How to find out if a person had chickenpox: all about the analysis for antibodies to chickenpox. Chickenpox

Chickenpox (varicella, chickenpox) is an acute and highly contagious disease. It is caused by a primary infection with the varicella-zoster virus. Chickenpox outbreaks occur worldwide and, in the absence of a vaccination program, affect a large proportion of the population by mid-young age.

When did chickenpox start?

Chickenpox has been known since ancient times. For some time it was considered a mild course and only in 1772 it was isolated as a separate disease. And in 1909 it was found that chicken pox and shingles have the same pathogen, which was later confirmed by laboratory tests. Subsequent study of the characteristics of the virus led to the development of a live attenuated varicella vaccine in Japan in the 1970s. The vaccine was licensed for use in the United States in March 1995.

What causes chickenpox and how can you get infected?

Varicella zoster virus (VZV) is a virus that causes chickenpox and belongs to the herpesvirus family. Like other viruses of this group, it has the ability to persist in the body after a primary infection.

After a person has had chickenpox, VZV does not leave the body, but is stored in the sensory nerve ganglia.

Thus, the primary infection with VZV leads to chicken pox, and herpes zoster is the result of reactivation of the latent infection of this virus, which is caused by a decrease in immunity due to various circumstances (hypothermia, stress, etc.) or concomitant diseases that are accompanied by immunodeficiency (malignant blood diseases, HIV etc.). For the presence of this property, the varicella-zoster virus belongs to the group of pathogens of slow infections. It is worth noting that the varicella-zoster virus itself has an immunosuppressive property.

VZV is believed to have a short survival time in the environment. All herpesviruses are sensitive to chemical and physical effects, including high temperature.

source of infection is a person with chickenpox or herpes zoster. The virus is found on the mucous membranes and in the elements of the rash. An infectious patient is considered from the moment the rash appears until the formation of crusts (usually up to 5 days after the last rash).

The varicella-zoster virus is highly contagious, meaning it is very likely to be transmitted through respiratory droplets or direct contact with the characteristic skin lesions of an infected person. Related to this is the fact that most of the population falls ill already in childhood.

80-90% of cases are under the age of 14 years. Also, chickenpox is characterized by high susceptibility (90-95%).

Most countries tend to have higher incidence rates in urban areas (700-900 per 100,000 population) and significantly lower in rural areas. The epidemiology of the disease differs in different climatic zones, for example, a significant difference is observed in temperate and tropical climates. The reasons for these differences are poorly understood and may relate to virus properties (which are known to be heat sensitive), climate, population density, and risk of exposure (for example, kindergarten or school attendance or number of siblings in a family).

Why is chickenpox so relevant in the modern world?

The relatively mild course and low mortality for a long time were the reason for the extremely calm attitude towards this infection.

However, at the moment, as a result of numerous studies, it has been found that the pathogen can affect not only the nervous system, skin and mucous membranes, but also the lungs, digestive tract, and genitourinary system.

The virus renders adverse effect on the fetus when the disease occurs in pregnant women. It is worth remembering that a mother can transmit the infection to the fetus if she is sick with chickenpox or herpes zoster (the virus is able to cross the placenta throughout pregnancy).

What are the manifestations of chickenpox (chickenpox)?

The varicella-zoster virus enters through the respiratory tract and conjunctiva. It is believed that the virus multiplies in the nasopharyngeal mucosa and regional lymph nodes.

The initial entry of the virus into the blood occurs a few days after infection and contributes to the entry of the virus into the epithelial cells of the skin, where the further reproduction of the virus and the corresponding skin changes occur.

Then comes secondary exposure to blood. It should be remembered that not only the epithelium of the skin can be affected, but also the mucous membranes of the gastrointestinal tract, respiratory tract, and genitourinary system. Considering that the virus is tropic to the nervous tissue, degenerative and necrotic changes can develop in the nerve nodes, roots of sensory nerves and the spinal cord.

Incubation period. The period from the entry of the virus into the body to the onset of clinical manifestations is from 5 to 21 days after exposure, more often 1-2 weeks. The incubation period may be longer in immunocompromised patients.

Infected individuals may have a mild prodrome that precedes the onset of the rash. In adults, it can be 1 to 2 days of fever and malaise, but in children, the rash is most often the first sign of illness.

The onset is usually acute. The fever lasts 2-7 days, with a severe course longer. Patients complain of an itchy rash, body aches, loss of appetite, sleep disturbance, headache. Nausea and vomiting may occur.

The first elements of the rash appear on the face and trunk, and then on the scalp and limbs; the highest concentration of lesions is on the trunk with the appearance of rashes within 4-6 days. At the same time, elements of the rash are present at several stages of development (for example, redness and papules can be observed simultaneously and in the same area as vesicles and crusts).

The rash can also occur on the mucous membranes of the oropharynx, respiratory tract, vagina, conjunctiva, and cornea.

Rash elements usually have a diameter of 1 to 4 mm. Vesicles (vesicles) are superficial, single-chamber and contain a clear liquid, surrounded by a red rim. Over time, they dry out and turn into crusts, after rejection of which there is temporary pigmentation and occasionally small scars.

The number of elements of the rash ranges from single to multiple. Vesicles may rupture or fester before they dry out and become crusty. The rash is accompanied by severe itching.

In 20-25% of patients, rashes can occur on the mucous membranes of the mouth, gums. Usually they open quickly, form erosions and are accompanied by soreness, burning and increased salivation.

About 2-5% of patients have elements of a rash on the conjunctiva.

Also, with chickenpox, as a rule, lymph nodes (submandibular, cervical, axillary, inguinal) increase.

Recovery from a primary chickenpox infection usually results in lifelong immunity. But in recent years, there have been more and more cases of recurrence of chickenpox. It is not common in a healthy person, and most often occurs in immunocompromised individuals.

What complications can occur with chickenpox?

The disease is usually mild, but complications can occur, including bacterial infections (eg, bacterial skin lesions, pneumonia) and neurological infections (eg, encephalitis, meningitis, myelitis), which can be fatal.

Secondary bacterial skin infections caused by streptococcus or staphylococcus aureus are the most common cause of hospitalization and outpatient medical visits. Secondary infection with invasive group A streptococci can cause abscesses and cellulitis.

Pneumonia after chickenpox is usually viral, but may also be bacterial. Secondary bacterial pneumonia is more common in children younger than 1 year of age. It is characterized by an increase in temperature up to 40 ° C, an increase in pallor and cyanosis of the skin, the appearance of a retrosternal dry cough and shortness of breath. Patients can take a forced position in bed.

Damage to the central nervous system in chickenpox range from aseptic meningitis to encephalitis. Cerebellar involvement followed by cerebellar ataxia is the most common manifestation of central nervous system disorders, but usually has a favorable outcome.

Encephalitis is one of the most dangerous complications chickenpox (10-20% of cases are fatal). This complication is manifested by headache, nausea, vomiting, convulsions and often leads to coma. Diffuse brain involvement is more common in adults than in children. May occur alone or with encephalitis varicella meningitis.

