CHICKENPO

X
Presented by:-
PRIYA YADAV
ROLL NO 02
2ND YEAT BSC NURSING (H)
COLLEGE OF NURSING
DR. RML HOSPITAL
Introduction
■ Chicken pox is also known as Varicella.
■ A highly contagious viral infection which causes an itchy, blister-like
rash on the skin.
■ Chickenpox is caused by a virus called varicella zoster.
■ The blisters are small and sit on an area of red skin that can be
anywhere and they are of Varying size.
■ Chickenpox is highly contagious to those who haven’t had the disease
or been vaccinated against it.
Causes
■ Chickenpox is a common childhood disease caused
by:-
Varicella zoster virus. Varicella zoster virus causes the
chickenpox infection; the virus is contagious to those
around you for 1 to 2 days before your blister appears;
vzv remains contagious Until all the blisters have
crusted over.
VARICELLA ZOSTER VIRUS
■ VZV also known as human herpesvirus 3
(HHV3) belongs to the herpesvirus family.
■ The envelope is interspersed by spikes made
up of viral glycoproteins.
■ The VZV genome is double stranded DNA
coiled upon a protein axis.
Structure of Varicella zoster
virus
Lab diagnosis
Lab diagnosis is usually not required but if required there are some
tests.
■ Polymerase chain reaction testing- the most sensitive method
for confirming the diagnosis of Varicella is the use of PCR to
detect vzv in skin lesions.
■ IGM testing- IGM testing is considerably less sensitive than
PCR testing of skin lesions; commercial IGM assay may not be
reliable and false negative IGM results are not uncommon; a
positive IGM ELISA s a result, although suggestive of a primary
infection, does not exclude re-infection or reactivation of Latent
VZV.
■ Blood testing- most children with varicella have leukopenia in
the first three days followed by leukocytosis; marked
leukocytosis may indicate a secondary bacterial infection but is
not a dependable sign; significant elevations of alanine
aminotransferase occur in 22-50% of children and adolescence
with varicella complicated by hepatitis but elevation return to
normal within one month in almost all cases.
■ Immunohistochemical staining- immunohistochemical
staining of skin lesions scraping can confirm varicella.
SIGN AND SYMPTOMS

■ Loss of appetite
■ Cold
■ Fever
■ Abdominal pain
■ Headache
■ General feeling of illness
■ Rash
■ Sore throat
■ fever may be higher for First few days, etc.
Etiology
■ Varicella zoster virus can cause two distinct lesions.
1. Chickenpox- primary lesion
2. Herpes zoster- reactivated lesions
■ Incubation period is 2 weeks
■ Most contagious
■ Ubiquitous
■ Less severe than small pox
■ Young children generally have either no or a very mild effect.
Pathogenesis
■ Day 0-3:- infection of conjunctivae and mucosa of the
upper respiratory tract.
■ Viral replication in regional lymph nodes.
■ Day 4-6:- primary viremia, viral infection in liver, spleen
and other organs.
■ Day 10-12:-secondary viremia
■ Day 14:- infection of skin and appearance of vesicular rash.
Pathophysiology
■ Chickenpox is usually acquired by the inhalation of airborne
respiratory droplets from an infected host.
■ The highly contagious nature of varicella zoster virus underlies
the epidemics That spread quickly through schools.
■ The varicella zoster virus Is the etiologic agent of the clinical
syndrome of chickenpox.
■ After initial inhalation of contaminated respiratory droplets,
the virus infects the conjunctivae or the mucosae of the upper
respiratory tract.
■ Viral proliferation occurs in regional lymph nodes of the upper
respiratory tract 224 days after initial infection; this is followed
by primary viremia on post infection days 4 to 6.
■ A second round of viral replication occurs in the body’s
internal organs, most notably the liver and the spleen, followed
by a secondary Viremia 14 to 16 days post infection.
■ the secondary Viremia is characterized by diffuse viral
invasion of capillary endothelial cells and the epidermis.
■ Vzv infection of cells of the Malpighian layer produces both
intercellular edema and intracellular edema, resulting in the
characteristic vesicle.
■ Exposure to vzv in healthy child initiate the production of host
immunoglobulin G(IgG), immunoglobulin M(IgM), and
immunoglobulin A(IgA) antibodies; IgG antibodies persist for life
and confer immunity.
■ After primary infection, vzv is hypothesized to spread from
mucosal and epidermal lesions to local sensory nerves.
■ Vzv then remains latent in the dorsal ganglion cells of the sensory
nerves.
■ Reactivation of vzv results in the clinically Distinct syndrome of
herpes zoster (shingles).
