8 Reasons Why Chickenpox in Adults Is Actually Dangerous

Announcement : It is generally accepted that children suffer from chickenpox, but adults are also at risk of contracting this disease. In this case, the disease is severe and entails complications.

An acute infectious disease, commonly called chickenpox, is a consequence of airborne infection of the body with the herpes virus type III. The same pathogen causes herpes zoster. For others, an infected person becomes dangerous already a day before the first signs of the rash appear, as well as 3-5 days after it disappears.

If a person has already had chickenpox in childhood, then immunity to the disease remains with him for life. However, children do not always become infected with chickenpox, which already threatens them with serious consequences in adulthood if they come into contact with the virus.

Chickenpox symptoms

A rash all over the body is the main symptom of chickenpox, and this rash also appears on the mucous membranes. Chickenpox in the mouth is an enanthema. The child's temperature rises, general weakness appears, muscles and head ache. Usually this condition lasts 2-5 days. With chickenpox there may not be a fever - it all starts with a rash.

The incubation period for chickenpox is 10-21 days from the moment of infection. The disease usually lasts 5-10 days, although there are cases of the disease lasting 3 weeks.

With a mild form of chickenpox, the child may not be bothered by anything: he will be active and in a good mood, and only a small rash on the body will indicate that the baby is sick.

Chickenpox by day

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CHICKEN POX IN ADULTS

What are the features of chickenpox in adults? In what cases is the prescription of antibiotics indicated? When can a malignant course of the disease be expected?

Chickenpox (VZ), due to its widespread distribution and high contagiousness, usually develops in children, but it often occurs in adults. Thus, in the period from 1991 to 1998, under our supervision in infectious diseases clinical hospital No. 2 there were 1145 adult patients with VO aged from 16 to 80 years. Among them, men predominated (837), mostly aged 18-23 years (643).

Hospitalization of patients was carried out both for epidemiological indications from closed groups (barracks, boarding schools, student dormitories) and for vital reasons.

Observations showed that the clinical symptoms of VO in adults did not differ from those in children, but the disease was much more severe. Thus, in 84.8% of patients the course of the disease was assessed as moderate, in 8.0% as severe, and only in 7.2% as mild. In four patients (0.34%), the disease was malignant and was fatal. Other researchers provide similar statistical data [1, 2, 3].

In typical cases, the disease developed acutely (78%) or subacutely (22%) with a one- or two-day prodromal period, during which an increase in temperature from low-grade to high (390C), malaise, weakness, and headache were noted.

The period of rash began with the appearance of one or two large papular elements, which very quickly turned into vesicles or pustules. Over the next 24 hours, the papular-vesicular rash rapidly increased and, with rashes, spread to the face, scalp, torso, and, to a lesser extent, to the extremities. Sleeping continued in 88% of patients for 3-4 days, accompanied by skin itching.

In 35.7% of patients, the rash was extremely abundant, almost completely covering the face and torso. A distinctive feature of the rash was rapid and abundant pustulization, which was observed in almost half of the patients (49.2%).

Pustulation was accompanied by a significant (39-400C) rise in temperature. Fever in the absence of treatment lasted up to 7-8 days.

Exanthema in 91.3% of cases was accompanied by enanthema on the oral mucosa, mainly in the area of ​​the palatine arches and soft palate. Enanthema initially looked like bright pink papules, and then turned into vesicles, which quickly opened to form ulcers covered with a white-yellow coating. Stomatitis developed, which caused severe pain when eating.

In addition to the oral cavity, enanthema was also detected on the mucous membrane of the genital organs with the same frequency in men and women (3.9%). When the rash was localized in the urethral area, patients experienced pain when urinating. In 0.9% of cases, rashes were observed on the conjunctiva, which was accompanied by pain in the eyes and a feeling of “sand.”

In 98% of cases, the disease was accompanied by lymphadenopathy with a predominant enlargement of the cervical and postauricular lymph nodes. With pustulization, lymphadenopathy was especially pronounced. Enlarged lymph nodes were determined visually by tilting the head.

In children, according to the observations of V. A. Postovit (1982), lymphadenopathy is observed only in 6% of cases.

No changes were detected in the internal organs. The hemogram in moderate cases of VO was characterized by normal or moderately reduced levels of leukocytes and lymphocytosis. In 2% of cases, against the background of a moderate increase in the content of leukocytes and lymphocytosis (up to 45-50%), atypical mononuclear cells were detected, the number of which did not exceed 10-12% of the number of lymphocytes.

Therapy for moderate cases included symptomatic and desensitizing agents. In case of severe pustulization, accompanied by high fever, antibiotics (usually penicillin) were prescribed for a short course (3-4 days).

A comparison of two groups of patients with VO with pustulization, who received and did not receive antibiotics, showed that the febrile period and regression of the rash in the former was significantly shorter by 2 days.

Severe disease was observed in 92 people (8%). It was characterized by high fever (39-400C) from the first days of the disease, severe intoxication, manifested by headache, dizziness, nausea, repeated vomiting, sleep disturbance, severe weakness, lack of appetite, as well as an extremely profuse rash, usually with pustulization. In eight patients, the formation of single blisters was observed, in one patient - vesicles with hemorrhagic contents.

Complicated forms of the disease were also classified as severe. Under our supervision there were five patients with various complications. Only one patient had an unfavorable premorbid background - a condition after childbirth. Two of them, women 23 and 26 years old, developed pneumonia during the acute period of VO.

Here is a brief description of the course of the disease of one of them.

