What causes chickenpox. Chickenpox (chickenpox). Specific signs of chickenpox

Chickenpox (also known as chickenpox) is a highly contagious infectious disease that primarily affects children. Chickenpox, the symptoms of which are characterized primarily by the appearance of a blistering rash, however, can also be diagnosed in adults, especially if the appropriate vaccinations have not been made.

general description

The causative agent of the disease is a virus belonging to the herpesvirus family (Varicella Zoster or otherwise - herpes zoster). This virus, when exposed to environmental conditions, dies quite quickly (literally within ten minutes). Taking into account this peculiarity of it, it can be said that the possibility of infection with chickenpox through those objects that were used by a sick person is excluded, as is the possibility of infection through third parties. Accordingly, heat, UV irradiation, sunlight and other types of exposure factors become detrimental to the virus.

For healthy children, chickenpox in most cases is not a serious disease. This, however, cannot be said about this disease in adults, pregnant women and newborn infants, in adolescents and in those individuals for whom immunodeficiency of one or another specific nature is relevant (in some cases this is possible after organ transplantation and with current HIV infection, much more often - with reduced immunity, against the background of acclimatization or after serious stress). What is noteworthy is that with immunodeficiency, situations even with repeated infection with chickenpox are possible.

The chickenpox rash heals without leaving a trace, because the skin lesions of the rash spread without affecting the epidermal layer. Meanwhile, scratching the rash (damage to the germ layer) can cause the formation of an atrophic scar (scars).

A person with chickenpox acts as a source of infection; he, in turn, is an epidemiological danger from the end of the incubation period until the moment in the course of the disease, during which the crusts begin to fall off. The pathogen spreads by airborne droplets; children from six months to seven years are most susceptible to the disease. And although chickenpox, as we have already noted, also occurs in adults, the incidence among them is not so frequent, which is mainly explained by the fact that they usually suffer from this disease in childhood.

Regarding susceptibility to chickenpox, an absolute figure is indicated, that is, 100%. Patients with this disease become contagious within 24 hours before the rash appears, after which they remain so for a period of five days after the last element of the rash characteristic of this disease is registered on the skin. The virus is released into the environment through the contents of vesicles that appear on the mucous membranes and skin of a sick person. Already the flow of air ensures the spread of infection over significant distances with subsequent infection, which is possible even as a result of minor fleeting contact with it.

The greatest activity in epidemiological terms is observed during the autumn/winter period; the increase in incidence also increases within the period every 4-6 years. Most often, children aged 5-9 years get sick; newborns at 2-3 months of life rarely get sick, which is due to the presence of maternal antibodies.

Features of the course of the disease

The mucous membrane of the upper respiratory tract acts as an entry point for infection. The course of chickenpox can be divided into several main stages.

• Infection, incubation period. The virus enters the body with its parallel fixation within the mucous membrane of the upper respiratory tract while simultaneously accumulating here and multiplying. Chickenpox, whose incubation period (there are no symptoms at this stage) lasts about two weeks, is also characterized by the non-infectivity of the sick person.
• The first symptoms of chickenpox. There is a gradual penetration of the chickenpox virus into the blood, after which, when a sufficient amount of it is reached in it, a reaction is formed from the immune system of the body itself to the foreign invasion. This period may be accompanied by fever, headache and weakness, as well as pain in the lumbar region. As for the main symptom of the disease, which manifests itself, as we have already identified initially, in the form of a rash, it is too early to talk about it within the period under review. The duration of the first symptoms of chickenpox is about 1-2 days, and it is from this time, that is, after the end of the incubation period and from the moment of transition to the period of the first symptoms, that the sick person becomes infectious to others.
• Acute (primary) stage. The blood flow ensures that the virus reaches its main targets in the form of nerve and skin cells. The nerves are not yet affected, only Varicella Zoster is consolidated in the spinal cord (more precisely, its roots). As for the skin, here the symptoms are already making themselves felt, that is, a characteristic rash appears, which occurs periodically, over the next few days (up to a week). In this case, the rash acts as a manifestation of the body’s reaction to the activity that the chickenpox virus carries out in it when it is concentrated within the skin. Much less often, the rash with chickenpox at this stage manifests itself in a subtle or unnoticeable manner, due to which diagnosing the disease is greatly complicated. Here, similar to the previous stage, the patient is still infectious to others.
• Recovery stage. In the normal state of the immune system of a patient with chickenpox, the rashes characteristic of it disappear after about 3-7 days. The overall state of health noticeably improves, and the previous, acute stage ends. Accordingly, with its completion, a period begins in which the patient becomes non-infectious to others, although the virus, due to its attachment in the nerve cells, remains in them forever.
• Acute (secondary) stage. This stage is relevant in a situation where the patient’s immunity is weakened, as well as in situations in which the nervous system is stimulated (which is also possible against the background of frequent stress) - here the chickenpox virus manifests itself again. The places where the rashes will be concentrated this time depend on the nerve that is most affected. In most cases, this includes the abdomen and axillary region, due to which, by the way, the disease is already defined as “herpes zoster” (or a synonym - herpes zoster). It is noteworthy that for this stage the occurrence of a rash is not necessary, due to which the symptoms are limited only to the appearance of pain along the course of the affected nerve (this course is especially common in elderly patients). During the period of manifestation of skin rashes, the patient, similar to chickenpox, is contagious to the environment.

Chickenpox: classification

In accordance with the characteristics of the course, the following classification of the disease is accepted and, accordingly, applicable:

• According to the mechanism of occurrence, chickenpox can be:
• congenital;
• acquired.
• According to the form:
• typical shape;
• atypical form:
• rudimentary atypical form;
• gangrenous form;
• hemorrhagic form;
• visceral form.
• In accordance with the degree of severity characterizing the course of chickenpox:
• mild severity;
• medium-heavy;
• heavy.
• In accordance with the characteristics inherent in the course of the disease:
• smooth course (no complications);
• course with complications;
• course in combination with a mixed infection.

Chickenpox: symptoms

Acquired chickenpox occurs in accordance with the following terms for each relevant period:

• incubation period - duration within 11-21 days (mainly, as we have already noted, the incubation period for chickenpox is two weeks, respectively, 14 days);
• prodromal period – within a day;
• the period of the height of the disease (appearance of a rash) – from 3-4 days or longer;
• convalescence – within a period of 1-3 weeks.

The prodromal period following the incubation period, which is important to note, does not occur in all patients. Its manifestations, in particular, boil down to elevated temperature (within the subfebrile range of 37-37.5 degrees), as well as the appearance of some malaise and a rash reminiscent of a rash with measles or a rash with scarlet fever (it persists for several hours).

