and remissions, which is not severe.

Incubation period

The incubation period is the time when the patient has no external or internal symptoms of the disease, but is already capable of infecting others. The spread of the chickenpox virus begins 20-25 hours before the first symptoms of chickenpox appear, and continues for another 5-6 days after the skin rash has completely disappeared.

The presence of an incubation period makes the disease even more dangerous, because the patient is not aware of the presence of infection in his body and comes into contact with other children or adults, which leads to the spread of the infection.