Patient D., 23 years old, a postpartum woman, was admitted to ICH No. 2 on November 26, 1998, on the fifth day of illness with a diagnosis of chicken pox, severe course, acute focal bilateral pneumonia, stage II respiratory failure.

She became acutely ill on November 22nd - single rashes on the skin, fever up to 38.80C, in subsequent days - up to 40-40.50C, the rash increased every day. On the 4th day of illness, the condition worsened: shortness of breath, cough, chest pain, and difficult to separate sputum. She was hospitalized with these complaints. Upon admission, the condition was serious. Dyspnea. Acrocyanosis. There is an abundant polymorphic rash on the skin: pustules, crusts, papules. On the mucous membrane of the oropharynx in the area of ​​the palatine arches there are rounded erosions, surrounded by a rim of hyperemia. Peripheral lymph nodes are enlarged, mainly cervical. Above the lungs, the percussion sound is shortened on both sides below the shoulder blades. Breathing is weakened, shallow, moist fine rales are heard in the lower parts of the lungs on both sides. Respiratory rate is 28-30 per minute, heart sounds are muffled and rhythmic. Blood pressure 120/80 mm. Hg Art., pulse 104 beats/min. When studying acid-base balance - respiratory acidosis, hypoxemia (pH - 7.30; pCO2 - 54.3; pO2 - 21.7; SВ = 23.3; BE = - 0.9). Hemoglobin - 127 g/l; leukocytes - 6.8 x 109/l; n - 47%; s - 5%; l - 40%; m - 8%; ESR - 10 mm/hour. On the radiograph: on both sides (more on the left) there is a decrease in the transparency of the pulmonary fields due to focal shadow formations of a confluent nature. The roots are “infiltrated”, the diaphragm is normal. The sinuses are free. The mediastinal shadow is without features. In the next few hours from the moment of admission, shortness of breath intensified, respiratory rate was 40-42 per minute, blood pressure was 110/60 mm. Hg Art., pulse - 96 beats/min. Therapy was carried out: amikacin 0.5x2 IM, intravenous drip glucose 5% - 400.0 + aminophylline 2.4% - 5.0 ml + prednisolone 90 mg; then Lasix 20 mg IV; after 10 hours, intravenous drip reopliglucin 400.0 ml + prednisolone 60.0 mg, sulfocamphocaine intramuscularly, oxygen inhalation, aminophylline 0.15 mg x 3 days. inside. By the end of the 1st day of stay in the clinic, there was an improvement in the condition. Shortness of breath decreased (respiratory rate - 26 per minute), cyanosis disappeared, and the temperature dropped to 37.10C. Subsequently, the patient’s well-being and condition quickly improved. From the 8th day of illness, the temperature returned to normal, the exudative elements of the rash became crusty. On the 11th day of illness, a chest x-ray showed positive dynamics: the disappearance of inflammatory shadow formations, restoration of the root structure. On the 12th day of illness she was discharged in satisfactory condition.

Japanese authors report pneumonia as the most common complication of VO in adults [5]. The authors emphasize that pneumonia can take an unfavorable course, especially in people with a complicated medical history and in pregnant women. In previously healthy individuals, the disease proceeds benignly.

In two cases, in boys aged 16 and 19 years, the disease was complicated by serous meningitis, which also developed in the acute period of VO. The course of serous meningitis did not differ from that caused by other viruses and was benign in nature.

One patient developed encephalitis during the acute period of VO.

Patient A., 22 years old, a military man, was admitted on the 3rd day of illness on March 5, 1998 in a moderate condition with a diagnosis of chickenpox. He complained of a moderate headache and an itchy rash. On the skin there is a slight polymorphic rash (papules, vesicles, single crusts). No pathology was detected in the organs, blood pressure was 110/70 mm. Hg Art., pulse - 88 beats/min, temperature 37.70C. In the following days, the patient's condition improved, the temperature returned to normal, and crusts formed on the skin. On the 6th day of illness, the temperature increased again to 38.20C, headache, dizziness, drowsiness, weakness, and diplopia appeared. On examination, he is somewhat stunned, answers questions sluggishly, viscosity of the nuchal muscles, a dubious Kernig sign, tremor of the tips of the fingers, tongue, missing the finger-nose test on both sides are determined, symptoms of Oppenheim, Gordon, Schaeffer, Babinsky are identified. In Romberg's position he is unstable, there is a deviation of the tongue to the left. A diagnostic lumbar puncture was performed: the cerebrospinal fluid is clear and flows out in frequent drops. The examination revealed no pathological changes. The patient was consulted by a neurologist. Conclusion: chicken pox, encephalitis. Treatment: daily intravenous glucose 5% 300.0 ml + Trental 200 mg + GHB 10% - 5.0 ml + magnesium sulfate 25% - 10.0 ml + Relanium 4.0 + Lasix 20 mg; orally - potassium orotate, cinarizine, nootropil, finlepsin, intramuscular vitamins B1, B6, 2.0 ml. With the treatment, the patient's condition gradually improved, and neurological symptoms regressed. On the 45th day of illness, the patient was discharged in satisfactory condition.

Of the 92 patients with severe VO, four had a fatal outcome. According to M. Voiculescu, L. Comes (1963), V. N. Wertzner et al. (1974), the causes of death in VO are generalization of the process, damage to the central nervous system, and pneumonia. Malignant forms of the disease are observed in persons with a burdened premorbid background and in the elderly.