Following the symptoms of the prodromal period or in a state of normal health (in the absence of this period), there is an increase in temperature in the range of 37.5-39 with a gradual deterioration in general health and the appearance of a characteristic rash in the patient. Initially, such a rash resembles a spot, which after a few hours transforms into a papule, and after that into a vesicle. Thus, small bubbles are obtained, the diameter of which is about 0.2-0.5 cm, they are located within the base that has not undergone infiltration, surrounded by a rim in the form of redness, the wall of these bubbles is externally tense. The vesicles have a single-chamber appearance, within the first day they resemble dew drops, but by the second day their contents become cloudy, after another day or two the bubbles dry out and simultaneously transform into a crust, which disappears within 1-3 weeks. After the crusts separate from the skin, either a depigmented spot or pigmentation remains on it. In the vast majority of cases, scars, as the final stage after a rash, do not remain on the skin.

The process of rash is not simultaneous; rather, its frequency can be distinguished over a period of several days. Because of this pattern of rash occurrence, the skin with chickenpox has elements that are at different stages of development (which is defined as false polymorphism). For a clear example, chickenpox (symptoms) is shown in the photo below, with a corresponding indication of the skin lesions associated with it.

Chickenpox rash (photo 1)

Chickenpox rash (photo 2)

Regarding the area of ​​concentration, a predominant localization can be identified on the face and torso, in the scalp and on the extremities. There is also a tendency to concentrate predominantly in those places where the skin is most susceptible to irritation, as well as in places with the greatest pressure on it. As a symptom accompanying the rash, one can also note a slight itching and the appearance of the rash itself in the mucous membranes, which implies damage to the genital organs, larynx, conjunctiva, and cornea. The rash blisters quickly soften and ulcerate; after about 5 days, the erosions heal.

Throughout the entire period during which the rash appears, patients experience fever (for several days), intoxication is moderate. The possibility of developing lymphadenopathy (enlarged lymph nodes) cannot be ruled out.

Now let us dwell on the features of the course of atypical forms of chickenpox.

Vestigial form The disease develops in children who have specific residual immunity, as well as in those patients who received blood products or immunoglobulin during the incubation period. This form is characterized by a generally mild course. The rash manifests itself in the form of a sparse type of maculopapular formations, and these formations do not always transform into vesicles. The course of the disease occurs when the patient’s temperature is normal, as well as when their general condition is satisfactory.

Hemorrhagic form acts as one of the most severe manifestations of chickenpox, which, in addition, is one of the most malignant in nature. The development of this form of the disease occurs in individuals with IDS (immunodeficiency syndrome), as well as in those individuals who received cytostatics and glucocorticoid hormones. It is also possible for a hemorrhagic form of chickenpox to appear in newborns. The disease is characterized by the appearance of high temperature and severe intoxication. In addition, multiple organ pathology develops in combination with hemorrhagic syndrome, which manifests itself in the form of hemorrhagic contents in the vesicles (bleeding in them), hemorrhages in the skin and tissue, in the mucous membranes and internal organs. Other bleeding also appears, namely from the nose and gastrointestinal tract, hemoptysis and hematuria (the appearance of blood in the urine). The form of the disease in question is also defined as fulminant purpura, and its main danger is that it can end in death.

Visceral form It is diagnosed primarily in premature children, newborns, as well as in children corresponding to the older age category with IDS (immunodeficiency syndrome) that is relevant for them. The course of this form is characterized by the severity of its manifestations, as well as long-term intoxication in combination with severe fever and profuse rash. The nervous system and internal organs are also affected, namely the kidneys, lungs, liver, pancreas, adrenal glands, endocardium, spleen, digestive tract, etc. Often this form of the disease ends in death.

Gangrenous form is a relevant option, again, for patients with immunodeficiency syndrome, although it is diagnosed extremely rarely. Its main features are the manifestation of severe intoxication and, in general, a long course. Chickenpox in the gangrenous form manifests itself in the form of large blisters, on which a scab (a crust that usually covers wounds from abrasions, burns and similar skin lesions; it is formed from dead tissue, pus and clotted blood) quickly forms with an area of ​​necrosis (death). ). The falling off of the scab is accompanied by the simultaneous exposure of deep ulcers, and they heal at an extremely slow pace. Often the disease in this form occurs with a complication in the form of sepsis with subsequent death.

Chickenpox: symptoms in adults

Chickenpox in adults, as we have already noted, can develop if they did not have to deal with this disease in childhood. In addition, cases in which chickenpox develops against the background of a depressed state of the immune system cannot be excluded, which can be facilitated by a number of factors (organ transplantation, hormonal therapy, chemotherapy, etc.), and in these cases the disease manifests itself again. If infection occurs against the background of a less pronounced influence of external factors on the body (exacerbation stage of a chronic disease, stress, etc.), then activation of the virus occurs with manifestations inherent in herpes zoster.

So, let's focus on the symptoms. The disease, which is mostly mild in childhood, manifests itself in adults with at least moderate severity of clinical manifestations. After 20 years, severe forms of the disease, as well as complicated forms, are suffered by adults, regardless of their involvement in a specific age category, with the same frequency. Let us repeat that in immunodeficiency states, as well as in the presence of other concomitant chronic diseases, chickenpox manifests itself much more severely.

The duration of the incubation period, as in the general description of the disease, is about two weeks. The prodrome stage is accompanied by general infectious symptoms (weakness, aches, low-grade fever, headache). The first signs of chickenpox in adults often appear in the form of symptoms corresponding to cerebral edema, as well as symptoms indicating involvement of the peripheral nervous system in current processes. In particular, this may include sound and photophobia, nausea, vomiting (without relief after it), convulsive twitching noted in the skeletal muscles, weakness, and impaired coordination of movements.

The appearance of pink spots on the skin characterizes the beginning of the period of rashes, which determines the following symptoms of chickenpox for adults:

• A rash that appears on the skin profusely and indicates by the 5th day the relevance of false polymorphism, to which, nevertheless, it corresponds.
• Enanthems appear on the mucous membranes (genital organs, mouth, respiratory tract).
• Repeated rashes appear in waves, which lasts for 10 days.
• At the height of the rash that is relevant to the disease, an increase in body temperature of up to 40 degrees is noted.
• The symptoms of intoxication are extremely pronounced.
• Complications in adults are determined by the relevance of the pyogenic flora. Pustules are formed from the vesicles, characterized by the duration of weeping. Opening them leads to the exposure of deep ulcers, their healing, in turn, is accompanied by the appearance of scars. If the level of functioning of the body’s immune system is inadequate, the possibility of developing phlegmon, abscesses and fasciitis cannot be ruled out, which can almost lead to sepsis or a necrotic form of this disease.
• Chickenpox in frequent cases occurs in an atypical form (we examined their varieties earlier, they also correspond to the manifestation in the picture of the disease in adults).