Rare complications of chickenpox are Guillain-Barré syndrome, thrombocytopenia, hemorrhagic and bullous chickenpox, glomerulonephritis, myocarditis, arthritis, orchitis, uveitis, iritis, and hepatitis.

Once infected, the virus remains hidden in nerve cells. and can be reactivated, causing a secondary infection - herpes zoster. It usually occurs in adults over the age of 50 or when the immune system is weakened and is associated with a painful rash that can lead to permanent nerve damage.

What is herpes zoster?

Herpes zoster (herpes zoster, herpes zoster) occurs in humans as a manifestation of the reactivation of a latent infection caused by a virus that was in the nerve ganglia after suffering chicken pox. The localization of subsequent rashes will depend on which nerve node the virus (VZV) was in a latent (sleeping) state.

Localization of the rash in case of damage to the trigeminal nerve node - on the scalp, in the forehead, nose, eyes, lower jaw, palate, tongue; in the presence of a virus in the spinal ganglia - on the neck, trunk, upper and lower extremities.

Features of the rash with herpes zoster are:

• vesicles are located on the skin in groups along the corresponding nerve,
• the disease begins most often with pain, followed by redness and corresponding rashes,
• As time goes by, the pain gets less and less
• the process is always one-sided,
• usually rashes are accompanied by fever, malaise, weakness.

What are the methods for diagnosing chickenpox?

Usually the diagnosis is made on the basis of the clinical picture and an objective examination of the patient.

To confirm the diagnosis, laboratory methods take blood, cerebrospinal fluid, as well as the contents of the vesicles and pustules. As an oriented method, microscopy is carried out.

In modern practice, serological diagnostic methods are used (ELISA, RSK, RNGA, RIA). In this case, blood is taken twice: at the beginning of the disease and during the period of convalescence. The reaction is considered positive if the antibody titer has increased by 4 times or more.

It is worth noting that ELISA and PCR are most commonly used. There is also a method for cultivating the virus, but due to laboriousness and high costs, it is not currently used.

How to treat chicken pox?

Uncomplicated patients are most often treated at home. The elements of the rash are treated with a concentrated solution of potassium permanganate. The oxygen that is released as a result of this prevents the attachment of a secondary infection, and also reduces itching. With a small amount of rashes, you can use brilliant green.

Only in severe or complicated cases, treatment is needed that is directed at the pathogen. These are drugs acyclovir, valaciclovir, famciclovir, which can be taken only after consulting an infectious disease specialist or a family doctor. Antiviral treatment is mandatory for herpes zoster. Local application of acyclovir ointments is also possible.

With severe itching, chickenpox patients should take antihistamines. With severe pain in patients with herpes zoster - analgesics. If there is a high temperature and severe intoxication, detoxification therapy (intravenous administration of certain solutions) is indicated. Individuals who have a reduced level of immunity are shown immunoglobulin.

How to prevent chickenpox?

Chickenpox can be prevented by vaccination. Specific prophylaxis is carried out with live vaccines from an attenuated varicella-zoster virus (for example, the Belgian vaccine ""). Vaccination is especially recommended for young children, and in the United States and for the elderly in order to prevent herpes zoster and postherpetic neuralgia.

In clinical trials, it has been found that people who have been vaccinated either do not get chickenpox or tolerate it in a very mild form.

• persons with malignant diseases,
• HIV-infected,
• those groups of people who have severe chronic pathology,
• patients who take glucocorticosteroids.

Vaccination shown:

• with a preventive purpose, especially recommended for high-risk categories:
  - routine vaccination at 12-15 months of age,
  - the usual second dose at 4-6 years of age.
• for emergency prevention of those who did not have chickenpox and were not vaccinated, but at the same time are in contact with patients.

The minimum interval between doses of varicella vaccine is 3 months for children under 13 years of age.

Although single-dose programs are effective in preventing severe varicella disease, as evidenced by a study in Australia (one of the few countries to include varicella vaccination as part of its national immunization program), evidence suggests that in order to interrupt transmission of the virus two doses are required. Emerging school outbreaks and high rates of chickenpox, although not usually severe, have prompted some countries to implement a two-dose vaccination schedule.

Vaccination is the most effective medical intervention ever invented by man.

In the article, we will analyze the course of the disease, the incubation period of the varicella-zoster virus, methods of treatment and remedies for itching and the risk of infection.

What is chickenpox and how is it transmitted

Chickenpox is a viral infection caused by a virus Varicella Zoster , also known by the acronym VZV (varicella-zoster virus), belongs, along with the other seven elements, to the family human herpes viruses.

In the past, almost everyone had chickenpox before the age of 15. Currently, with the introduction of the vaccine, the number of infected people has decreased significantly.

Chickenpox, especially if it affects children, has mild symptoms and a benign prognosis, but in some cases, fortunately rare, can cause dangerous complications.

How the disease develops and progresses

The chickenpox virus infects, first of all, the cells of the mucous membranes that cover the inner wall of the respiratory tract. Then it moves to the adjacent lymphatic system and begins to multiply here. Then from the lymphatic system enters the blood.

With the flow of blood, it reaches the liver and spleen, and then returns to the lymphatic system, from where, after a cycle of reproduction, it passes to the skin and mucous membranes and gives rise to smallpox.

A viral infection stimulates the body to produce certain classes of antibodies, in particular:

• Immunoglobulin G or IgG, isolated from plasma cells, which, through various mechanisms, bind and destroy viruses or mark them.
• Immunoglobulin M or IgM, are secreted by lymphocytes (a category of white blood cells), they strike first without identifying the virus.
• Immunoglobulin A or IgA, are synthesized by plasma cells at the level of lymphatic tissue associated with the mucous membranes of the nose, eyes, lungs and gastrointestinal tract.

However, the virus does not completely disappear from the body, but remains in a latent state in the nerve ganglia of the spinal cord, waiting for conditions to weaken the immune system.

Time of incubation and development of infection

Chickenpox is an infectious disease that spreads very quickly.

Transmission, and hence infection, occurs on contact with fluid from the papule or contact with the smallest particles of saliva containing the virus, which are released into the air when sneezing or coughing.

The infected person is contagious relatively short period of time from the second day from the appearance of a skin rash to the appearance of a crust on all abscesses. When the scabs shed (especially in adults) there may be skin blemishes, but they are not contagious.

chicken pox has duration, on average, about 10 days, but, in some cases, can be much shorter, about 5 days. Incubation period diseases, that is, the period of time that elapses between the moment of infection and the onset of symptoms, can vary from ten days to a little less than a month. On average, it's two weeks.

Risk factors that increase the likelihood of developing the disease:

• No history of chickenpox.
• School work or other form of contact with children.

chickenpox symptoms

The clinical picture that chickenpox manifests itself is quite typical and this makes it easy to diagnose.

The main symptom is vesicular rash, very itchy, distributed throughout the body, especially on the trunk and head, more rarely on the lower extremities.

The specific symptoms of chickenpox can be divided into two stages:

Stage before the appearance of a rash on the skin

The disease is sometimes preceded (especially in adults) by the appearance of nonspecific symptoms of a prodromal nature:

• General malaise, "for no reason."
• Lack of strength and fatigue even after little effort.
• Lack of appetite and nausea.
• Headache, muscle pain and joint pain.
• Rhinitis, that is, a runny nose.
• Fever.
• Rash in the oral cavity, pharynx and mucous membrane of the respiratory tract.