Our observations confirm this position: in two patients, VO developed against the background of a blood disease, in one patient - against the background of severe congenital organic damage to the central nervous system, and one patient was elderly. Below is an extract from her medical record.

Patient P., 77 years old, was admitted to ICH No. 2 on 02/09/99 on the 4th day of illness. I got sick on February 6, felt weak, headache, and tired. I didn't measure the temperature. On the 2nd day of illness, single papules appeared on the chest. Over the next 2 days, the rash increased, the temperature rose to 390C, and the patient’s health sharply worsened. On the fourth day of illness, she was hospitalized with a diagnosis of “chicken pox?” Upon admission, the patient was in serious condition, stupor, temperature 390C, acrocyanosis. Abundant vesicular rash with hemorrhagic contents on the face, scalp, torso, individual necrotic elements in different places. The conjunctiva and mucous membrane of the oropharynx are moderately hyperemic, with isolated aphthae on the soft palate. There is harsh breathing in the lungs, dry wheezing, respiratory rate - 36 v/min. Heart sounds are muffled, rhythmic, blood pressure is 90/60 mm. Hg Art., pulse - 88 beats/min. The abdomen is soft and painless. Consciousness is confused and makes contact with difficulty. There are no meningeal or focal symptoms of central nervous system damage. Based on the above, a diagnosis was made: chicken pox, hemorrhagic form. An. blood: Hb - 121.0 g/l; L. - 4.5x109/l; n - 13%; s - 11%; e - 2%; L - 73%; m - 1%; ESR - 18 mm/hour. Among lymphocytes, 21% are atypical mononuclear cells with wide basophilic protoplasm. ASH from 9.02 upon admission: pH - 7.30; рО2 -52.7; pCO2 - 32.5; SВ - 17.2; BE = - 9.1; Ht - 35.9%; Na - 138.4 mmol/l; K - 3.45 mmol/l. Despite intensive therapy, the patient's condition progressively worsened and 9 hours after admission the patient died.

Pathological and anatomical diagnosis:

main - chicken pox, a generalized form with damage to the skin, liver, kidneys, spleen, lungs, mucous membrane of the pharynx, esophagus, conjunctiva, necrotizing encephalitis; complication - cerebral edema; concomitant - atherosclerosis of the aorta, coronary arteries, diffuse cardiosclerosis.

In the above case of a generalized form of VO, the immediate cause of death was cerebral edema that developed as a result of necrotizing encephalitis.

Dutch authors report deaths from chickenpox encephalitis in elderly people [6], explaining the malignancy of the course by age-related immunosuppression.

In contrast to the generally known opinion about the severe course of infectious diseases in people with immunodeficiency, we observed only a mild course of VO in HIV-infected people. There were three HIV-infected patients with VO in our clinic. In all three cases, the disease began with the appearance of a rash without prodrome, without fever, with slight intoxication and moderate exanthema. At the same time, the course of the disease was long and sluggish; the vesicular-pustular rash crusted over only by the end of the second week. In these cases, no complications were observed.

Literature

1. Vertsner V. N. Chicken pox. M.: Medicine, 1963. 2. Comes L. Chicken pox. Infectious diseases / Ed. prof. Voiculescu M.I. Bucharest: Meridian, 1963, p. 286-297. 3. Postovit V. A. Chicken pox. — In the book: Children's droplet infections in adults. M., 1982, p. 5-50. 4. Yushchuk N. D., Vengerov Yu. Ya. Chicken pox. In the book: Lectures on infectious diseases. M.: VUNMTs, 1999. 5. Saitou-M, Niitsuma-K, Kasukawa-R. Two cases of severe adult varicella pneumonia, Nihon-Kokyuki-Gakkai-Zasshi. Mar 1998; 36(3): 251-5. 6. Westenend PJ, Hoppenbrouwers WJ Fatal varicella-zoster encephalitis; a rare complication of herpes zoster, Ned-Tijdschr-Geneeskd. 1998 Mar 21;142(12):654-7.

Note!

• In adults, chickenpox is more severe than in children; the typical course is moderate, characterized by intoxication, an abundance of rashes, and early pustulization.
• Severe and complicated course of VO is observed at any age and is not always associated with an unfavorable premorbid background. The malignant course of the disease can be predicted in persons suffering from blood diseases, severe congenital pathology, as well as in the elderly
• With profuse pustulization, antibacterial therapy is effective, shortening the period of fever and promoting rapid regression of pustules

How is chickenpox transmitted?

Most often, children from 3 to 7 years old suffer from chickenpox. In children under one year of age, adolescents and adults, chickenpox is a rare occurrence. The mode of transmission of chickenpox is airborne. The causative agent of the disease is herpes virus type 3 (varicella-zoster). This virus begins to rapidly multiply in the blood and lymph of the sick person, and when it ends up in the upper layers of the skin, the same rash of chickenpox appears.

Read also Epstein-Barr Virus: what it is and how to treat What is Epstein-Barr Virus and what drugs are prescribed for its treatment.

Answers to common questions

Is there a way to prevent chickenpox?

The preventive measure – not to contact people who are sick – is not always effective. The fact is that infection can occur even before the first manifestations of the disease are detected in the patient. That is, he can communicate with friends without knowing that he is contagious.

It is possible to prevent the onset of the disease by vaccination with special live vaccines, which are based on a weakened chickenpox virus.

Which specialist should I contact for treatment?

Chickenpox in children is treated by a pediatrician or pediatric infectious disease specialist. If an adult gets sick, you should call a therapist or an adult infectious disease specialist immediately after detecting the first symptoms of chickenpox.