Chickenpox in infants: symptoms

As we already noted initially, chickenpox in children and the symptoms characteristic of it appear extremely rarely before three months of their life, which is explained by their receipt of maternal antibodies through the transplacental route. Meanwhile, if the mother has no previous history of chickenpox as a past disease, the production of corresponding antibodies does not occur, and therefore, in fact, their transmission does not occur. Accordingly, contact with infection leads to the fact that the child may become ill almost immediately after birth. If the indicated picture of the possible acquisition of the disease corresponds, it, in turn, is characterized by some features, which we will also highlight:

• frequent detection of a prodrome period with chickenpox, lasting for a period of 2-4 days, accompanied by severe symptoms of intoxication;
• within the period during which rashes characteristic of the disease appear, there is also an increased temperature and symptoms of intoxication expressed in manifestations (which also consists of general cerebral manifestations);
• the rashes that appear are often abundant in nature, the evolution of the elements shows slowness, and the contents in the vesicles are often hemorrhagic;
• the duration of the rash period is about 7-9 days;
• Bacterial complications are often associated with the disease;
• the course of the disease in often cases is characterized by its own severity;
• the course of the disease cannot be excluded in accordance with the scenario inherent in its visceral form, hemorrhagic form or gangrenous form.

It is also worthwhile to dwell separately on such a form of the disease as intrauterine chicken pox, and in particular on related clinical forms such as embryofetopathy (which is defined as congenital chickenpox syndrome) and the neonatal form of chickenpox.

Intrauterine chickenpox. When considering statistics regarding current morbidity, we can highlight indicators of 5 cases per 10,000 for pregnant women. In case of infection of the fetus within the first four months of pregnancy, subsequently, accordingly, the clinic inherent in the specified syndrome of the congenital form of the disease appears.

Embryophetopathy during the first trimester, in terms of possible risk, it occurs in 2% of cases, during the second trimester - in 0.4% of cases. The congenital form of the disease is characterized by the presence of skin pathology in the form of areas of scarring with their clear distribution into multiple types of scarification, dermatomas, and hypopigmentation. Pathologies of the central nervous system, bones, eyes, intestines, and urinary system are also relevant; intrauterine growth retardation, as well as retardation in psychomotor development, cannot be ruled out.

During the first months of a newborn’s life, the mortality rate in this case is about 25%, but if the infection occurred after the 20th week of pregnancy, embryofetopathy does not develop, congenital chickenpox in this case becomes latent (hidden, without manifestations in the form of noticeable symptoms and signs pointing to it). Subsequently, over the next few months, the child may experience symptoms consistent with the manifestations of herpes zoster.

Neonatal chickenpox is a disease in the form in which it manifests itself in the event of infection of the fetus during the last three weeks of pregnancy, during childbirth, or within the first 12 days from birth. Children whose mothers fell ill with chickenpox 5 days before birth or within the first 3 days after this experience symptoms of this disease by 5-10 days of life. Due to the absence of the corresponding antibodies in the body of such children, the course of the disease is characterized by significant severity, as well as the addition of pathological conditions indicating damage to internal organs (intestines, kidneys, heart, lungs, etc.). Hemorrhagic syndrome and complications are also added, as a result of which the picture of the disease is reduced to fairly high mortality rates (it reaches about 30%).

In the event that a pregnant woman falls ill within 6-20 days before the onset of childbirth, chickenpox symptoms in the newborn appear immediately after birth. Considering the fact that in this case there was a transplacental transfer of antibodies from the mother, the course of the disease in the vast majority of cases is quite favorable.

Complications of chickenpox

Complications of the disease are caused by the generalization of the process, as well as damage to internal organs by the virus, which often occurs in combination with the addition of pathogenic microorganisms and disruption of adaptation mechanisms in the immune and endocrine systems.

Complications include the following:

• herpetic lesions affecting the respiratory system (laryngitis, tracheitis, pneumonia in combination with respiratory failure);
• pathological lesions associated with detoxification organs (nephritis, liver abscesses, hepatitis);
• lesions associated with the functions of the peripheral and central nervous systems (meningitis, encephalitis, cysts in the brain, cerebral edema, cerebellar ataxia, polyradiculoneuritis, paresis and muscle paralysis);
• damage to blood vessels, heart (myocarditis, hemorrhagic syndrome, thrombophlebitis, arteritis, etc.);
• pathologies of muscles and joints (fasciitis, myositis, arthritis, etc.).

Quite often, meningoencephalitis and encephalitis develop from the listed pathologies. Complications of a neurological scale are caused by both the direct impact of the virus and the immune response produced by the body, against the background of which, in turn, demyelination of nerve fibers occurs.

Encephalitis often develops during the period of height of rashes or the period of convalescence. According to the first option, encephalitis develops due to the virus entering the central nervous system (hematogenous or axonal routes), which determines the severity of the subsequent infectious process. With febrile fever, cerebral symptoms develop (convulsions, headache, impaired consciousness, vomiting); some patients experience meningeal signs. In the future, focal symptoms in combination with hemiparesis are noted in the foreground.

If we are talking about encephalitis within the period of convalescence (in days 5-14 of the disease), then here we can note its relevance, regardless of the specific form of severity of the disease. Cerebellitis predominantly develops with general cerebral symptoms (vomiting, headache and lethargy), as well as with symptoms accompanying the condition of cerebellar damage (which manifests itself in the form of ataxia, muscular hypotonia, nystagmus, tremor). Meningeal symptoms are absent or mild.

Diagnosis

To diagnose the disease, data obtained from epidemic analysis, as well as laboratory and clinical studies, are used. Laboratory diagnosis is based on the following:

• virological methods - through their use, the virus is isolated from tissue cultures; in addition, it is also isolated from the fluid of blisters in rashes and damaged exfoliating skin;
• express diagnostic methods - first of all, consist of an immunofluorescence reaction, which makes it possible to detect viral antigens through smears or scrapings taken from the bases of vesicular formations;
• molecular genetic methods - involve the isolation of DNA belonging to the virus from vesicular fluid, cerebrospinal fluid and blood, which involves the use of polymerase chain reaction (or abbreviated PCR).
• serological methods - in particular, ELISA, through the implementation of which antibodies of certain classes are determined.