Rash phase

After 1-2 days, specific symptoms appear. This is, first of all, rash with reddish raised papules. They fill with liquid and swell.

After a few days, the papules ulcerate, the contents come out, crusts form, which then fall off. The rash usually starts on the face and scalp, then spreads to the chest, arms, legs, palms of the hands, and soles of the feet.

Rash very itchy, and scratching it by the sick only exacerbates the problem. The mucous membranes are also affected by the rash. In adults, the rash can be especially extensive and severe.

Complications of chickenpox

As we have already mentioned, chicken pox, especially if you get sick in childhood, is a mild disease and does not give any problems and complications. However, in adults, especially those with a weakened immune system, the disease is more severe, and can even lead to complications that can also be terrible and even threaten the patient's existence.

It should be noted that in rare cases, complications may also occur in children.

The most common complications that can result from chickenpox infection are:

• Bacterial infections(staphylococci or streptococci) "with pleasure" will take advantage of ulcerations of the skin and mucous membranes. This complication occurs most often in children because they tend to scratch the skin.
• Pneumonia. May be caused directly by the varicella-zoster virus or be the result of invasion by another bacterium. It is more common in adults or children with weakened immune systems.
• Glomerulonephritis. Inflammation of the kidneys and, in particular, in the glomeruli, caused by infection with the varicella-zoster virus.
• Encephalitis. Inflammatory disease of the brain caused by the invasion of the VZV virus.
• Hepatitis. Inflammation of the liver as a result of VZV infection.
• Myocarditis. Inflammation of the myocardium (muscular tissue of the heart) as a result of VZV infection.
• Schonlein-Henoch purpura. This is vasculitis, or inflammation of the blood vessels, caused by the accumulation of IgA as a result of a VZV infection.
• Reye's syndrome. A rare but serious complication that involves inflammation and swelling of the brain occurs mainly in children aged 4 to 12 who take aspirin during a VZV infection.

Remedies for chickenpox

Almost everyone recovers from chickenpox without problems.

In the case of a benign form of the disease. therapy is rest and treatment of symptoms antipyretics such as paracetamol. Often also used antihistamines to soothe itching.

Aspirin is absolutely contraindicated, because in such a situation it can cause severe liver and brain disease - Reye's (Reye's) syndrome.

In adults and children who have immunological problems are prescribed antiviral drugs such as acyclovir. They help to avoid complications such as encephalitis and viral pneumonia.

In the case of bacterial infections, it becomes necessary to carry out antibiotic therapy.

In case of contact with an infected person before the onset of symptoms, vaccine or immunoglobulin. This can prevent the occurrence of the disease or significantly reduce its aggressiveness.

Natural remedies for itching

In addition to drug therapy, some simple remedies can be used to reduce the annoying symptoms of chickenpox.

• Wash skin with soap and water to prevent the risk of developing bacterial infections.
• Gauze wet wipes soaked in calendula infusion or rice starch, applied to the skin, help soothe itching and prevent scarring.

Chickenpox prevention

The best prevention against chickenpox is vaccine. In Russia, vaccination against varicella is not mandatory, but is recommended for children and for employees of educational institutions who did not have this disease in childhood.

Individuals at high risk of complications and pregnant women may receive doses of antibodies against the virus or immunoglobulin.

Prevention also includes isolating sick people. Lasting no more than 2 weeks, and less with mild forms.

Finally, the hygiene of the premises where the patient with chickenpox lives is important. The virus is very sensitive to a mixture of chlorates and therefore to bleach (sodium hypochlorite).

Chickenpox is an infectious disease that is most often diagnosed in children. But the most severe symptoms occur when chickenpox occurs in HIV-infected adults. Such patients have a very high likelihood of developing complications such as:

• pneumonia;
• disseminated tuberculosis;
• changes in the tissues of internal organs;
• lichen.

Humans are the only carriers of the smallpox virus. Transmission of the disease occurs after the virus enters the mucous membranes or through direct contact with patients. In healthy people, the rash appears three days after infection, and in HIV patients after seven days. Also, patients with immunodeficiency do not tolerate treatment well and can remain contagious for up to a month (while healthy people can only transmit the virus for 15-20 days). Since chickenpox is primarily a disease of young children, and most patients acquire the immunodeficiency virus as adults, the likelihood of diagnosing the disease is extremely small.

Features of the course and treatment of chickenpox in HIV patients

Chickenpox in HIV infection is characterized by prolonged veremia and an increased incidence of new lesions on the body. The primary rash occurs about 7 days after direct contact with a carrier of the virus. But two days before the appearance of smallpox, the following unpleasant symptoms develop:

• general malaise;
• subfebrile fever;
• myalgia.

It is necessary to notice such characteristic symptoms as early as possible and begin treatment before the onset of the first pockmarks. Chickenpox and HIV in adults is a rather dangerous combination, because there is a rather high risk of developing secondary bacterial infections, as well as life-threatening visceral lesions. Treatment of chickenpox in patients with HIV usually involves the introduction of acyclovir intravenously.

Rubella in HIV

Compared to chickenpox, rubella is a less severe disease. Most people recover within three days. Rubella in HIV-infected people is much more severe and causes the following complications:

• arthralgia - prolonged pain in the joints, which can last a month or more;
• otitis media - inflammation of the middle ear;
• encephalitis is a severe inflammation of the brain, which in most cases is fatal.

Rubella prevention is complicated by the fact that AIDS vaccination is not recommended for most patients. Thus, the probability of infection with rubella increases tenfold.

Chickenpox (chickenpox) is an acute infectious disease caused by a type of herpes virus that occurs with the appearance on the body of a characteristic rash consisting of different elements (spots, nodules, vesicles and crusts). It is by a rash that is not characteristic of other diseases that chickenpox is recognized. According to the causative agent of chickenpox, it belongs to the family of herpes viruses, it is called "Varicella".

Varicella zoster virus is one of many types of herpes virus. It was first discovered and studied in 1911. It was found that during the primary contact of the human body with it, chickenpox occurs. With repeated infections with the same virus, a person becomes ill with herpes zoster. The well-known “cold” on the lips is also caused by the herpes virus of the same species, but slightly different from the chicken pox virus.

The herpes virus is the smallest rounded particle with a size of only 300 nanometers. It consists of a core, represented by a DNA molecule, and a shell. The main property of the causative agent of chickenpox is its volatility and instability in the external environment. Under the influence of heat and light, it dies within 5-7 minutes, but this does not prevent the virus released during sneezing, breathing or coughing from spreading for many meters around and settling in the body of another person, who in this case is affected by chicken pox.

Prevalence

There is no country in the world where people do not get chickenpox. In 80-85% of cases, the varicella-zoster virus affects children under seven years of age. The stay of the child most of the day in the same room with a dozen peers, rare ventilation, crowding in children's groups, close contact of the kids with each other contribute to infection, which occurs by airborne droplets. It is enough to pick up the virus for one child, as the whole group of the kindergarten falls ill.