Is it possible to swim if you have chickenpox?

Due to the fact that the quality of tap water in most cities leaves much to be desired, in case of this disease you should take a shower (not a bath) using boiled or filtered water. Otherwise, there may be a risk of a bacterial infection joining the viral form, which, in turn, can cause serious complications. It is better to wash with warm water. It is strictly forbidden to use a washcloth, rub the skin or steam it.

Complications of chickenpox

The main and dangerous complications of chickenpox are myocarditis and encephalitis. Such complications are typical for adults and those children who have weakened immune systems.

In addition to ordinary chickenpox, there are bullous, gangrenous and hemorrhagic forms. These are severe types of disease with complications. If the wounds become infected with a bacterial infection, another complication may develop - pyoderma. This complication often occurs in children.

The rash with ordinary chickenpox leaves no traces, but with such suppuration, scars are possible.

Possible complications

As a rule, the disease goes away without serious consequences, especially if you do not scratch the papules. However, in rare cases, complications after chickenpox can still occur.

Among them:

• bacterial infection caused by streptococcus;
• viral pneumonia, which is more common in children of the first year of life and manifests itself in the form of high body temperature, excessive paleness of the skin, dry cough and severe shortness of breath even at rest;
• temporary disruption of the central nervous system;
• encephalitis;
• chickenpox meningitis.

To avoid such consequences, monitoring of the development of the disease and treatment must be carried out under the supervision of a physician - therapist, pediatrician or infectious disease specialist.

How to treat chickenpox

Chickenpox is treated symptomatically: with antipyretic drugs, antihistamines in the form of tablets or ointments for external use. In some cases, taking antiviral medications is recommended to help the body fight off the infection faster. Mouth ulcers heal well with sea buckthorn oil and Solcoseryl ointment. You can also rinse your mouth with weak solutions of furatsilin, soda, and potassium permanganate. Herbal decoctions diluted with alcohol tinctures of propolis or calendula are also suitable.

Solcoseryl dental adhesive paste

Meda Pharma, Switzerland

Wound healing, angioprotective, membrane stabilizing, regenerating, cytoprotective, antihypoxic drug, which is available in the form of an injection solution, gel and ointment for external use.
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Preparations for treating skin ulcers relieve inflammation, disinfect, accelerate healing, dry, and reduce itching.

Chickenpox during pregnancy

If a woman did not have chickenpox as a child, she may become ill during pregnancy. In fact, the likelihood of this happening is low. Tests done on those who do not remember that they had chickenpox show that the vast majority (up to 90%) already have antibodies to Varicella Zoster in their blood, that is, they still had contact with the virus.

There is a group of infections united by the principle of danger to the fetus and the health of the unborn child - the so-called ToRCH infections. The chickenpox virus is not included in this group. Although the “H” in ToRCH stands for herpes, it refers to herpes infection types I and II (“herpes simplex”), not Varicella Zoster. Compared to classic ToRCH infections, chickenpox is less dangerous.

Still, it’s better to try not to get sick. If you have chickenpox in the first trimester, miscarriages and undeveloped pregnancies are possible. Sometimes chickenpox leads to congenital malformations and deformities of the child (congenital chickenpox syndrome) - in approximately 1% of cases. In general, the risk to the fetus during this period is about 5%. In the second trimester, the risk of any consequences is even lower (no more than 1-2%).

Chickenpox is most dangerous just before childbirth. If a mother gets chickenpox 7-10 days before delivery, then the child may be born already sick with chickenpox (about 10-20% of cases), and this is dangerous (various complications, even death). Therefore, during this period it is better to play it safe and exclude contacts with children who have not had chickenpox - potential virus carriers.

Make an appointment Do not self-medicate. Contact our specialists who will correctly diagnose and prescribe treatment.

Rivanol

"Rivanol" is an antiseptic for external use in the form of a solution, effective in combating mainly coccal microorganisms (streptococci, staphylococci). It is these bacteria that usually cause complications with chickenpox (carbuncles, boils). "Rivanol" is used to spot treat ulcers 3-3 times a day. Contraindications: kidney problems and pregnancy.

Rivanol 0.1%

Dina+, UK

Rivanol is an antiseptic, has antimicrobial activity, fights coccal microorganisms, and is used in gynecology, urology, surgery, dermatology, and ophthalmology.
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Chickenpox treatment

Treatment of chickenpox is symptomatic. Sick people should stay at home. For intense itching, antihistamines are prescribed orally. It is recommended to use antipruritic ointment for chickenpox, treat the blisters with Castellani liquid or brilliant green solution. An antiseptic for chickenpox not only reduces itching, but also prevents infection from entering the blisters.

Warm baths and wearing light, soft clothing can help relieve symptoms.

How to treat chickenpox in severe form or with the threat of complications is decided by an infectious disease specialist or pediatrician. Antiviral drugs may be prescribed to activate the body's own immune processes.

Tsindol

“Tsindol” for chickenpox perfectly relieves inflammation, disinfects wounds, and dries out burst blisters. The suspension should be used to treat the rash 3-5 times a day, depending on the severity of the condition. "Tsindol" is completely safe, so it is prescribed to children under one year of age and to pregnant women. The only contraindication is intolerance to zinc oxide.

Tsindol

Yaroslavl Pharmaceutical Factory, Russia

Diaper rash, diaper rash, prickly heat, dermatitis, ulcerative skin lesions, superficial wounds, eczema in the acute phase, herpes simplex, streptoderma, trophic ulcers, burns, bedsores.
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Prevention

Preventive measures are divided into nonspecific and specific.