Chickenpox treatment

To treat chickenpox, hospitalization is necessary in severe forms of its course, as well as in cases in which complications develop (myelopathy, encephalitis, nephritis, meningoencephalitis, etc.). In other cases, treatment is carried out at home.

Bed rest is prescribed for all patients: the usual course of the disease determines a period of 3-5 days for this; the course of the disease with complications requires an individual determination of this period based on the severity of the patient’s condition. Patients also require good care aimed at the affected areas of the skin and mucous membranes, which will ensure the possibility of preventing complications. Daily baths and changes of linen are recommended. Vesicles are processed using a 1% solution of brilliant green.

It is also necessary to rinse your mouth after eating using a disinfectant solution based on a decoction of chamomile, furatsilin or calendula; you can also use ordinary boiled water. To wash the eyes, a solution of furatsilin is used; the appearance of purulent discharge requires the use of drops of sodium sulfacyl (20-30%).

In addition, etiotropic therapy based on the following components is also relevant.

• Viricidal drugs

These include inosine pranobex and abnormal nucleosides (the drugs acyclovir, famciclovir and valacyclovir). The effectiveness of acyclovir is noted only at the beginning of treatment, within the first day from the moment the patient develops a rash. Mild and moderate forms of the disease require its administration for a period of 7-10 days; for the treatment of severe forms, the drug is administered by intravenous drip for a period of 7-10 days, after which the treatment regimen with the drug changes to its usual use (internally). Acyclovir ointment must be applied to the affected areas of the skin, and its effectiveness is also determined when applied to conjunctivitis. Children over 12 years old can be prescribed valacyclovir, adolescents over 17 years old, and adults can be prescribed famciclovir. Inosine has a suppressive effect on the varicella zoster virus, as well as a number of other viruses; in addition, it has an immunomodulatory effect.

• Interferon medications

Mild and moderate forms of the disease involve the use internally or in the form of rectal suppositories (drugs Viferon, Kipferon, Genferon Light). Viferon suppositories are prescribed one twice a day for a period of 5 to 10 days. Children under 7 years old are prescribed Viferon-1, from 7 years old - Viferon-2. Viferon ointment is used for affected areas of the skin.

• Interferon inducers

They are used in the treatment of mild/moderate forms of the disease (drugs neovir, poludan, kagocel, etc.). Poludanum, etc. are used as topical preparations.

• Immunoglobulins

These types of drugs are necessary in the treatment of moderate/severe forms of the disease.

• Antibiotics

Prescribed in case of development of such forms of chickenpox as bullous, pustular or gangrenous. In addition, the use of antibiotics is also important against the background of the development of bacterial complications.

In the pathogenetic therapy of chickenpox for mild/moderate forms of the disease, drinking plenty of fluids is used; for severe/complicated forms, intravenous drip administration of glucose-saline solutions is used. Taking into account the monitoring of the immunogram, immunocorrective drugs and cytokine drugs are prescribed. Additionally, vitamin-mineral complexes and multivitamins, enterosorbents and probiotics are prescribed, and, if appropriate, metabolic drugs, expectorants and mucolytics, antihistamines and protease inhibitors are prescribed. In case of severe itching, first generation antihistamines (diazolin, tavegil, suprastin) are recommended. The use of glucocorticoids is relevant only in the development of encephalitis.

To eliminate symptoms, antipyretic drugs (ibuprofen, paracetamol) are used. The use of acetylsalicylic acid is unacceptable, because this can lead to the development of Reye's syndrome in patients!

Urticaria is one of the most common diseases treated by an allergist. In general, the term urticaria refers to a number of specific diseases characterized by different specific nature of occurrence, but manifesting themselves in the same way. Urticaria, the symptoms of which manifest themselves in the form of a cluster of blisters on the skin and mucous membranes, reminiscent of a burn received when the skin is exposed to nettles, is so called for this reason.

Migraine is a fairly common neurological disease accompanied by severe paroxysmal headaches. Migraine, the symptoms of which are pain, concentrated on one side of the head mainly in the area of ​​the eyes, temples and forehead, nausea, and in some cases vomiting, occurs without reference to brain tumors, stroke and serious head injuries, although and may indicate the relevance of the development of certain pathologies.

Herpes is a viral disease that manifests itself in the form of characteristic rashes (vesicles), grouped together and localized in the mucous membranes and on the skin. Herpes, the symptoms of which arise against the background of exposure to herpes viruses, most often occurs in the form of a labial (more precisely, labial) infection; its manifestations are traditionally defined as “colds on the lips.” There are other forms of the disease, for example, genital herpes (predominantly affecting the genitals), as well as forms in which a variety of areas are affected.

Chickenpox or chickenpox is a highly contagious viral pathology with an acute course. A characteristic sign of chickenpox are specific vesicular elements (vesicles) filled with transparent contents. The majority of those affected are aged 3-6 years, so chickenpox is considered a “childhood disease”. In preschool institutions and primary schools, chickenpox is capable of epidemic spread.

Etiology

The disease is viral in nature. The causative agent is called “Varicella Zoster virus”, also known as “Herpes Zoster”. The virion belongs to DNA-containing viruses and contains two chains of nucleotides. According to the nomenclature, it belongs to the family of herpes viruses, the subfamily of alphaherpes viruses, the third type. A single serotype of the virus has been identified, the reservoir of which is exclusively human.

The Varicella zoster virion (VZV) is characterized by its large size (150-200 nm) and spherical shape. Therefore, VZV is visible by light microscopy of the vesicle contents.

The transmission mechanism is aerogenic or contact. In the external environment, the chickenpox virus is unstable and dies in 10 minutes; when exposed to ultraviolet radiation and heated to 60°C, it is viable for less than 1 minute. Therefore, the method of transmission in the vast majority of infections is through airborne droplets (when talking, sneezing, coughing) within a radius of 20 meters from the source of infection, and less often through direct contact. Other methods of transmission are not feasible due to the instability of the virion.

Contagiousness during airborne infection can reach 100%. The implementation of contact transmission leads to the disease in 98% of people who do not have immunity against chickenpox.

Pathogenesis of chickenpox

The release of chickenpox virus into the external environment by a sick person begins one day before the appearance of the first rash and ends 120 hours after the appearance of the last vesicular element. During the entire period of the rash, the patient is highly contagious for those who have not been ill or for patients in a state of immunodeficiency.

