VARICELLA ZOOSTER

Varicella-zoster virus (VZV) is a ubiquitous human alpha

herpes virus that causes varicella (chicken pox) and
herpes zoster (shingles). Varicella is a common mildest
childhood illness, characterized by fever, viremia, and
scattered vesicular lesions of the skin.
VZV establishes latency in cells of the dorsal root ganglia.
Herpes zoster, caused by VZV reactivation, is a localized,
painful, vesicular rash involving one or adjacent
dermatomes. The incidence of herpes zoster increases
with age or immunosuppression. 
The VZV virion consists of a nucleocapsid surrounding a
core that contains the linear, double-stranded DNA
genome
Source of infection is a chickenpox or herpes zooster
patient.
Infectivity is maximum during the initial stage of the
disease, when the virus is present abundantly in the
upper respiratory tract.
Buccal lesions appear in the early stage of the disease
and the vesicular fluid are rich in virus content.
Pathogenicity
Portal of entry respiratory tract or conjunctiva.
Incubation period 2 weeks after which the lesions appear.
The patient is considered to be infectious during 2 days
before and 5 days after the onset of the lesions.
In children there is little prodromal illness and disease is first
noticed when skin lesions appear.
Rash appears usually on the trunk.
Evolution of rash is so rapid that the various stages- macule,
papule, vesicle, pustule and scab – cannot be readily followed
in individual lesions.
Rash is centripetal in distributions, affecting mailnly trunks
and sparind distal parts of the limbs and is very superficial
without involving the deeper layers of the skin, like a dew
drop lying on the skin.
When varicella occurs in adults, systemic symptoms may be
severe.
The rash very profuse and the entire disease much intense
than in children.
Varicella pneumonia is more common in adults and often
fatal in the elderly.
Other complications are myocarditis, nephritis, acute
cerebellar ataxia, meningitis and encephalitis.
Chicken pox in pregnancy may be dangerous for both
mother and the baby, with enhanced risk of pneumonia.
Baby may develop 2 types of complications depending on
the period of gestation when the women develop chicken
pox.
If occurs in the first half of pregnancy, the fetal infection
may usually be assymptomatic. Some children may
develop fetal varicella syndrome.
When maternal varicella occurs near delivery babies may
develop congenital or neonatal varicella. High risk of
penumonia and encephalitis occurs during this stage.