Nonspecific prevention includes general measures to prevent the spread of infectious diseases, including:

• avoid contact with a sick adult or child;
• Regularly carry out wet cleaning and ventilation of the room in which the sick person is staying.

Specific prevention is represented by a vaccine with a weakened live virus. Depending on the specific drug, the chickenpox vaccine is given to adults in one or two doses.

Should I get vaccinated against chickenpox?

The chickenpox vaccine is not included in the National Preventive Vaccination Calendar, but doctors recommend getting vaccinated.
Especially if there was contact with a sick person (within 72 hours) or there are concomitant pathologies or conditions that increase the risk of complications. These include immunodeficiency, cancer, diabetes mellitus, bronchial asthma and chronic renal failure. Absolute contraindications to chickenpox vaccination include:

• allergy to chicken eggs, since a similar protein is used in the preparation of the vaccine;
• individual intolerance to antibiotics from the aminoglycoside group;
• severe immunodeficiency, in which even a weakened virus can trigger the development of chickenpox;
• pregnancy.

As an emergency prophylaxis, immunoglobulin is administered to those who have contraindications to vaccination.

The chickenpox vaccine contains a weakened live virus. Photo: pixs4u / Depositphotos

For people who have already had chickenpox but have a weakened immune system, and people aged 50 years and older, vaccination against herpes zoster is recommended5.

The US Centers for Disease Control and Prevention recommends using the recombinant Shingrix vaccine produced by the British pharmaceutical company (GlaxoSmithKline). Russia does not yet have its own vaccine against herpes zoster. Its production, according to media reports, will begin in 20276.

Vaccination in preparation for pregnancy and after it

A woman who plans to become pregnant and has not previously had chickenpox can be vaccinated at least 3 months in advance of her intended conception. However, breastfeeding is not a contraindication to vaccination. If necessary, the vaccine can be administered in the first months after birth.

Calamine

Calamine topical lotion is based on zinc and calamine oxide. The medicine for chickenpox relieves itching, irritation and inflammation well, and works as an antiseptic. “Calamine” is also as harmless as possible, but is not suitable for those who have individual sensitivity to zinc.

Calamine

The drug Calamine lotion is used in dermatological practice, in the treatment of diseases accompanied by itchy skin.
Therefore, the lotion is prescribed for the complex treatment of chickenpox, eczema, and psoriasis. Used for dermatitis, acne, herpes. Used in the treatment of skin rashes, herpes zoster, urticaria, rubella, etc. from 231

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Treatment

Treatment of chickenpox in its standard course occurs at home after consulting a doctor. It is aimed at improving the general well-being of the patient: drugs whose active ingredient is paracetamol are used to reduce elevated body temperature.

In the vast majority of cases, patients suffer from unbearable itching of the skin. To alleviate the condition, special ointments and solutions are prescribed based on zinc and potassium permanganate, with the addition of tea tree oil. Antihistamines may be recommended. Often, a specialist will prescribe ointments whose action is aimed at destroying the viral pathogen.

In more serious cases (especially if there is concomitant shingles), the doctor will prescribe analgesics. In case of extremely reduced immunity, the patient is given immunoglobulins, and in case of intense intoxication of the body, detoxification solutions are administered.

Furacilin

Wounds with chickenpox should be treated with a 0.02% solution of Furacilin 3-4 times a day (it is better to use a cotton pad). The product relieves inflammation, kills germs, and dries wounds well. "Furacilin" can also be used for ulcers on the mucous membranes.

Furacilin solution

Samaramedprom OJSC, Russia; PJSC "Biosintez", Russia; JSC Dalkhimfarm, Russia; Vips-Med, Russia

Externally: purulent wounds, bedsores, stage II – III burns, minor skin damage (including abrasions, scratches, cracks, cuts).
Locally: blepharitis, conjunctivitis, boil of the external auditory canal; osteomyelitis, empyema of the paranasal sinuses, pleura (washing the cavities); acute external and otitis media, tonsillitis, stomatitis, gingivitis. from 100

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Diagnostics

In most cases, the diagnosis of chickenpox is made based on a conversation with the patient and specific symptoms. The doctor asks if there has been recent contact with an infected person and examines how the rash looks and develops.

If the clinical picture is unclear, the doctor will additionally prescribe laboratory tests confirming the presence of Varicella Zoster activity in the body. Usually carried out:

• Enzyme-linked immunosorbent assay (ELISA). Allows you to detect high levels of IgM and IgG antibodies to the causative virus and an increase in their titer by more than 4 times within 10 days.
• Polymerase chain reaction (PCR). Makes it possible to determine the presence of DNA of the Varicella Zoster virus in the patient's blood.

Differential diagnosis

Chickenpox should be distinguished from other pathologies with similar skin rashes.

Diseases with similar symptoms:

Mild forms of chickenpox are treated at home; in case of moderate and severe forms or the development of complications, hospitalization in an infectious diseases hospital is indicated.

Hospitalization is indicated for severe chickenpox or if complications occur. Photo: Wavebreakmedia / Depositphotos

In severe cases of the disease, drug therapy is carried out using the following drugs:

• Antiherpetic drugs - acyclovir, famciclovir, valacyclovir. Aimed at suppressing the herpes virus and accelerating recovery. Used in a course of 7 to 14 days.
• Non-steroidal anti-inflammatory drugs (NSAIDs) - paracetamol, ibuprofen. Allows you to reduce body temperature and eliminate headaches.
• Antihistamines - loratadine, desloratadine. Prescribed for severe skin itching.