Children who do not attend kindergarten are at risk of contracting the varicella virus at school. Adults usually get infected from their children. This rarely happens, as an adult, most likely, has already had chickenpox in childhood and has a strong immunity to it.

There is a clear seasonality of chickenpox disease: more than 80% of infections occur in the cold season.

How does infection occur?

Chickenpox (chickenpox) is transmitted from a sick person to a healthy person by air (by air from neighboring rooms, through ventilation openings), by airborne droplets (by sneezing and coughing) and transplacental (from a sick mother to a fetus). The contact route of transmission of the infection has not been proven. This means that you can not get chickenpox through objects, towels, clean dishes. The varicella-zoster virus does not live on them. Also, you can not get infected from a person who is immune to chickenpox if he was in contact with the patient. For example, a kindergarten teacher who had chickenpox as a child and had contact with a sick child would not infect anyone at home. The varicella-zoster virus is not carried on hands or clothing.

After entering through the nose or mouth, varicella-zoster virus particles invade the cells of the mucous membrane of the upper respiratory tract and actively divide, reproducing similar particles - virions. This period lasts from 11 days to three weeks, and is called the incubation period.

The incubation period of chickenpox, like any infectious disease, means that there is a pathogen in the body, but there are no clinical manifestations of the disease yet. During incubation, the virus is not transmitted, a sick person becomes contagious 1-2 days before the first element of the rash appears. From this moment begins the height of the chickenpox disease.

After reproduction, the varicella-zoster virus enters the lymphatic vessels and travels to nearby lymph nodes (submandibular, cervical, occipital). This is where the virions accumulate. This corresponds to the prodromal period. Then, from 4-5 days of illness, a period of viremia sets in - the spread of virus particles with blood flow to the epithelial cells of the skin and to the nerve nodes. The circulation of the varicella-zoster virus in the blood is short-term (this is typical for all infectious diseases) and is accompanied by a deterioration in the general condition of the patient, a rise in temperature, weakness, and chills.

The herpes virus has a tropism (compatibility, affinity, preference) to the cells of the epithelium of the skin and internal organs and to the nervous tissue. With the blood flow, it enters the cells of the surface layer of the skin, where rashes appear, passing through several successive stages. Part of the virions rush to the ganglia (nodes) of the trigeminal nerves (nerves that innervate the face, upper forehead, jaw). This is a favorite habitat for herpes viruses. Here, in the nodes of the trigeminal nerve, viruses can exist in a latent (sleeping) state for many years, without interfering in any way with a person living a normal life. With a decrease in immunity, various diseases, cooling, they “wake up” and a person becomes ill with herpes zoster.

In severe forms of chickenpox, the virus infects the epithelial tissues (surface) of internal organs - the liver, spleen, and others. In the case of normal chickenpox, the virus is limited to skin lesions.

After entering the skin, the virions destroy the cells of the epidermis in the course of their life, forming a typical element of the chickenpox rash - a vesicle (vesicle). The vesicle contains a large concentration of herpes viruses, so a person is contagious until all the vesicles have passed, and for another three days after the latter has dried.

Thus, quarantine for a person who has contact with a sick person with chickenpox lasts 21 days. After this period, it can be concluded whether infection has occurred. If so, then isolation of such a patient can stop the further spread of chickenpox.

Chickenpox classification

According to the form, chickenpox is divided into:

I. Typical chicken pox (with a primary lesion of the virus of the skin and mucous membranes of the oral cavity), which, according to the severity of the manifestations of the infectious process, is divided into:

1. Easy
2. Medium
3. heavy

II. Atypical chicken pox, including varieties:

1. A rudimentary form of chicken pox. It occurs in young children if, after contact with a patient with chickenpox, gamma globulin, an immune preparation containing antibodies to many viruses, was immediately injected. Then the clinical picture of chickenpox is blurred, the child's health does not suffer, skin rashes are limited to a few vesicles, the virus is stopped.
2. Visceral or generalized form of chickenpox. Children get sick, more often newborns, with severe chronic diseases that weaken the immune system, or taking drugs that suppress it. The visceral form proceeds with severe symptoms of intoxication caused by the virus, fever, involvement of internal organs in the process: lungs, intestines, liver. Possible death of the baby.
3. Hemorrhagic form of chickenpox. In adults and children with congenital diseases of the hemostasis system responsible for blood clotting, in children with leukemia (blood cancer). With this form of chickenpox, the contents of the vesicles of the rash on the 2-3rd day of the disease become bloody - hemorrhagic. Bubbles break and bleed, nose and stomach bleeding join)
4. The gangrenous form of chickenpox is often a continuation of the hemorrhagic form, it can occur in children weakened by serious illnesses. The formation of areas of necrosis (death) of the skin around the vesicles is characteristic, in the place of the opened vesicles, deep ulcerative defects are formed, merging with each other. A bacterial infection aggravates the process. Forecast - unfavorable

Downstream windmill happens:

• complicated chickenpox;
• uncomplicated chickenpox.

Symptoms of a typical form of chickenpox in children

Chickenpox refers to childhood infections, because 80% of people become infected with it in childhood, primary school and preschool. In almost 95% of cases, chickenpox in children occurs in a mild typical form and goes through several periods:

1. Incubation. It lasts from the moment of infection with the virus until the onset of the first symptoms (from 11 to 23 days). The child's well-being does not suffer, there are no symptoms
2. prodromal period. Lasts no more than 3-4 days. The child is worried about subfebrile temperature (up to 38C), weakness, lethargy, apathy, sleep and appetite disturbances. Sometimes there is redness of the throat, diarrhea, vomiting. More often, the prodromal period of chickenpox in children occurs with unexpressed symptoms of intoxication or without them at all.
3. Eruption period. It begins with a rise in body temperature to 38-38.5 C and the appearance of a rash on the face and head. Soon, the elements of the rash affect the entire body, except for the palms and feet. At first, the rashes are not abundant (10-20 elements), but very quickly they become more (100-150).

The chickenpox rash element goes through three stages of development:

1. Spot stage - roseolous.
2. The bubble stage is vesicular.
3. The stage of drying followed by the formation of a crust.

Rashes in the first stage - round and oval spots, red and pink, with a clear contour, dense to the touch. The sizes of spots are 2 - 5 mm. During the day, the stain turns into a bubble filled with a clear or cloudy liquid. Bubbles (vesicles) are dense to the touch, like small dew drops on the surface of the body. Sometimes they are surrounded by a pink corolla. The vesicles contain live herpes varicella-zoster viruses that can be detected under a light microscope. On day 2-3, the liquid in the vesicle dissolves, a brown crust forms in its place, which soon dries up and falls off. If you do not rip off the crust, then there will be no trace in place of the element. Small light pigment spots at the site of the rash disappear after 2 months, they are almost invisible.

A rash with chickenpox is characterized by a wave-like appearance, that is, each new portion of the elements “sprinkles” every 2-3 days and is accompanied by a short-term rise in temperature. Therefore, you can see the elements of the rash at different stages of development at the same time (spots, vesicles, crusts are adjacent to each other). This feature is not present in other infections.