The disease develops when the Varicella Zoster virion adheres to the mucous membranes of the nose and mouth of a non-immunized person. After attachment, Varicella penetrates epithelial cells, where viral particles accumulate. As a result of the multiplication of the varicella zoster virus, the host cell dies, and the virions are transported to regional lymph nodes. VZV then enters the bloodstream, which causes fever and other manifestations of general intoxication.

The chickenpox virus has been shown to have tropism for epithelial cells in which viral DNA replication occurs. As a result, the epithelial cell dies with the formation of a small (2 mm) cavity with transparent exudate. When the vesicles are opened, the post layer of the epidermis does not suffer, and the result is not crusts. The formation of blisters is also possible on the mucous membranes of the digestive and genitourinary systems or eyes. The germ layer is not damaged by the virus, therefore, in the absence of mechanical action, scars do not form.

Important! After chickenpox, the virus persists in the ganglia for life, causing the clinical picture of herpes zoster in immunodeficiencies.

Clinical picture

Chickenpox is prone to epidemic spread in the winter and spring seasons. In other periods, the disease is episodic in nature, in some cases it occurs in an abortive form without skin manifestations or with isolated rashes.

Incubation period

From the moment of contact with the source of infection, the incubation period takes an average of 2 weeks, but can last from 11 to 21 days. At this time, the sick person has not yet released VZV into the environment. Pathogenetically, during the incubation stage, the chickenpox virus replicates in the mucosal epithelium and accumulates in regional lymph nodes.

Prodromal period

The prodrome for chickenpox is no more than 2 days in patients over 30 years of age. Chickenpox in children can manifest itself in the form of rashes. Pathogenetically, the essence of the period lies in a systemic nonspecific immune reaction during primary viremia.

Clinically the disease manifests itself:

fever up to 38,

weakness,

lethargy,

increased fatigue,

lower back pain,

headache, dizziness,

nausea,

feeling of irritation in the throat,

decreased appetite.

During this period, the virus begins to be released into the external environment and the patient becomes infectious to those who have not recovered.

Period of rash

In most cases, the diagnosis of chickenpox is made at this stage of the disease, since the first signs of chickenpox in 12% are specific exanthema. During this period, the virus replicates in target cells with their further death, which is morphologically manifested by a vesicular rash on the skin. The patient is contagious.

General clinical signs:

Febrile fever of an undulating nature for 1-1.5 weeks;

Severe itching in the rash areas, more typical for patients over 16 years of age;

Refusal to eat, typical if chickenpox develops in infants;

Feeling of general malaise.

Characteristics of rashes (photo examples)

Enanthema with chickenpox has the appearance of small blisters on the oral mucosa, surrounded by a thin rim of redness. Vesicles are prone to maceration and the formation of aphthae. Healing occurs within 24-48 hours. The number of rashes in 80% does not exceed 10 elements, but in infants it can be higher, which causes pain and refusal of the bottle.

The chickenpox rash is located mainly on the skin of the torso, the face is less affected.

There are 4 forms of chickenpox (the photo shows what chickenpox looks like in different forms):

Typical: vesicular;

Atypical:

Bullous;

Gangrenous.

In a typical course, the rash appears in waves every 24-48 hours. Healing of the element occurs through the formation of a crust within a day or three after the development of the vesicle. In general, the healing process takes 10-14 days, but can extend up to 3 weeks.

The period of rash lasts 6-8 days, respectively, the patient experiences 3-5 waves of exanthema. Therefore, by the 4th day, the rash in a patient with chickenpox becomes polymorphic.

Convalescence

The cessation of the rash coincides with the resumption of fever. If there is no sleep over the last 48 hours, the patient enters the recovery period. At the same time, the patient’s contagiousness disappears.

Recovery lasts up to 3 weeks until the scabs fall off.

Complications and prognosis

With an uncomplicated course of the disease, the blisters heal without scars. The prognosis for life and health is favorable. With chickenpox in pregnant women, the likelihood of developing birth defects does not exceed 0.5% up to 14 weeks and 2% up to 20. After 20 weeks, the risk of a teratogenic effect of the virus has not been identified.

Congenital chickenpox occurs as a result of illness in a pregnant woman 4-5 days before birth. Every fifth newborn in such a situation develops congenital chickenpox, which in 30% leads to the death of the child. Congenital chickenpox in children is characterized by a severe course with complications such as:

Bronchopneumonia;

Loose stools;

Perforation of the walls of the small intestine;

Generalized damage to internal organs.

It has a short incubation period of 6-11 days. Requires active interferon therapy.

In adults and older children, complications arise against the background of secondary forms:

Pyoderma in the bullous form;

Myocarditis and nephropathy with hemorrhagic chickenpox;

Meningoencephalitis, lymphadenopathy, pneumonia in the gangrenous form.

Immunity after chickenpox

As a result of the disease, the person who has recovered from the disease develops a stable, but not sterile, immunity against Varicella Zoster.

With moderate immunodeficiency, resulting from stress, hypovitaminosis, old age, previous influenza, etc. activation of the varicella zoster virus persisting in the nerve ganglia is possible. As a result, the patient develops herpes zoster. With this pathology, the patient experiences burning pain and rashes in the area innervated by the intercostal or cranial nerve. The patient becomes contagious through direct contact with non-immunized citizens.

Repeated clinical examination of chickenpox is possible in cases of severe immunodeficiency resulting from HIV infection, exposure to radiation, or treatment with cytostatics.

Treatment and prevention of chickenpox

In the typical course of chickenpox, specific treatment is not required. Medical intervention is aimed at preventing bacterial contamination of the contents of the vesicles. For this, local antiseptics are used: brilliant green solution, Castellani paint, concentrated solution of potassium permanganate, etc.

At high body temperatures and the risk of developing febrile convulsions, the use of antipyretics is permissible.

Antihistamines are used to combat itching.

Specific therapy is carried out in the treatment of secondary and complicated forms, as well as in the treatment of patients with immunodeficiency:

antivirals: acyclovir, vidarabine

human alpha interferons.

Prevention consists of isolating patients for 9 days from the moment the rash appears. Contact persons are excluded from the non-immunized team for 21 days for observation and control.

For the purpose of artificial immunization against chickenpox, the vaccines Varilrix and Okavax have been developed, but they are not widely used at the moment.

The disease is a viral infection that manifests itself as a watery skin rash, most often identified as a childhood disease, but also occurs in adults. It is believed that chickenpox is based on the herpes virus, which in this case is transmitted by airborne droplets during communication and close contact between children and adults. Most often this is a disease that manifests itself in children under 12 years of age. But sometimes adults also get it.