Additionally, doctors can use antibiotics, immunomodulators, vitamin complexes, etc.

What to apply to the rash?

In mild forms of the disease, the only treatment may be local treatment of the rash elements and personal hygiene.

The most common alcohol dyes used for topical treatment are brilliant green or methylene blue. The doctor can also use antiseptics (chlorhexidine, fucorcin) and cosmetics containing zinc (calamine). The latter not only act as an antiseptic, but also eliminate itching.

Calamine is used for various skin diseases, including chickenpox. Photo: benedamiroslav / Depositphotos

Chlorhexidine

"Chlorhexidine" (or its analogue "Miramistin") for chickenpox is applied to the vesicles 2-3 times a day. The product is also suitable for rinsing your mouth. "Chlorhexidine" is a broad-spectrum antiseptic with antimicrobial and antifungal effects.

Chlorhexidine

Update, Russia

Prevention of sexually transmitted infections (chlamydia, ureaplasmosis, trichomoniasis, gonorrhea, syphilis, genital herpes).
Disinfection of purulent wounds, infected burn surfaces; treatment of infections of the skin and mucous membranes in surgery, obstetrics and gynecology, urology (urethritis, urethroprostatitis), dentistry (gingivitis, stomatitis, aphthae, periodontitis, alveolitis). from 12

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Is chickenpox a mild infection?

In the vast majority of cases, the disease has a mild to moderate course in childhood and a severe course in adults. However, complications of chickenpox in adults are rare - no more than 7% of the total number of cases.

Most often, complications develop with concomitant diseases that reduce the body’s immune strength (for example, diabetes mellitus, HIV infection, cancer) and during pregnancy.

Among the most common complications:

• inflammatory lesions of the lungs and brain;
• inflammation of the heart, liver and kidneys;
• bacterial infections of the skin, soft tissue and bones2.

Chickenpox and herpes zoster

With rare exceptions, people only get chickenpox once. However, this type of virus is able to remain in the body. Most often it hides in the nerve ganglia along the spine2.

When the immune system is weakened due to hypothermia or immunodeficiency states, the virus is reactivated, resulting in the development of herpes zoster. It manifests itself with characteristic skin lesions and pain.

Chickenpox during pregnancy

Chickenpox is a serious danger for pregnant women, especially in the first trimester. Intrauterine transmission of the virus can cause developmental abnormalities (limb deformities, microcephaly, hydrocephalus, soft tissue calcification, growth retardation) and intrauterine fetal death3.

A pregnant woman can get chickenpox, which poses a great danger to the baby. Photo: patchananp.gmail.com / Depositphotos

When a pregnant woman falls ill 1–4 weeks before giving birth, in 50% of cases chickenpox is transmitted to the child. Despite a high titer of passive antibodies obtained from the mother, 23% of newborns develop a clinically significant infection. Infection can occur both through the placenta and through the mucous membranes of the birth canal3.

If the pathology occurs within 1 week before or after birth, newborns are at high risk of infection, because maternal antibodies do not have time to be transmitted to the child. The most dangerous is the appearance of a characteristic skin rash in the mother 5 days before birth or within 2 days after. In these cases, a severe neonatal form of chickenpox develops with high mortality in newborns (up to 30%3).

The disease poses a risk to the expectant mother. According to statistics, pneumonia occurs in 10–20% of pregnant women with chickenpox and is more severe in the long term3.

Poksklin

Cooling mousse "Poksklin" for chickenpox has a completely natural base (panthenol, aloe vera, chamomile and lavender). The product cools and reduces scratching, so scars do not form. “Poksklin” relieves inflammation, has an antiseptic effect and accelerates the healing process of wounds.

Poksklin

PharmaVal AS, Netherlands

Poksklin cooling hydrogel was developed to relieve the symptoms of chickenpox over large areas of the body.
While spreading thick creams and ointments over the body can damage the blisters, the cooling hydrogel is very easy to apply and does not cause friction in sensitive areas when applied to the skin. PoxClean provides an immediate cooling effect, which significantly relieves itching. For this purpose, it can be used as many times as necessary. PoxClean contains the ingredient 2QR, a biologically active antibacterial complex. This component helps your child's natural skin immunity to block harmful bacteria. The antibacterial component in PoxClean is a polysaccharide obtained from the plant extract of Aloe Vera. It creates a barrier on the skin, thereby preventing the penetration and spread of bacteria on the surface of the skin. from 890

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Childish and harmless?

JSC Family Doctor - Chickenpox is a predominantly childhood disease

Chickenpox is considered a childhood disease. This does not mean that only children get sick, but if the probability of getting sick is very high, then, most likely, you won’t have long to wait until you get sick - childhood will not have time to end. Up to 6 months, the child is protected by innate immunity, but then the risk of getting sick increases. While a child is being raised at home, he does not have many places where he can encounter the virus, but when he begins to socialize - goes to kindergarten or school, an encounter becomes almost inevitable.

There are a lot of childhood diseases, and, as a rule, they try to prevent the disease, for which immunoprophylaxis is carried out - the child is given appropriate vaccinations. There are no vaccinations against chickenpox in the National Preventive Vaccination Calendar. Or rather, there is, but this vaccination is recommended only for those who are at risk (primarily those who have problems with immunity - HIV-infected people, cancer patients, those who suffer from severe chronic diseases). Why is that?