A rash on the mucous membrane in the oral cavity, on the palate, tongue, in the larynx is called an enanthema. It often accompanies skin rashes, may not manifest itself in any way. Sometimes there is discomfort when swallowing, increased salivation. Babies can be naughty and refuse to breastfeed. Occasionally, the cornea of ​​​​the eyes and the conjunctiva, the inner side of the eyelids are affected. The rash here is of particular concern.

Chickenpox rash strongly, unbearably itches.

A rash in girls can occur on the mucous membrane of the labia, where the rashes are few and not very disturbing.

The period of rashes in children lasts from 8 to 10 days. The cervical, submandibular and occipital lymph nodes are enlarged and may hurt.

Recovery period. Begins after the last wave of rashes. 3-5 days after the appearance of the last element of the rash, a person becomes non-infectious, when the crusts fall off, he is considered recovered.

Dr. Komarovsky - chickenpox in children

Dr. Komarovsky - how to treat chickenpox in children?

Features of chickenpox in adults

In adults, the disease is more severe and fraught with complications. This is due to the fact that the child has antibodies to the varicella-zoster virus in the blood, obtained from the mother (if the mother has been ill with it herself and has immunity). Antibodies are special proteins produced in the body in response to the introduction of an infectious agent; they are specific for each pathogen. When the varicella-zoster virus enters the body, the corresponding antibody proteins combine with the antigens (proteins) on the surface of the viruses with which they are similar, and inactivate (neutralize) them. Therefore, it is easier for a child's body, in which there are antibodies to chickenpox, to overcome the disease.

The immune system of an adult has no means of combating the chickenpox virus in its arsenal. There are few or no specific antibodies that can stop the virus obtained from the mother. Many other antibodies and immune complexes accumulated throughout life circulate in the blood. That is why chickenpox in adults is difficult.

During both the prodromal period and in the stage of rashes, severe weakness and febrile temperature (38.5-39.0 C) are disturbing. The elements of the rash in adults are larger and itching is more pronounced. On the mucous membranes of the oral cavity and labia in adult women, the enanthema is very itchy.

There is swelling of the tonsils, pain in the pharynx, enlarged, painful lymph nodes in the neck, axillary, submandibular.

The duration of the disease is the same as in children.

Video - chickenpox in adults

How to distinguish chickenpox from others from other infections?

There are many infectious diseases, accompanied by a rash and symptoms of intoxication. Already at the stage of examining the patient and collecting anamnesis (data on the history of the disease), the doctor can accurately establish the diagnosis. Most infections have the same general symptoms: fever, weakness, nausea. The rash varies from disease to disease. It is by the nature of skin rashes that the doctor diagnoses a particular disease and the virus that struck the patient.

A rash with chickenpox has polymorphism, that is, different elements are present on the body at the same time: in the stage of spots, vesicles and crusts. This is due to the jerky addition of new portions of elements, accompanied by a rise in temperature. First, spots appear on the skin of the face and head under the hair. The rash is located randomly on the trunk, on the skin of the palms, there is no stop. Elements of different sizes, on average, 2 - 5 mm, the skin between them is not changed. Red spots during the first day from the moment of appearance are transformed into bubbles with transparent or cloudy contents, sometimes with a pink corolla along the edge. After a couple of days, the vesicles dry up, become covered with a brown crust. She soon disappears. In place of the torn off crust, a scar or fossa remains.

Chickenpox rash is very itchy, scratching the skin is dangerous because of the risk of introducing a bacterial infection. The rash lasts 7 to 10 days.

The general condition with a typical flowing chickenpox does not suffer much.

A rash usually appears on the 3-5th day from the onset of the disease. A few days before skin rashes on the mucosa of the cheeks, gums, tongue, small whitish spots appear with a pink corolla around the circumference against the background of a bright red, edematous mucosa - Filatov-Koplik spots.

This is the hallmark of measles. The elements of the rash are dense red spots protruding above the surface of the skin, resembling irregularly shaped nodules. Sometimes they merge with each other. The rash begins to appear behind the ears, on the nose, and on the neck.

The next day, the rash covers the shoulders and chest, moving to the back and abdomen. By the third day, the whole extremities are covered with a nodular rash. After 4-5 days, the rash quickly begins to darken, acquire a brown color (pigmentation stage), and peel off slightly. Moreover, the rash darkens in the same sequence as it began - from top to bottom. After 1.5 weeks, the rash disappears. The staging of rashes (the face, chest, back, abdomen, limbs are affected in turn) is its distinctive feature with measles.

During the entire period of skin rashes, a patient with measles has an elevated temperature.

The patient's condition is severe, he suffers from a strong dry cough, runny nose, stomatitis, headache, eyes fester. There may be colitis with bloody stools, vomiting on the background of fever.

rubella rash is small-spotted. All elements of the same size, light red, do not merge with each other, do not itch or peel off. The rash is not abundant, it is located on the unchanged skin of the extensor surfaces of the arms and legs, around large joints, on the back, buttocks. The first elements appear on the face. After 3-5 days, the rash disappears without a trace.

3-4 days before the rash, on the oral mucosa, hard and soft palate, behind the cheeks, an enanthema occurs, which differs from the Filatov-Koplik spots with measles: rashes 3-4 mm in size, pink, not white.

Rubella is easily tolerated, the temperature does not exceed 37.5 ° C. There are minor cough, runny nose and conjunctivitis. A distinctive feature of rubella are enlarged, painful occipital lymph nodes, which are easy to feel by bending the patient's head.

The rash in scarlet fever is pink, punctate. Appears on the cheeks, abdomen, lateral surfaces of the body, flexion surfaces of the arms, legs, armpits and inguinal folds on reddened skin. In the folds of the skin, the rash is more abundant, the color of the skin becomes bright red. Some points turn into bubbles with cloudy contents. There is no itch.

The rash does not last more than a week, leaves no traces. The hallmark of the scarlatinal rash is its appearance on reddened skin, on the face elements appear on the burning cheeks, but do not affect the nasolabial triangle, which remains pale in color. The characteristic appearance of a scarlet fever patient: a puffy face with bright red cheeks, a pale, sharply defined nasolabial triangle, shining eyes.

When the rash disappears, the patient begins pityriasis peeling (the skin comes off in scales from the ears, trunk, limbs and face). On the palms and soles, the so-called lamellar peeling occurs. It starts with the appearance of cracks. The skin comes off in layers.
A distinctive feature of scarlet fever is a specific sore throat, in which the tonsils, pharynx, and tongue are affected. They blush intensely (“fire in the pharynx”), but the redness is clearly delimited and does not affect the hard palate.

The state of this disease is moderate, intoxication disappears after 5-7 days.
a rash with meningitis (inflammation of the pia mater caused by meningococcus) occurs on the 1-2 day of the disease, covers the entire body, is especially pronounced on the hips and buttocks.

Elements are small hemorrhages of various sizes (hemorrhages) from round to irregular stellate shape with a focus of necrosis in the center of the element. Where rashes are abundant, the elements can merge with each other, forming large areas of necrosis (skin necrosis), in place of which scars remain. The disease is severe, characterized by repeated vomiting that does not bring relief, high fever, lethargy, convulsions, loss of consciousness. In infants, the hallmark of the disease is a high-pitched, monotonous cry.