1st exposure
■ Body first exposed, create antibodies.
1. IgM
2. IgG
3. IgA
■ B and T memory cells are also created
■ If the virus is in the body again the memory cells will detect it.
■ This will help a faster response
■ If there is a second exposure, memory cells will stimulate to
create antibodies.
Mode of transmission
Transmission
■ Acquired by inhaling virus containing particles, trapped in tiny
droplets released into the air from the nose or throat of an
infected person.
■ The virus enters the body by infecting cells in the respiratory
tract.
■ It spreads to many other parts of the body, including the skin,
where it causes the characteristic rash.
■ a person with chickenpox is contagious one to two days before
the rash appears and until all blisters have formed scabs.
■ It makes from 10 to 21 days after an infected person for
someone to develop chickenpox.
Stages of chickenpox
Oral manifestations
■ Small blister like lesions occasionally involve the oral
side mucosa chiefly the buccal mucosa, tongue, gums,
and palate as well as the mucosa of the pharynx.
■ The mucosal lesions, initially slightly raised vesicles
with the surrounding erythema, rupture soon after
formation and forms small eroded ulcers with red
margin
 Complication
■ Bacterial infection of lesions
■ Pneumonia
■ Hospitalization: 3 per 1000 cases
■ Death: 1 per 1000 cases
■ CNS involvement leads to encephalitis, transverse myelitis,
Reye’s syndrome.
■ Myocarditis, nephritis, arthritis
Increased risk of
complication
■ Normal adults
■ Immunocompromised person
■ Pregnant women
Chickenpox during pregnancy
may result:
■ Congential varicella syndrome
■ Severe varicella syndrome
■ Risk of neonatal death.
 Prevention
■ Chicken pox or varicella vaccine protect 70% to 90% of those
people who are vaccinated.
■ Varicella vaccine contain live virus and so is not recommended
to children having compromised immune system or severe
illness.
■ The vaccine should not be given to children who are allergic to
neomycin Or gelatin
■ this vaccine is given to adults which also prevents shingles.
■ Side effect of vaccine is redness or soreness at the site of
infection.
Treatment
■ Drugs used in the treatment of chickenpox are:-
Antiviral drugs, antihistamines and antipyretics.
■ Commonly used drug is ACYCLOVIR available as ZOVIRAX in the
market, FAMICLOVIR available as FAMVIR and FOSCARNET as
FOSCOVIR.
■ Antiviral medicines can be taken orally intravenously or applied on the skin.
■ These are prescribed to the people with long term illness.
■ Also Other drugs are given to reduce fever, cold, itching, irritation of the
rash, sore throat etc.
 Vaccination
■ Varicella vaccine, also
known as chickenpox
vaccine, is a vaccine that
protects
against chickenpox. One
dose of vaccine prevents
95% of moderate disease
and 100% of severe
disease.
Medical management
The primary varicella infection in the healthy child is a rather
benign disease that requires symptomatic therapy only.
■ Pharmacologic therapy
The symptoms of chickenpox in the paediatric population can be
treated topically and with oral agents.
■ Antiviral therapy
the routine use of acyclovir or valacyclovir in healthy children is
recommended by the AAP if it can be given within 24 hours after
the rash first appears in children older than 12 years, those with
chronic cutaneous or pulmonary disorders, those on long term
salicylate therapy and children receiving corticosteroids.
■ Varicella zoster immune globin
it is indicated for high risk individuals within 10 days
ideally within 4 days of chickenpox exposure; this agent
reduces complications and the mortality rate of varicella, not
its incidence.
■ Antibiotic therapy
suspicion of secondary bacterial infection should prompt
early institution of empirical antibiotic therapy until the
results of culture studies become available.
Nursing diagnosis
■ Hyperthermia related to viral infection
■ Impaired skin integrity related to mechanical factors
example stress, tear, friction.
■ Disturbed body image related to lesions on the skin.
■ Deficient knowledge about the condition and treatment
needs.
■ Risk for infection related to damaged skin tissue.
Interventions for a child with
chickenpox
■ Patient education
educate parents about the importance and safety of the
Varicella Zoster vaccine.
■ Manage pruritis
manage pruritis in patients with varicella with cool
compresses and regular bathing; warm soaks and
oatmeal or corn starch baths may reduce itching and
provide comfort.
■ Trim fingernails
trimming the child’s fingernails and having the child
wear mittens while sleeping may reduce scratching.
■ Dietary measures
Advise parents to provide a full and unrestricted diet
to the child; some children with varicella have reduced
appetite and should be encouraged to take sufficient
fluids to maintain hydration
Questions