Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

Varicella-Zoster 1515

■Incubation periods: usually 14–16 days (10–21 days) (may be pro-

longed after passive immunization)

■Primary infection; chickenpox, reactivation; “shingles”

Signs & Symptoms

■Chickenpox – primary infection varicella-zoster; acute, generalized

viral disease

➣Fever

➣Mild constitutional symptoms

➣Skin eruption; initially maculopapular, later vesicular (×3–4

days)

➣Lesions commonly occur in successive crops

➣Lesions often high number covered versus non-covered area

➣More severe in adults/adolescents

■Shingles

➣Local manifestation of latent varicella infection in dorsal root

ganglia

➣Vesicles restricted to skin areas of sensory nerves (1–3 sensory

dermatomes)

➣Severe pain/paresthesia common

➣Systemic symptoms are few

➣More common in elderly or immunosuppressed

tests

■Usually a clinical diagnosis

➣can culture vesicles but not practicable in most settings

➣DFA/Tzanck smear of lesion

■Serology (ELISA, IFA) limited utility in acute setting – can retrospec-

tively confirm care

■PCR is available in some settings

differential diagnosis

n/a

management

■Susceptible persons at high risk for developing severe varicella – give

VZIG w/in 96 h, give as soon as possible with exposure.

■May be treated with acyclovir, valacyclovir, famciclovir, and foscarnet

■Therapy should be initiated early to maximize efficacy

■Oral therapy can be used for otherwise healthy persons, persons on

long-term salicylate therapy and persons on short course steroids.

■Immunocompromised patients; intravenous therapy