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Case Presentation-Chickenpox
Case Presentation-Chickenpox
Case Presentation-Chickenpox
Chickenpox
Guided By-
Dr. Rajeev Yadav
Dr. Manoj Gupta
Presentation By-
Dr. Sohan Khanna (JR2)
Demographic Data
• Name- XYZ
• Age-10 yrs.
• Sex- Male
• Religion- Hindu
• Address- Shahpura, Distt.-Jaipur
• Occupation-Student
Chief Complaints
• Patient also complained of rash since 2 days which was first noticed
on the trunk. The rash was also present on arms and legs.
Allergic History
• No history of any allergy known to patients’ parents
Personal History-
Patient is non-vegetarian, his sleep pattern is normal, bladder and
bowel habits are normal.
Birth History-
• Prenatal – Uneventful
• Natal- Full term normal Vaginal Delivery, home delivery
Cried at birth immediately
Birth weight – 2800g
Birth length – Don’t know
• Postnatal - Uneventful
• History of Breast Feeding and Complimentary Feeding-
• Child was exclusively breast fed for 7 months
• Complimentary feeding started at 7th month
• Weaning – bananas and khichdi was given
• Growth Development-
• Child start to stand when he is around 1 year old
• Start to walk at 2 year old
• Start to speak when he is 1.5 year old
• All milestone was up to date to his age
• Immunization History-
• Immunization card is not available.
• His mother does not remember vaccination details except that OPV was given.
Last dose of which was when the patient was 5 years old.
Family History-
He is the eldest son of a non consanguineous marriage between 30 years old
father and 25 year old mother.
He has 1 younger sister who is not experiencing similar symptoms currently.
• Contact History-
• The patient’s father is a shopkeeper and has studied till 12th class.
• Lives in a pakka house with two rooms ,a separate kitchen and separate toilet and
bathroom.
Local Examination
• Multiple Maculopapular rash seen on Head, Face, Neck, Trunk, Arms and legs
• Scratch Marks seen near the site of rash
• Oral Cavity - Poor hygiene
• Nose: NAD
• Bilateral Ears: NAD
Systemic Examination
• CNS-
Normal sensorium
Oriented to time place and person.
Bilateral pupils react to light
• Respiratory System:
Air entry equal on both sides
• P/A - Soft ,non tender, umbilicus inverted and central and no signs of
organomegaly & bowel sounds heard on auscultation
• CVS- S1 S2 heard, no murmur present
Investigations
• Hb-13.6 g/dL
• Platelet count-1,80,000/mm3
• Advised tests –
• CBC
• RFTs
• LFTs
• Serum electrolytes
• Urea, Creatinine
• Chest X-Ray
Diagnosis
• Provisional- Child was provisionally diagnosed as case of Chickenpox
• Confirmatory Diagnosis- The lab diagnosis is rarely required. It can be done by-
1. Detecting VZV DNA using PCR or isolating VZV in cell culture from vesicular fluid, crusts,
saliva, cerebrospinal fluid or other specimens.
2. Direct immunofluorescence
3. Detection of VZV-specific serum lgM antibody - not the method of choice for confirming
varicella. Detection of serum lgM and PCR are of limited value for the confirmation of HZ.
• Herpes Simplex
• Enterovirus
• Bullous Impetigo
• Drug Reactions
• Contact Dermatitis
• Insect Bites
Smallpox Chickenpox
1. Incubation: About 12 days (range: 7-17 days) About 15 days (range 7-21 days)
2. Prodromal/ symptoms: Severe Usually mild
3. Distribution of rash :
(a) centrifugal (a) centripetal
(b) palms and soles frequently involved (b) seldom affected
(c) axilla usually free (c) axilla affected
(d) rash predominant on extensor surfaces and bony (d) rash mostly on flexor surfaces.
prominences
5. Evolution of rash:
(a) evolution of rash is slow, deliberate and majestic, passing (a) Evolution of rash is very rapid
through definite stages of macule, papule, vesicle and
pustule. (b)
(b) scabs begin to form 10-14 days after the rash appears (b) scabs begin to form 4-7 days after the rash appears
6. Fever subsides with the appearance of rash, but may rise Temperature rises with each fresh crop of rash
again in the pustular stage (secondary rise of fever).
During the first day
or two of rash, it
may be impossible,
from the rash alone
to differentiate
smallpox from
chickenpox
On day 3, the rash
associated with
each of the diseases
continues to look
very similar
• By Day 5, all of the
smallpox lesions are
at the same stage of
development
• However, patient
with chickenpox
shows different
stages of rash-
papules, vesicles,
pustules
• By day 7, no
formation of scabs
in smallpox lesions
• Most of chickenpox
lesions have
already formed
scabs, and some
scabs, in fact, have
already separated
• By day 10, smallpox
scabs have just begun
to form
• In chickenpox, most of
the scabs have fallen
off by day 10 (in
chickenpox, scabs
begin to form as early
as day 3 or 4, and fall
off by day 14)
Smallpox- pocks are more dense on arms and legs Chickenpox- pocks are more on back compared to
than trunk arms and legs
Herpes Simplex Enterovirus
Bullous Impetigo
Drug Reactions Contact Dermatitis Insect Bites
Management
• Worldwide distribution
• Burden in India – No. of cases = 66, 963 and No. of deaths = 50 (as per National
• Agent : V- Z virus aka "Human (alpha) herpes virus 3". Recovery from primary infection
and spinal dorsal root ganglia, often for decades, without clinical manifestations. When
CMI wanes with age or following immune-suppressive therapy, the virus may
oropharyngeal secretions and lesions of skin and mucosa. Rarely, patient with herpes
zoster. The virus can be readily isolated from the vesicular fluid during the first 3 days
• Infectivity: 1-2 days before the appearance of rash, and 4 to 5 days thereafter The
virus tends to die out before the pustular stage. The patient ceases to be infectious
• (a) Age : primarily among children <10 years age. Few persons escape infection until
• (b) Immunity : One attack gives durable immunity; second attacks are rare. The maternal
antibody protects the infant during the first few months of life. No age, however, is
exempt in the absence of immunity. The IgG antibodies persist for life and their presence
recovery from V- Z infections and in protection against the reactivation of latent V-Z virus
• (c) Pregnancy : Infection during pregnancy presents a risk for the fetus leading to
who become infected with VZV during the first 20 weeks of gestation. Infants,
• Controlling Source - notifications, isolation of cases for about 6 days after onset of rash
(till the crusts fall off) and disinfection of articles soiled by nose and throat discharges
• Period of Isolation – from 10th day to 21st day post-exposure or until 28th day if exposed
• Protection of Susceptible Host – Acyclovir given orally (>12 years age) or i.v (complicated
• Avoid healthy children and adults coming in contact with a case of chickenpox
• Do not put finger in mouth or rub eyes after touching infected person
Pre-Exposure Vaccination
• Live attenuated varicella virus vaccine (not yet been introduced in National
Immunization Program)
• Post-partum mothers : 1st dose - after delivery and before discharge from
hospital 2nd dose – 4-8 weeks after the 1st dose
• 2 doses of vaccine are about 90% effective at preventing chickenpox for 10 years.
• Adverse reactions can occur as late as 4-6 weeks after vaccination. Tenderness
and erythema at the injection site seen in 25%, fever in 10-15%, and a localized
maculopapular or vesicular rash in 5%: a smaller percentage develops a diffuse
rash, usually with five or fewer vesicular lesions.
• Spread of virus from vaccinees to susceptible individuals is possible, but the risk of
such transmission even to immuno-compromised patients is small, and disease,
when it develops, is mild and treatable with acyclovir.