According to doctors, chickenpox in childhood is quite easy, which cannot be said about adults. They tolerate the disease quite hard, complications may appear. The causative agent of this disease, causes and methods of treatment will be discussed in this article.

In what places can you most often get chickenpox?

Most often, small children become infected with chickenpox in nurseries and kindergartens, schools, on playgrounds in the courtyard of a residential building, in children's cafes, etc. Due to the transmission of the virus by airborne droplets, the virus spreads quite easily when children are in mass places. no more than 2 times. This is different from chicken pox. The causative agent will be discussed below.

After experiencing an illness, antibodies are formed in the body, forming immunity to this disease. Therefore, adults who are convinced that they had chickenpox in childhood, popularly called chickenpox, have no fear in contacting a sick child. It is often very difficult to understand that a child or adult has become infected with chickenpox, since the incubation period of the disease is twenty-one days. The causative agent of chickenpox has already settled in the body.

Therefore, a child infected with chickenpox continues to visit public places and spread the virus. Under such circumstances, an entire epidemic of chickenpox infection often occurs in kindergartens and schools. Doctors believe that widespread infection over a period of time will minimize further outbreaks of chickenpox. The pathogen (transmission methods are airborne) quickly enters the body; fleeting contact is enough for this.

Thus, having been ill at the same time, part of the group in kindergarten is a partial guarantee of the absence of chickenpox in children during this year.

The causative agent of chickenpox

Microbiology confirms that the causative agent of the disease is the Strongyloplasma varicella virus, which has an icosahedral shape. Refers to DNA-containing viruses.

There is an opinion that the variola virus and the herpes zoster virus are virions of the same virus, morphologically and structurally identical to the herpes simplex virus.

How does chickenpox manifest?

The causative agent of the disease is the third type of herpes viral infection.

Chickenpox is characterized by profuse rashes on the skin in the form of red blisters with liquid. Initially, the patient begins to experience severe itching, and then small rashes appear, which are subsequently filled with liquid.

When these bubbles burst, they leave marks. Sometimes pockmarks can persist as scars throughout life. It is not recommended to scratch rashes that have already appeared. They mainly cover the back, armpits, scalp, arms and legs, face and scalp. If an adult has chickenpox, then he experiences more difficulties due to rashes on the scalp and genitals due to the treatment.

In addition to itching and rashes, chickenpox is often accompanied by an elevated body temperature of 37-39 degrees, headache, and muscle weakness. In adults, it can stay at a level of 40 degrees or higher, muscle pain can be accompanied by cramps in the limbs, dizziness and nausea.

This is how chickenpox (the causative agent) manifests itself when diagnosed.

Symptoms and paths of the disease are reviewed. Let's move on to diagnosis and treatment.

Diagnostics

The onset of the disease is determined primarily by rashes on the skin.

For diagnosis, biochemical blood tests are performed to determine the herpes virus in the active phase. A urine test can also show the level of inflammation in the body.

This is how chickenpox is most often determined.

The pathogen and symptoms are interrelated.

Treatment

First of all, a sick child or adult must be isolated from society to eliminate the possibility of spreading the virus. It is advisable not to go outside; in sunlight, the rashes become larger. The treatment period for chickenpox is 2-3 weeks from the onset of the disease.

Treatment for chickenpox is comprehensive, aimed at combating the signs of the disease and increasing the level of immunity.

A number of antiviral drugs are prescribed to combat herpes. For adults in tablets or in the form of injections, for children more often in the form of liquid syrups. One of these drugs is Acyclovir. Chicken pox (the causative agent of the infection is the herpes virus) will go away much faster as a result of taking this remedy.

At elevated temperatures, adults and children are prescribed antipyretic drugs. For children in the form of rectal suppositories and syrups, for adults in tablets.

Antihistamines may be prescribed to relieve itching. It is very difficult for children to restrain themselves from scratching their skin.

In order to fight skin rashes, children spot-treat the blisters with a cotton swab dipped in brilliant green. During the day, process approximately 3-4 times. The rash continues for the first 3-4 days after the first manifestations of the disease.

It is not recommended for both children and adults to swim, since skin rashes do not heal in a timely manner when they come into contact with moisture. During the entire period of illness, you can take a bath no more than 3-4 times using a series of chamomile. The disinfecting, healing and drying properties of these herbs will have a positive effect on the treatment process. The causative agent of chickenpox in children is the same as in adults - type 3 herpes viral infection.

For adults, if it is not possible to treat chickenpox manifestations with brilliant green, it is recommended to carry out procedures using alcohol or an iodine alcohol solution.

To increase the protective properties of the body, children and adults are prescribed a complex of vitamins and immunomodulator drugs, for example “Immunal”.

How else is chickenpox treated? The causative agent of the infection is a virus, so treatment should be approached comprehensively.

It is important to review the diet of the sick child during treatment. Limited in outdoor walks and physical activity, weakened by the effects of the virus, the child needs additional energy, which he can get from food. Be sure to include dairy products, fruits and vegetables, and cereals based on cereals and legumes in the menu.

It is very important to maintain the level of water-alkaline balance in the body; the patient should drink a lot of water. To improve your health and quickly remove toxins, you can drink a decoction of rose hips, which well stimulate the liver and kidneys.

Treatment for chickenpox is most often carried out at home. But if a child or adult does not feel well, the temperature remains above 38 degrees, the issue of outpatient or inpatient treatment is decided. This is why the chickenpox pathogen is dangerous.

When treating chickenpox, it is very important to properly treat rashes on the face and the surface of the skin of the body. If there is a complication, the formation of pus, or inflammation, they will definitely leave scars. To prevent this, it is necessary to carry out treatment using a weak solution of potassium permanganate and alcohol.

If the disease is very severe, a course of antibiotic treatment is prescribed. In such cases, treatment may be delayed and take more than 20 days. The older the patient, the greater the likelihood of complications. In addition, due to the age of the patient, the process of treating rashes is more difficult. The skin of fair-haired people, genitals and face is almost impossible to treat with brilliant green. It leaves pigment that is undesirable for aesthetic reasons.

Every person experiences chickenpox once in their life. In rare cases, a person can become infected twice. After all, the causative agent of chickenpox is the herpes virus, and every person has it in the body.

If there are several children in a family and one of them gets chickenpox, then it is advisable to isolate the second one so that the infection does not spread. But if children are under 5 years old, sometimes parents deliberately allow a second child to become infected with the virus so that there are no serious consequences if they become infected with chickenpox in adulthood.

