When It's Not Just a Rash (Part 1). Herpes Zoster / VZV and Chicken Pox

The Herpes Zoster / VZV and chicken pox. Symptoms, complications and treatments of chicken pox.

Many people think of chicken pox being an illness of the very young - a rite of passage for school age children.  Within this country and in industrialized nations, this would have been the case until 1995 when the varicella vaccine (chicken pox vaccine) was approved within the United States.  In developing countries, chicken pox is frequently considered a severe illness among the elderly.

What is chicken pox?  Chicken pox is caused by varicella zoster virus (VZV), also known as herpes zoster, zoster virus, varicella virus and human herpes virus type 3 (HHV-3).  The term "herpes zoster" is often used when the virus has reactivated and become shingles

Chicken pox is an extremely contagious disease which can be spread through the air by coughing or sneezing, or by direct contact with the fluids from the rash.  Though it is not usually considered a fatal illness, it is now believed to cause about one third of all stroke cases in children.  Adults make up 75% - 80% of all fatalities from chicken pox and the complications from chicken pox are more severe in adults.  Fatalities are more common in adults who live in poorer countries who may not have access to medical care, as well as pregnant women and adults with compromised immune systems. These complications are often the result of pneumonia, hepatitis or encephalitis.  One study showed that 10% of pregnant women with chicken pox get pneumonia, the severity of which increases the further along in gestation.  Ninety percent of cases of varicella pneumonia occur in the adult population. In adults, there is some evidence to suggest that males have symptoms which are more severe than females.  Chicken pox has also been observed in other primates.  It is one of the 25 viruses in the family Herpesviridae and one of at least eight forms of herpes which has been known to infect humans frequently.

Symptoms of chicken pox:  Symptoms of chicken pox often start before the appearance of the actual rash and can be infectious from one to five days before the rash appears.    It can remain contagious until the blisters have scabbed, which may not occur for another five to ten days from the onset of the rash. Chicken pox usually develops 14 to 16 days after contact with someone who is infected, though it can occur anytime between 10 and 21 days.

Early symptoms may include:  Fatigue; Sore throat; Temperature between 100-104 degrees Fahrenheit; Headache; Loss of apatite.  The characteristic red and swollen bumps or blisters normally start 1-2 days after the onset of these symptoms, though it may sometimes take a few days longer. 

Treatment of chicken pox:  There is some evidence that taking an anti-viral drug, such as Acyclovir, within 24 hours of the rash onset may decrease symptoms by one day.  However, it has not been shown to decrease the incidence of complications in children.  Topical lotions and creams such as calamine lotion or other lotions containing zinc oxide are often frequently used to help relieve the itching from the rash, though again there have been no formal studies showing its effectiveness.  Baths in oatmeal, or with a small amount of vinegar are sometimes recommended in order to help relieve itching, which may be beneficial as scratching can cause a secondary infection.  Aspirin should never be given to children due to risk of Reye's Syndrome.

When to get immediate medical attention:  As adults often have more severe complications from chicken pox, they should consider seeing a doctor as soon as chicken pox is suspected.  Anyone with a compromised immune system, the elderly, infants and women who are pregnant should seek immediate medical attention.  Pregnant women are also in danger of passing antibodies via the placenta to the fetus.  If infection occurs during the first 28 weeks of gestation, the risk of fetal varicella syndrome (also known as congenital varicella syndrome) greatly increases.  This can lead to serious physical abnormalities, including underdeveloped digits and bladder malformation as well as other, serious complications.  In addition, anyone who has developed a severe rash inside their mouth or has difficulty swallowing, breathing or is having severe pain and/or stiffness in the head and neck should get immediate medical help, as these can be symptoms of severe complications. 

The good news is that most children get chicken pox without ever having severe complications.  New vaccines can almost eliminate any chance of children ever getting chicken pocks in the first place.  Adults who have previously had chicken pox or have been vaccinated need not worry about catching chicken pox again.  However, the zoster virus which causes chicken pox never goes away once someone has been infected.  Anyone who has had chicken pox may later come down with shingles, the risk doubling for those over 60.

Please look for my next article in this installment regarding shingles.

(All sources are linked to in the above article.)

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