In a mild form, meningococcal infection occurs like a common cold, does not have a rash, and may go unnoticed.

A rash with shingles (herpes) appears after 2-3 days of the prodromal period, characterized by a rise in temperature, pain and burning along the affected nerves. Most often, the elements of the rash in the form of reddish nodules 2-6 mm in size are located in the projection of the intercostal nerves and in the lumbar region against the background of slightly reddened skin. The nodules very quickly become bubbles with transparent contents, then dry out with the formation of a crust. They can merge. Pass in 7-14 days, leaving a slight pigmentation. Pain along the nerve fibers after an exacerbation of herpes often persists for up to 1-2 months, the general condition does not suffer significantly. If a person who does not have antibodies to the herpes virus comes into contact with the patient, he will get chickenpox.

A rash with streptoderma caused by the introduction of a streptococcal infection into the skin is a small yellowish vesicles on open areas of the body, face, soles, feet. The skin under the rash is hyperemic. More often the rash is located in the region of the nasolabial triangle, near the nostrils, lips. The bubbles are filled with a cloudy liquid, their size rapidly increases to 1.5 cm, then they merge with each other. Then the bubbles burst, covered with yellow crusts. The skin at the site of the rash itches. The elements of the rash are not abundant, located at a great distance from one another. Such a rash is called "impetigo", it has polymorphism, but does not have the jerky nature of rashes, as with chickenpox. The general condition of the patient with streptoderma is satisfactory, only in young children a rise in body temperature is possible.

Diagnosis of chickenpox

The diagnosis of "chicken pox" is made when the patient is examined by a doctor at home. A rash on the skin characteristic of the disease and an indication of contact with a patient with chickenpox about three weeks ago leave no doubt about the correctness of the diagnosis.

Laboratory disease is confirmed by the detection of herpes viruses in a smear-imprint of fluid from a vial under a light or electron microscope. Serological diagnostic methods are used:

• ELISA (immunofluorescence analysis);
• RSK (compliment binding reaction).

Laboratory diagnostic methods are required for an atypical form of chickenpox or a blurred clinical picture of chickenpox. In children, in most cases, a visual examination is sufficient to make a diagnosis.

Treatment

A patient with chickenpox does not need specific treatment. You can alleviate the patient's condition by the following measures:

1. Hygiene. The child must be bathed with soap, especially the perineum, vulva to prevent secondary infection with bacteria.
2. Wearing cotton clothing to reduce sweating that aggravates itching.
3. Keeping short-cut nails in children clean, which minimizes the risk of infection when scratching the skin.
4. Taking warm baths with a weak solution of potassium permanganate daily will help reduce itching.
5. Lubrication of spots and bubbles with a solution of brilliant green (brilliant green) 1% or 2% potassium permanganate.
6. Rinsing the mouth with antiseptics (furacillin, potassium permanganate) in the presence of enanthema.
7. Restriction in the diet of spicy, solid foods.
8. Antihistamines (fenistil, fenkarol, erius, zyrtec, cetrin) in age dosages help to cope with itching in both adults and children.
9. Antiviral drugs (isoprinosine, valtrex, acyclovir) are used in adults, with severe chickenpox and complications. The typical, mild form of chickenpox in children does not require medication.
10. The addition of bacterial flora is an indication for the appointment of antibiotics.

The introduction of human immunoglobulin can alleviate the condition, increase nonspecific immunity.

Why is chickenpox dangerous for pregnant women?

A woman who becomes infected with the chickenpox virus during pregnancy passes it on to her fetus. The prognosis for the fetus depends directly on the period at which the infection occurred. When a pregnant woman who is not immune to the virus gets chickenpox in the first trimester, the pregnancy can end in miscarriage. Possible malformations in the child. However, this disease is not an indication for abortion. A woman is given a human immunoglobulin preparation (a protein isolated from the blood of healthy people containing antibodies to various infectious agents) to reduce the risk of infection of the fetus. Subsequently, it will be necessary to pass tests to determine fetal pathologies, ultrasound screening and amniocentesis (amniotic fluid sampling for analysis).

In women who become infected with the varicella-zoster virus in the second trimester of pregnancy, when the placenta has formed, the risk to the fetus is minimal (2% or less). A healthy placenta protects its inhabitant from viral invasion. Treatment with immunoglobulin is prescribed only in cases where the risk to the mother or child outweighs the risk of side effects from the introduction of the substance.

The chickenpox virus is most dangerous for the fetus of a pregnant woman who fell ill a few days before childbirth. In this case, the child does not have antibodies to chickenpox, he becomes ill in the coming weeks after birth. A severe course of the disease is characteristic, and a fatal outcome is possible. Immunoglobulin administered to an infant can alleviate the condition, avoid the death of a newborn.

Women who get chickenpox 1-2 weeks before giving birth have a chance to give birth to a child with a set of specific antibodies produced by her body and transferred through the placenta to the baby. In this case, chickenpox in a newborn is not so difficult, so obstetricians can deliberately delay independent birth in order to enable the mother to pass antibodies to the baby. His own immune system is still immature and unable to produce them on its own.

The disease occurs in a pregnant woman in the same way as in any adult, with the same symptoms. To get rid of itching, local remedies are prescribed, since many antipruritic drugs are contraindicated for them.

Chickenpox in HIV-infected patients

Chickenpox in HIV-positive people is not common, since the immunodeficiency virus is infected mainly in adulthood, when chickenpox is already behind.

The incubation period lasts a week. Throughout all periods of the disease, high fever with chills, muscle pain, weakness, and headache are disturbing. There are many rashes, they last up to a month, and a person is contagious for a long time. A secondary bacterial infection joins the skin rash. The probability of complications increases many times - pneumonia, damage to internal organs.

Treatment of HIV-infected patients with chickenpox includes intravenous administration of large doses of acyclovir, a specific drug for herpes infection.

Complications of chickenpox

Chickenpox complications occur in people with weak immune defenses and in atypical forms of the disease. They can be caused both by the varicella-zoster virus itself, and by a bacterial infection that has joined the viral one.

The herpes virus in chickenpox can cause many diseases. Let's consider them in order.

1. Encephalitis - inflammation of the gray and white matter of the brain and its membranes. The cerebellum is often affected. A complication develops at the end of the rash period. Symptoms of encephalitis are manifested as a result of inflammatory edema of the brain tissue and are neurological in nature:

• , stagger;
• paralysis of the limbs; may be unilateral;
• tremor (trembling) of the hands and feet;
• ataxia - impaired coordination of movements;
• nystagmus - uncontrolled movements of the eyeballs;
• slow speech
• cerebral symptoms: vomiting, headache, convulsions, lethargy, apathy, high fever.

Encephalitis can develop even with a mild course of a typical chickenpox. Requires inpatient treatment. The prognosis for life is favorable.

2. Paralysis of the optic nerve and nerves of the face. They can be characterized by numbness, lack of movement and sensitivity of the corresponding muscles. Complication passes in 3-5 days.