In fact, chickenpox falls into the category of fairly simple diseases. Fever and acute manifestations of the disease exist in the first three days. Then the patient feels well, and the matter remains with the healing of the skin rashes.

Considering that this is a viral infection, against the background of chickenpox, inflammatory processes in the upper respiratory tract may occur in parallel: bronchitis, tracheitis, pharyngitis or rhinitis.

Pregnancy and age up to one year

How does chickenpox manifest in pregnant women and infants?

The pathogen (characteristics are given above) can enter the body of a pregnant woman and an infant. What to do in this case? More on this below.

Due to the sterile conditions of the maternity hospital, the spread of chickenpox within the walls of the maternity ward practically does not occur. If a woman in labor has been infected with chickenpox, the child is placed in an isolated box. The mother is also isolated from other patients. In addition to diagnosing and treating chickenpox, a number of measures are taken to prevent the spread of the virus to other patients.

When pregnant women are infected with chickenpox, antiviral therapy is used using medications that do not penetrate the placenta and do not affect the fetus. Antibiotic treatment is excluded in this case. The patient is placed in a hospital, treatment is carried out under supervision. In late pregnancy, there is a risk of the baby becoming infected with chickenpox during childbirth.

A complex disease can cause miscarriage in the early stages of pregnancy and premature birth in later stages.

The main prevention of chickenpox is disinfection and sterilization of the premises where the patient was.

Prevention at home

How is chickenpox prevented? The causative agent, the transmission routes have been considered by us. Therefore, after completing the course of treatment for chickenpox, maximum ventilation is carried out in the room where the patient was. Bed linen and towels are washed and ironed. It is necessary to wash the patient's clothes.

Wet cleaning is carried out using chlorine-containing chemicals in the room where the patient was and in common areas.

When staying in a patient’s house or apartment, it is necessary to ensure complete isolation and visit the patient wearing a medical mask.

Provide the patient with dishes, towels, and personal hygiene products for personal use.

It must be remembered that chicken pox is quite dangerous for an adult. The causative agent and path of the disease are known to everyone.

Prevention in public places

In kindergartens and schools, constant sterilization and treatment of premises using chlorine is mandatory.

When diagnosing chickenpox in children, patients are isolated from healthy children.

In kindergartens and educational institutions, mass vaccination against antiviral diseases is carried out.

Personal prevention of chickenpox

To prevent the disease chicken pox (the causative agent of the disease is a virus), it is necessary to maintain immunity at the proper level. In order to increase the protective functions of the body, a complete diet is used using foods high in fiber, vitamins, and microelements.

• Take immunomodulatory drugs.
• Take vitamin complexes.
• In the risk zone, when visiting public places, antiviral ointments and medical masks are used.
• Antiviral vaccinations are used.
• When visiting patients with chickenpox, it is necessary to use antiviral agents, avoid contact and use a medical mask.

Who is more susceptible to chickenpox?

• People with weakened immune systems, those who have just had the disease, or those who already have inflammatory diseases are more susceptible to the chickenpox virus.
• Children in nurseries and kindergartens. They have constant contact and easily transmit viral infection to each other by airborne droplets.
• Parents who have not previously had chickenpox are susceptible to infection if their children are sick. A sick child needs to be cared for, and most often this role falls to parents. In this case, if one of the parents has already had chickenpox, he should be entrusted with the responsibility of caring for the sick child.
• Teachers, nannies and other workers of kindergartens and educational institutions. They are forced to come into contact with sick children and are primarily at risk of contracting a viral infection.
• Pharmacy, trade and service workers. People in this profession are constantly in contact with the public and are at risk of becoming infected by airborne droplets with almost any viral infection.
• Doctors, nurses, medical staff. Due to their profession, they are unable to avoid contracting a viral infection.
• Close relatives and family of a patient with chickenpox. Without the possibility of isolation, being in the same living space with a sick person, they are constantly at risk of contracting the virus through airborne droplets.

Consequences of chickenpox

Since the causative agent of chickenpox (microbiology confirms this) is a virus, the main consequences in a child are a weakened immune system. Prolonged isolation, lack of fresh air, lack of appetite and infection by the virus worsen the child’s health. If chickenpox occurs with complications in an adult, this also reduces the level of his immunity.

After vigorous scratching, chicken pox rashes leave small scars in the form of holes on the skin. They can remain for life, which is not entirely aesthetically convenient.

In rare cases, after chickenpox, the patient may experience difficulties in the functioning of the kidneys and liver.

Due to prolonged use of alcohol-containing solutions, dry skin and various types of dermatitis may occur. To avoid such unpleasant consequences, after completing the course of treatment it is necessary to lubricate the skin with fatty creams, glycerin and other moisturizers.

Chickenpox is primarily considered a childhood disease. In adults, this is most often a secondary syndrome. Sometimes the virus is cumulative. If a person has already had chickenpox once, then upon contact with infected patients, chickenpox may manifest itself in the form of skin diseases, for example, shingles. Adults are most at risk of getting chickenpox again if they have a low immune system and are susceptible to illness.

In case of severe mass epidemics in public organizations and educational institutions, quarantine may be declared. Chickenpox belongs to the category of rapidly spreading viral infections, and during an epidemic, more than half of the team can become infected. In order to extinguish the outbreak of infection, in such cases a quarantine is declared. Because being in a society with a large number of adults or children whose incubation period lasts, when there is a possibility of spreading the infection, is undesirable.

The total period from the moment of infection to the end of treatment for chickenpox ranges from 2 weeks to 1 month. Within 10-12 days after the absence of obvious manifestations of the disease, the person is still a spreader of the infection. After completing treatment, doctors recommend not taking your child to school or kindergarten for another week. This is dangerous for other children by spreading the infection.

Sometimes chicken pox can only appear as itching and a rash. The pathogen and symptoms of the disease are often interrelated.

In children with a high level of activity, the disease is mild, without high body temperature, complications of skin rashes and general condition of the body.

Which doctor should I contact if I have chickenpox?

Typically, in children who go to kindergarten and school, a skin rash when infected with chickenpox is detected and diagnosed initially by a medical worker at the organization.

The second stage is visiting a local pediatrician or calling a doctor at home if the patient is not feeling well.

A local pediatrician diagnoses chickenpox and prescribes a course of treatment and medications to be used.

During outpatient treatment, constant monitoring of the patient by a pediatrician is necessary.

If the patient requires hospitalization, the local doctor writes a referral to a hospital, where further treatment is carried out.

If the patient has complications, the decision to hospitalize is made independently. To do this, an ambulance is called, after which further treatment is carried out within the walls of a medical institution.