It is believed that you only get chickenpox once: a stable, specific immunity is formed that lasts a lifetime. That is, it is enough to get sick in childhood, and you will not encounter this disease again. In any case, this statement is true for the vast majority. In childhood, chickenpox is easily tolerated. But if childhood is behind you, and you haven’t encountered chickenpox, then it’s better to avoid it in the future. Adults suffer from this disease much worse. So, if you are an adult who has not had chickenpox, then it is better to play it safe and get vaccinated.

Fenistil

"Fenistil" is a safe antihistamine (antiallergic) drug of a new generation. To reduce the itching of chickenpox, antihistamines are used, this is especially true for children who cannot control themselves and scratch the wounds. It is not advisable to use Fenistil gel for chickenpox, since due to the treatment of large areas of the body it can be toxic to the body. But Fenistil drops for chickenpox are a good way to relieve itching. The number of drops is calculated based on the patient's weight.

Fenistil

GlaxoSmithKline, GSK, UK

The antiallergic effect of Fenistil is associated with competitive blockade of H1-histamine receptors.
Symptomatic treatment of allergic diseases such as: urticaria; allergic rhinitis; food allergies; drug allergy. Elimination of itching from: insect bites; chicken pox; atopic dermatitis. from 237

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And here it is - chickenpox...

First, the child complains of feeling unwell: suddenly he has a headache, body aches, and a sore throat. It is clear that he is unwell, but what kind of illness is still unclear. Then (a few hours later or the next day) the temperature rises, and a rash appears against its background. However, there may be no fever or symptoms preceding it, but there will definitely be a rash.

The elements of the rash have their own “life cycle”: small red spots turn into bumps resembling mosquito bites (papules), then liquid accumulates in them (such elements are called vesicles). The vesicles burst, and crusts appear in their place, which then fall off, revealing clean skin. The transformation of papules into vesicles usually occurs within 24 hours; crusts appear a couple of days after the formation of vesicles. But they take longer to disappear – this can take up to two weeks.

The rash appears in waves, as people say - “sprinkles.” At the same time, there may be papules, vesicles, and crusts on the child’s body. On average, the rash period lasts from 5 to 8 days. It is believed that five days after the last elements of the rash appear, the child ceases to be contagious.

In other words, there is reason to believe that in just over a week the disease will pass, and it will leave behind a short-lived memory in the form of crusts, which will also disappear without a trace. It is hardly possible to speed up recovery. Therefore, all treatment for chickenpox is symptomatic. It is aimed at eliminating the problems that the disease brings with it. The first problem is temperature. If it is not high (and it may not exist at all) or if the child easily tolerates high temperature, it is better not to bring it down at all. Consult your doctor - he will tell you how to act specifically in your case.

JSC Family Doctor - Treatment of Chickenpox

The second problem is itching. The chickenpox rash is very itchy, but you can’t scratch it. The virus accumulates in the vesicles, and scratching can cause additional spread of the rash throughout the body. Also, damaged vesicles heal less well, their contents can fester (in this case, the vesicles turn into pustules), and in their place, pockmarked pits form, which do not disappear for a long time.

Make sure your child does not sweat: sweat increases the itching. Change your underwear more often.

In our country, it is customary to smear chickenpox rash with brilliant green. The treated vesicles dry out faster, preventing the possibility of their inflammation. This will not make the child recover any faster, but sanitary treatment of the rash is encouraged. In the end, brilliant green is a good marker: if you don’t need to smear anything else, it means the rash has stopped and the disease is over.

If new elements of the rash no longer appear, you can (and should) go for a walk with the child. However, you should stay away from other children, as it will still be contagious for some time.

When all the vesicles have crusted over, the child can be washed, but it is better not to use any shampoo or soap. Under no circumstances should you rub your child with a washcloth - touches should be gentle so as not to tear off the scabs. It’s better not to wipe it with a towel, but to blot it.

Cetirizine

Doctors often prescribe Cetirizine (Zyrtec) for chickenpox. For children - in drops, for adults - in tablets. The drug relieves symptoms well in itchy allergic dermatoses, has no contraindications and is usually well tolerated.

Cetirizine

JSC VERTEX, Russia

seasonal and year-round allergic rhinitis and conjunctivitis (itching, sneezing, rhinorrhea, lacrimation, conjunctival hyperemia);
urticaria (including chronic idiopathic urticaria); hay fever (hay fever); itching; angioedema (Quincke's edema); itchy allergic dermatoses. from 36

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Sources

1. Chicken pox: adults at risk. Excerpts from the state report “On the state of sanitary and epidemiological well-being of the population of the Russian Federation.” Publishing house “Russian Doctor”, November, 2021.
2. Chickenpox. Mayo Clinic.
3. Chebalina, E. A., et al. “Chicken pox in pregnant women: risk, prevention, diagnosis, management tactics (clinical lecture).” Medical and social problems of the world 19, no. 4 (2014): 74-82.
4. Yushchuk N.D. et al. “Chickenpox in adults” Attending physician #01/00 (2000).
5. Scott Frothingham. Chickenpox in Adults. Healthline. 2018
6. TASS News Agency, “Production of a domestic vaccine against herpes zoster will begin in 2027.”
7. Rusakov, V. A., A. V. Chebykina, and V. A. Maidan. “Methods of medical control of chickenpox incidence.” Bulletin of the Russian Military Medical Academy S1 (2018): 170-172.

