Varicella Zoster

by Chris Nickson, Last updated January 17, 2013

OVERVIEW

VZV = an alpha herpes virus
90% of adults have evidence of infection
spread via droplet excreted from the throat of patients with chicken pox OR via contact with vesicle fluid in chicken pox or shingles.
after infection:

1. asymptomatic
2. chicken pox
3. shingles (herpes zoster)

site of latency = nerve cell body (spinal cord and cranial nerves)

CLINICAL FEATURES

Chickenpox

febrile response
vesicular rash that appears in crops
generalized lymphadenopathy

Shingles

blistering rash that always stops at the midline
risk factors: increased age, immunosuppression or deficiency, stress

INVESTIGATIONS

clinical diagnosis
viral isolation from tissue culture
electron microscopy
antigen detection

MANAGEMENT

aciclovir
prevention = immunization with live vaccine or zoster immunoglobulin

COMPLICATIONS

chicken pox -> pneumonia, congenital varicella or neonatal chicken pox
shingles -> post-herpetic neuralgia, zoster keratitis, motor-nerve paralysis

Risk factors for developing pneumonia

Smoker
Contact with index case
> 100 spots
Duration of fever
Chronic Lung Disease
3rd trimester pregnancy
Immunosuppression

About Chris Nickson

FCICM FACEM BSc(Hons) BHB MBChB MClinEpid(ClinTox) DipPaeds DTM&H GCertClinSim

Chris is an Intensivist at the Alfred ICU in Melbourne and is an Adjunct Clinical Associate Professor at Monash University. He is also the Innovation Lead for the Australian Centre for Health Innovation and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He has a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia's Northern Territory, Perth and Melbourne. He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. He coordinates the Alfred ICU's education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the 'Critically Ill Airway' course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of Lifeinthefastlane.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. His one great achievement is being the father of two amazing children. On Twitter, he is @precordialthump.

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