3. Myelitis - inflammation of the spinal cord. A severe complication characterized by a loss of functions of organs that receive innervation from certain segments of the spinal cord. Both the very substance of the brain inside the spinal canal and the nerve roots and fibers extending from it become inflamed. Symptoms depend on the height of the lesion, are noted:

• paralysis of the arms, legs;
• violation of the act of breathing;
• the functions of the pelvic organs are impaired (delay in the excretion of feces and urine, or, conversely, incontinence);
• trophic disorders are characteristic: bedsores and non-healing ulcers on the skin.

It is treated permanently, the prognosis for life depends on the severity of the disease and the level of the spinal cord affected by the inflammatory process. The most severe is upper cervical myelitis, leading to complete paralysis of the muscles of the body and death from paralysis of the respiratory muscles.

4. Bacterial complications of chickenpox:

• stomatitis (inflammation of the oral cavity, accompanied by pain when chewing, swelling of the mucous membrane);
• laryngitis (rough cough, fever);
• bronchitis, (cough, shortness of breath, fever. Rare);
• vulvovaginitis (inflammation of the labia and the entrance to the vagina in girls);
• balanoposthitis (inflammation of the foreskin and head of the penis in boys);
• phlegmon of the perineum (purulent inflammation of the subcutaneous tissue);
• dermatitis (with secondary bacterial infection of the elements of the skin rash);
• bursitis (inflammation of the intra-articular bag. Severe course is characteristic);
• (inflammation of the veins and the formation of blood clots. Rare).

Severe complications of chickenpox are treated in stationary conditions.

Vaccination, chickenpox vaccination and prevention

Prevention of chickenpox comes down to interrupting the ways the virus spreads. A sick person who has contact with a chickenpox patient is placed in isolation for 21 days. With an exactly known date of contact, isolation lasts from 11 to 21 days, since in the first ten days from the moment of infection, a person does not shed the virus.

A child who has had chickenpox is allowed to visit a children's institution 8 days after the appearance of the last bubble.

If the chickenpox virus is found in a child in the garden, it must be isolated from other children, placed in a separate room. After the room is enough to ventilate and wash. Disinfection is not required, as the virus is unstable and will die within 10-15 minutes.

During an outbreak of chickenpox in a children's institution, a morning filter is needed: a garden health worker examines all children who come to the institution for skin rashes, red throats, enlarged lymph nodes. The temperature is being measured.

Since ancient times, it has been known that chickenpox is ill once in a lifetime, and it is better to have it in childhood, when it is mild. Therefore, many parents specifically allow their child to come into contact with a sick chickenpox. Perhaps this action is justified, but in medical practice there are no recommendations about this.

Vaccinations and vaccines against varicella

Since 2008, the chickenpox vaccine has been used in Russia. Trademarks of imported vaccines are patented: “Okavaks” - produced in France and “Varilrix” - Belgium. Both vaccines contain live attenuated varicella-zoster herpesviruses.

In Russia, the chickenpox vaccine is not mandatory. According to the national calendar of chickenpox vaccinations, children from 2 years old (permissible from one year old) and adults at any age should be vaccinated. It is necessary to vaccinate all children from 2 years of age against chickenpox, without fail when leaving for places of mass recreation and rehabilitation of children.

Vaccination is contraindicated for pregnant women. It should be vaccinated 2-3 months before planning pregnancy. If conception occurred immediately after vaccination, then there is no indication for termination of pregnancy.

The vaccine is recommended to be administered after contact with a patient with chickenpox within 72 hours, during the incubation time, a large amount of antibodies to viruses will have time to form. The disease will either not develop, or it will pass easily, without complications.

The vaccine is administered subcutaneously in the upper arm once to children from 2 to 13 years of age. Adults will need a second injection after 6-10 weeks.

The skin at the injection site may sometimes develop swelling and redness. After vaccination against chickenpox, delayed reactions may occur in the form of a rash similar to chickenpox on the skin and mucous membranes for 1-3 weeks. This is a normal phenomenon caused by the course of immunological reactions in the body. After a few days, this wind-like condition passes on its own.

Before getting vaccinated against chickenpox, you should consult a doctor, as the vaccine has contraindications. It should not be done in any acute illness, leukemia, AIDS, patients on hormone therapy, with a recent introduction of human immunoglobulin, blood transfusions, as well as with an allergic reaction to the drug neomycin.

Immunity after chickenpox

A person who has been ill with chickenpox develops a stable lifelong immunity, which will immediately stop the chickenpox virus after it enters the body.

It is extremely rare to get chickenpox again, mainly people with an immunodeficiency state. After vaccination, immunity from chickenpox is acquired in 90% of cases. The chickenpox virus that enters the body of a recovered person will no longer cause chickenpox. In this case, another disease occurs - herpes zoster, characterized by stages of exacerbations and remissions, which is not difficult.

Conclusion

Chickenpox (chickenpox) is a common disease in children. She, along with measles, rubella, mumps, diphtheria, whooping cough, is a “childhood” infection. Chickenpox in adults is less common, but is more severe and can cause complications. Atypical forms of chickenpox are now almost never found. A healthy person who does not have a severe chronic pathology, congenital or acquired immunodeficiency should not be afraid of meeting with the herpes virus. Vaccination can prevent chickenpox and reduce the risk of complications.

- an acute infectious disease of viral etiology, characterized by the appearance of a characteristic bubble rash against the background of a general intoxication syndrome. The causative agent of chicken pox is the herpes virus type 3, transmitted from the patient by airborne droplets. Chickenpox is one of the most common childhood infections. It is manifested by characteristic profuse itchy vesicular rashes that appear at the height of fever and general infectious manifestations. A typical clinic allows you to diagnose a disease without conducting any additional research. Treatment for chickenpox is mainly symptomatic. To prevent secondary infection, antiseptic treatment of rash elements is recommended.

General information

- an acute infectious disease of viral etiology, characterized by the appearance of a characteristic bubble rash against the background of a general intoxication syndrome.

Exciter characteristic

Chickenpox is caused by the Varicella Zoster virus of the herpesvirus family, which is also the human herpesvirus type 3. This is a DNA-containing virus, not very stable in the external environment, capable of replication only in the human body. Inactivation of the virus occurs quite quickly when exposed to sunlight, ultraviolet radiation, heating, drying. The reservoir and source of chickenpox are sick people during the last 10 days of the incubation period and the fifth to seventh day of the rash period.

Chickenpox is transmitted by aerosol mechanism by airborne droplets. Due to the weak resistance of the virus, contact-household transmission is difficult to implement. The spread of the virus with a fine aerosol emitted by patients when coughing, sneezing, talking, is possible over a fairly long distance within the room, it is possible to carry it with air flow into adjacent rooms. There is a possibility of transmission of infection transplacental.

People have a high susceptibility to infection, after the transfer of chickenpox, intense lifelong immunity is maintained. Children in the first months of life are protected from infection by antibodies received from the mother. Chickenpox most often affects children of preschool and primary school age who attend organized children's groups. Approximately 70-90% of the population recover from chickenpox before the age of 15 years. The incidence in cities is more than 2 times higher than in rural areas. The peak incidence of chickenpox occurs in the autumn-winter period.