Fenkarol

Fenkarol is a relatively new anti-allergy drug on the pharmaceutical market, but has already proven its effectiveness and safety. The product is good at relieving itching and inflammation due to chickenpox. Typically, Fenkarol is well tolerated and has no side effects. The only contraindication is pregnancy.

Fenkarol

Olaina Chemical Plant, Latvia

- hay fever;
- acute and chronic urticaria; - angioedema; - allergic rhinitis; — dermatoses (including eczema, psoriasis, atopic dermatitis); — neurodermatitis; - skin itching. from 176

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Frequently asked questions

Survey

To make a diagnosis, a clinical examination and indication of the fact of contact with a patient with chickenpox is sufficient. Specific laboratory examination is required if necessary to differentiate the disease from other conditions accompanied by a blistering rash.

Laboratory confirmation of chickenpox:

• detection of viral DNA in the blood using PCR - polymerase chain reaction;
• an increase in specific IgM and IgG antibodies in the blood by 4 times or more in 10 days.
• In a general blood test, a decrease in leukocytes and neutrophils and an increase in lymphocytes are observed. In some patients, the level of monocytes increases to 10%. A general blood test has no diagnostic value.

If complications are suspected, an X-ray of the lungs, an ultrasound of the heart, and an MRI of the brain are performed.

What is chickenpox?

Chickenpox is a viral disease that is transmitted by airborne droplets. Its distinctive feature is skin rashes in the form of blisters filled with serous fluid. At the same time, signs of general intoxication of the body are revealed: rise in temperature, fever, weakness, headache, as with a cold.

When can you get chickenpox?

How is chickenpox transmitted in adults? It must be said that the virus is not resistant to environmental conditions, so you can become infected through contact with a sick person through airborne droplets. By sneezing, blowing your nose and coughing, the carrier spreads the chickenpox pathogen and can infect someone who is near him. The virus is also contained in the serous fluid of the vesicles and, when scratched, can get on other things. Despite the fact that he will not live long in the external environment, you should be careful about the things that the patient comes into contact with.

Thus, a person is contagious from the moment the virus enters the body (throughout the entire incubation period) until all vesicles disappear. To protect others from the disease, the carrier person is recommended to stay at home and avoid contact with other people (if possible). Doctors recommend that children who have been in contact with the patient not attend kindergartens and schools for 3 weeks so as not to spread the infection.

There is a practice when chickenpox is prevented in adults. But it is prescribed by a doctor and according to indications.

Chickenpox during pregnancy

If a woman does not have immunity to the chickenpox pathogen at the time of conscious planning of pregnancy, she will be recommended to undergo appropriate vaccination. Infection during pregnancy is dangerous for the fetus until about 20 weeks. At this stage, the virus causes intrauterine death of the fetus, which ends in miscarriage or stillbirth. It is also possible to develop severe defects that lead to disability of the born child.

At later stages, the effect of the virus on the body of both mother and fetus weakens, reaching a second peak immediately before childbirth. Infection with chickenpox in the later stages is fraught with the development of pneumonia, which can also lead to the death of the child. In such cases, special therapy with immunoglobulins and specific antibodies is carried out.

Lack of immunity to chickenpox in general is not an indication for termination of pregnancy.

Contagiousness

The cause of the disease is the chickenpox virus, Varicella Zoster. It belongs to the group of herpes viruses and is also called the third type of herpes virus. It is very unstable in the environment and dies when exposed to sunlight. In drops of saliva it remains active for about 15 minutes. The chickenpox virus can spread over long distances, which is why it got its name.

The source of infection is a person with chickenpox. It becomes contagious from the last day of the incubation period - that is, even before symptoms appear. Infectivity ceases on the fifth day after the appearance of the last rash. The spread of infection occurs through airborne droplets - the virus is released with droplets of saliva when sneezing or coughing. In this case, it is not necessary to be in close contact with the patient - the virus can even pass into neighboring rooms through ventilation grilles.

Adults usually become infected with chickenpox when caring for a sick child or when being in the same room as a sick child. Only an adult who did not have chickenpox as a child can get sick. Repeated cases of chickenpox are casuistically rare. The exception is adults with weakened immune systems - cancer, HIV infection.

After chickenpox, the virus remains in the body for life. It is its presence that ensures the maintenance of specific immunity and prevents the occurrence of recurrent cases. Reactivation of the infection occurs against the background of hypothermia, stress, weakened immunity and manifests itself in the form of herpes zoster, which also occurs only once.

Prevalence

In 2021, the incidence in Russia was 570 cases per 100 thousand population. Of this amount, the incidence in adults is only 10%. Men and women get sick equally. Chickenpox is registered in all regions. Chickenpox has a clear seasonality - the peak incidence occurs in autumn and winter.

Kinds

Chickenpox occurs in several clinical forms:

• typical - with malaise and blistering rash (usually without pus);
• rudimentary - with a very scanty rash;
• hemorrhagic - the contents of the vesicles are bloody;
• generalized - with damage to internal organs.

Purulent blisters with chickenpox in adults appear in the event of a secondary infection. This is usually observed due to improper skin care and poor hygiene.

There are three degrees of severity of chickenpox:

• light;
• average;
• heavy.

The severity is determined by the severity of symptoms of intoxication and the abundance of the rash.

Forms and stages of the disease

The disease occurs with or without obvious symptoms. Dermatologists identify several characteristic forms of chickenpox:

The hidden or atypical form has several varieties. All of them are dangerous with serious complications: