Varicella

chickenpox, waterpox; sheep flakes, chicken pox 

Non-reportable, common disease caused by varicella (VZV).

• 98% of the >15 year-olds have undergone initial infection, but primoinfection is still possible in adulthood (varicella adultorum).
• Appears mainly in winter and spring.

• Incidence: approx. 50,000-75,000 / year in Switzerland

• Mortality: approx. 0.03 / 100'000 inhabitants / year.

• Incubation period: approx. 2 weeks.

• Diaplacentary transferable. Congenital varicella syndrome in 1-3/1000 pregnancies, mortality: approx. 10%. Infection in the last trimester leads to a mother's mortality of 20-45%. 

Transmittance

• Droplet or smear infection or direct contact (saliva, fluid content, cough, sneezing).

Infectiousness

• The affected person is already in contact 1-2 days before the onset of the disease. Once all the bubbles have dried up, there is no longer any risk of infection. Despite the formation of antibodies, the virus cannot be excreted from the organism and remains latent in the sensitive ganglia of the posterior roots. Reactivation, usually due to immunosuppression (exclusion of HIV in young people) leads to herpes zoster.

• In 95% of cases, the infection progresses with pronounced symptoms, but in children there are often no complications. Fever, lymphadenopathy, reduced AZ and pruritus are more common in adults.

• Overall, the clinical picture is polymorphic (Heubner's starry sky, lesions appear one after the other and not at the same time). Red maculae, small erythematous papules along the entire integument become vesicles on erythematous ground. These then cloudy and become secondary pustules. After crust formation there is no longer any danger of infection.

Clinical diagnosis, if necessary:

• PCR VZV

• Immunofluorescence (Syva MikroTrak®)

• Viral culture

• On the entire integument, capillitium, palmar temporarily affected, plantar usually no infestation.

• Conjunctives, larynx or genital mucosa are also rarely affected.

Thin blister cover, degeneration of basal cells, giant epidermal cells, herd-shaped colliquation of rete cells, inclusion bodies.

• Impetiginization
• Skin gangrene
• Purpura fulminans
• Meningitis or meningoencephalitis
• Ataxia in cerebellitis

• Reye syndrome (CAVE: no administration of ASS)

• Rarely: Guillain-Barré type.

• Varicella pneumonia (1-6 days after exanthema, often clinically and auscultatorically difficult to diagnose → X-ray chest).

• Otherwise, involvement of eyes, ears, joints, muscles, heart, and kidneys.

• Ictal reaction 

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