Chickenpox pathogenesis

The entrance gate of infection is the mucous membrane of the respiratory tract. The virus invades and accumulates in epithelial cells, subsequently spreading to regional lymph nodes and further into the general bloodstream. The circulation of the virus with the blood stream causes the phenomena of general intoxication. The varicella-zoster virus has an affinity for the epithelium of integumentary tissues. The replication of the virus in the epithelial cell contributes to its death, in place of dead cells there are cavities filled with exudate (inflammatory fluid) - a vesicle is formed. After opening the vesicles, crusts remain. After separation of the crust, a newly formed epidermis is found under it. Chickenpox rashes can form both on the skin and on the mucous membranes, where the vesicles progress quickly enough in erosion.

Chicken pox in people with a weakened immune system is severe, contributes to the development of complications, secondary infection, exacerbation of chronic diseases. During pregnancy, the probability of transmission of chickenpox from the mother to the fetus is 0.4% in the first 14 weeks and increases to 1% up to the 20th week, after which the risk of infection of the fetus is practically absent. As an effective preventive measure, pregnant women with chickenpox are prescribed specific immunoglobulins that help reduce the likelihood of transmitting the infection to the child to a minimum. More dangerous is chickenpox, which developed a week before the birth and in the month following the birth.

Persistent lifelong immunity reliably protects the body from re-infection, however, with a significant decrease in the body's immune properties, adults who had chickenpox in childhood can become infected with it again. There is a phenomenon of latent carriage of the varicella-zoster virus, which accumulates in the cells of nerve nodes and can become activated, causing shingles. The mechanisms of viral activation in such carriage are not yet clear enough.

chickenpox symptoms

The incubation period for chickenpox ranges from 1-3 weeks. In children, prodromal phenomena are mild or not observed at all; in general, the course is mild with a slight deterioration in the general condition. Adults are prone to a more severe course of chickenpox with severe symptoms of intoxication (chills, headache, body aches), fever, sometimes nausea, vomiting. Rashes in children can occur unexpectedly in the absence of any general symptoms. In adults, the period of rashes often begins later; fever, when elements of the rash appear, may persist for some time.

The rash with chickenpox is in the nature of bullous dermatitis. Rashes are single elements that occur on any part of the body and spread without any regularity. The elements of the rash are initially red spots, progressing into papules, and then into small, even, single-chamber vesicles with a clear liquid, which collapse when pierced. The opened vesicles form crusts. Chickenpox is characterized by the simultaneous existence of elements at different stages of development and the emergence of new ones (spilling).

The chickenpox rash causes intense itching, and scratching may infect the vesicles with the formation of pustules. Pustules during healing can leave a scar (pockmark) behind. Uninfected vesicles do not leave scars, after the separation of the crusts, a healthy new epithelium is found. With suppuration of loose elements, the general condition usually worsens, intoxication worsens. The rash in adults is usually more profuse, and in the vast majority of cases, pustules form from the vesicles.

The rash spreads over almost the entire surface of the body, with the exception of the palms and soles, mainly localized in the scalp, on the face, neck. Podsypanie (the emergence of new elements) is possible for 3-8 days (in adults, as a rule, they are accompanied by new feverish waves). Intoxication subsides simultaneously with the cessation of rashes. A rash can appear on the mucous membranes of the oral cavity, genital organs, and sometimes on the conjunctiva. Loose elements on the mucous membranes progress to erosion and ulcers. In adults, the rash may be accompanied by lymphadenopathy; for children, damage to the lymph nodes is not typical.

In addition to the typical course, there is an erased form of chickenpox that occurs without signs of intoxication and with a short-term rare rash, as well as severe forms that differ in bullous, hemorrhagic and gangrenous. The bullous form is characterized by a rash in the form of large flabby blisters, leaving long-healing ulcerative defects after opening. This form is typical for people with severe chronic diseases. The hemorrhagic form is accompanied by hemorrhagic diathesis, small hemorrhages are noted on the skin and mucous membranes, and nosebleeds may occur. Vesicles have a brownish tint due to hemorrhagic contents. In persons with a significantly weakened body, chicken pox can proceed in a gangrenous form: rapidly growing vesicles with hemorrhagic contents are opened with the formation of necrotic black crusts surrounded by a rim of inflamed skin.

Complications of chickenpox

In the vast majority of cases, the course of chickenpox is benign, complications are observed in no more than 5% of patients. Among them, diseases caused by a secondary infection predominate: abscesses, phlegmon, in severe cases - sepsis. A dangerous, difficult-to-treat complication is viral (chickenpox) pneumonia. In some cases, chicken pox can provoke keratitis, encephalitis, myocarditis, nephritis, arthritis, hepatitis. Severe forms of disease in adults are prone to complications, especially with concomitant chronic pathologies and a weakened immune system. In children, complications are noted in exceptional cases.

Diagnosis of chickenpox

Diagnosis of chickenpox in clinical practice is based on a characteristic clinical picture. A complete blood count in chickenpox is nonspecific, pathological changes may be limited to an acceleration of ESR, or signal an inflammatory disease with an intensity proportional to the general intoxication symptoms.

Virological research involves the detection of virions by electromicroscopy of vesicular fluid stained with silver. Serological diagnosis has a retrospective value and is performed using RSK, RTGA in paired sera.

Chickenpox treatment

Chicken pox is treated on an outpatient basis, except in cases of severe course with intense general intoxication manifestations. Etiotropic therapy has not been developed, in the case of the formation of pustules, they resort to antibiotic therapy for a short course in medium dosages. Individuals with immune deficiency can be prescribed antiviral drugs: acyclovir, vidarabine, interferon alfa (new generation interferon). Early appointment of interferon contributes to a milder and shorter course of infection, and also reduces the risk of complications.

Chickenpox therapy includes skin care measures to prevent purulent complications: vesicles are lubricated with antiseptic solutions: 1% brilliant green solution, concentrated potassium permanganate (“brilliant green”, “potassium permanganate”). Mucosal ulcerations are treated with 3% dilution of hydrogen peroxide or ethacridine lactate. Intense itching in the area of ​​​​rashes is relieved by lubricating the skin with glycerin or wiping with diluted vinegar, alcohol. As a pathogenetic agent, antihistamines are prescribed. Pregnant women and patients with a severe form are prescribed a specific anti-varicella immunoglobulin.

Forecast and prevention of chicken pox

The prognosis is favorable, the disease ends in recovery. Vesicles disappear without a trace, pustules can leave smallpox scars. Significant worsening of the prognosis in people with immunodeficiency, severe systemic diseases.

Prevention of chickenpox is to prevent the introduction of infection into organized children's groups, for which, when cases of the disease are detected, quarantine measures are taken. Patients are isolated for 9 days from the moment the rash appears, children who have been in contact with sick children are separated for 21 days. If the day of contact with the patient is precisely determined, the child is not allowed in the children's team from 11 to 21 days after contact. Immunocompromised contact children who have not had chickenpox before are prescribed anti-varicella immunoglobulin as a preventive measure.

Recently, vaccination against chicken pox has been used. For this purpose, the vaccines Varilrix (Belgium) and Okavax (Japan) are used.