0071643192.pdf

PEDIATRICS

TREATMENT

Symptomatic care only

COMPLICATIONS

Aplastic anemiamay develop in patients who have an underlying hemoglo-

binopathy (such as sickle cell disease). Anemia may be severe, requiring RBC

transfusion.

VARICELLAZOSTERVIRUS(VZV)

■ A herpes virus

■ 1° infection: Varicella (chickenpox)

■ Highest incidence in late winter, early spring

■ Historically affected children <10 years of age

■ Transmission via direct contact or airborne droplets

■ Reactivation of previous VZV infection: Zoster (shingles, Herpes zoster)

■ Highest incidence in immunocompromised and elderly.

SYMPTOMS/EXAM

Chickenpox

■ Fever precedes rash by 1–2 days.

■ Rash typically starts at hairline, with initial formation of macules, which

progress to fluid-filled vesicles (“dew drops on a rose petal”). Crops of

lesions typically appear at the same time with vesicles in various stages of

healing on body (as opposed to smallpox, which has all lesions in the same

stage of healing) (see Figure 5.12).

Zoster

Rash in dermatomal distribution, typically on trunk or face

DIAGNOSIS

Clinical diagnosis

TREATMENT

Chickenpox

■ In healthy children <12 years of age, chickenpox is usually a self-limited

illness, requiring supportive care (oral antihistamines to treat itching, and

antipyretics).

■ Avoid aspirin due to the risk of Reye’s syndrome.

■ Children >12 years of age are at higher risk for severe disease, and should

receive oral acyclovir.

■ Immunocompromised patients should receive IV acyclovir and VZIG.

Zoster

Treat with oral acyclovir if within 72 hours of eruption onset.