If the infection occurred at home, then it is necessary to call a local pediatrician to determine the diagnosis and treatment procedure. Next, after the appointment, carry out treatment.

If an adult is infected with chickenpox, it is necessary to consult a general practitioner at a medical facility at the first manifestations of the rash. If the therapist has doubts, the examination is carried out by a dermatologist. Next, treatment is prescribed at home or on an outpatient basis. In case of complications, it is necessary to call an ambulance for hospitalization.

It is very easy to determine that a patient has chickenpox. Itching begins, and after scratching, small red pimples appear, which begin to appear more and more. Almost throughout the day the patient is completely covered. The tonsils, nasopharynx, and eyelid mucosa may become inflamed.

This is why chicken pox is dangerous. The causative agent and causes are discussed above.

Despite the fact that this is a fairly common viral disease that is widespread, we should not forget that it still has consequences.

The less attention is paid to the treatment of chickenpox, the more likely the occurrence of consequences that are undesirable for the health of especially the child’s body. Any virus affects the formation of a growing child. In addition, an advanced, severe disease can cause systemic changes, blood diseases, etc. In this regard, preventive measures and compliance with the treatment regimen should not be neglected.

What drugs are used to treat chickenpox?

• Alcohol solution of brilliant greens.
• Manganese solution.
• Glycerol.
• Alcohol.
• "Fukortsin".
• "Acyclovir" and its foreign-made analogues.
• Zovirax, other antiviral drugs.
• Antibiotics "Amoxiclav", penicillin group, tetracycline group.
• Vitamin complexes for children and adults.
• Antihistamines: Clarotodin, Suprastin or others of Russian and foreign origin.

When infected with chickenpox, it is important to diagnose the disease in a timely manner, follow all necessary measures to isolate the patient, and the doctor’s instructions. Under no circumstances should you interrupt treatment or go outside or into society before the prescribed time. For severe pockmarks on the face after chickenpox, treat the scars with Contratubeks ointment for 1 month. A month after the end of treatment, to diagnose the consequences, it is necessary to take biochemical blood and urine tests.

If necessary, you need to do an immunogram; based on the results of the diagnosis, it will be clear how negative the impact of the disease was on the human body.

In the article, we consider the causative agent of chickenpox, symptoms and methods of treating this disease.

Chickenpox (varicella) is a highly contagious disease caused by the herpes virus type 3, which is also known as Varicella-zoster or Herpes zoster. Distributed throughout the world, according to some data, every person is 100% susceptible to primary infection.

The name “chickenpox” is associated with the erroneous assumption, widespread in the Middle Ages and modern times, that this disease is a type of smallpox - and for its relatively fast and mild course it was nicknamed “chickenpox”.

No differential diagnosis with smallpox is required, since, firstly, the latter disease is practically not found in developed countries, secondly, symptoms specific to chickenpox have been identified, and thirdly, in isolated doubtful cases, laboratory tests of blood and the contents of the vesicles give the exact answer.

How it begins

The Varicella Zoster virus is a herpes virus, and its effect on the body is quite similar to the development of other forms of herpes. The behavior of Varicella-Zoster is due to two of its properties: dermatotropism and neurotropism, that is, “love” for skin cells and nerve cells, respectively.

Chickenpox has several stages, and between some of them the time interval can be tens of years.

Both a child and an adult who has never had chickenpox can catch a primary infection, and in adults the course of the disease is usually more severe.

The most common age of the disease is 4-7 years.

Infants are also seriously ill and only in very rare cases:

• with intrauterine infection (the mother falls ill in the last week of pregnancy);
• in the absence of breastfeeding and, accordingly, the mother’s protective antibodies;
• in severe immunodeficiency conditions (including cancer and AIDS).

There is a risk of infection of a healthy breastfed child if the mother does not have specific immunity (she has not had chickenpox at all and has not been vaccinated).

Incubation period

• Infection
  The virus enters the body by airborne droplets and is fixed on the mucous membrane of the upper respiratory tract, where it accumulates and multiplies - but no symptoms of chickenpox are observed. On average, this stage lasts about 2 weeks, the patient is non-infectious.
• First symptoms
  Gradually, the chickenpox virus begins to penetrate the blood and, when its quantity becomes sufficient, the body’s immune system reacts to the foreign presence. The patient may have a fever, weakness, headache, lower back pain, but no rash yet. This period lasts 1-2 days, during which the patient can infect others.
• Primary acute stage
  Through the bloodstream, the virus reaches its targets - skin and nerve cells. There is no damage to the nerves yet, Varicella Zoster is only gaining a foothold in the roots of the spinal cord, but specific symptoms appear on the skin - a rash that occurs in fits and starts over the next 4-7 days. The rash is the body’s reaction to the activity of the chickenpox virus concentrated in the skin; in rare cases, it is almost invisible, which complicates diagnosis. The patient remains infectious.
• How many days does it last
  If the patient has a healthy immune system, then after 4-7 days the rashes stop, the general condition improves, and the acute stage ends. The patient ceases to be contagious, but the virus becomes firmly entrenched in the nerve cells and remains there for life.
• Secondary acute stage
  When the immune system is weakened or the nervous system is stimulated (including as a result of frequent stress), the chickenpox virus reveals itself again. This time, the location of the rash depends on which nerve is most affected - most often it is the axillary region or the abdomen, which is why the secondary manifestation of Varicella Zoster was called herpes zoster (zoster (lat.) - to encircle). There may be no skin manifestations at this stage - symptoms are limited to pain along the nerve, which is especially common in older people. During periods of skin rashes, the patient, as well as with chickenpox, remains contagious, including for children.

Today there are no ways to completely destroy the herpes virus type 3 in the body. Having established itself in the nerve endings, Varicella Zoster becomes very little susceptible to antiviral drugs and immune agents - their action is aimed mainly at treating exacerbations, and is effective when the virus is localized in skin cells during these periods. Therefore, chickenpox can only be described as the first stage of a chronic disease - herpes virus type 3.

However, after the first infection, a person develops a strong immunity against Varicella Zoster - therefore, they do not get sick with chickenpox again (that is, the first acute stage), all subsequent manifestations are the result of the activity of the virus already present in the body.

Given this nature of the immune response, in many countries, including, partially, in Russia, they consider it advisable to vaccinate rather than specifically expose children to infection in preschool age, which is also very common in our time.

How can you get chickenpox?

As we have already noted, the virus is transmitted by airborne droplets from an infected person in the period between the first and last day of the rash, as well as 1-2 days before the appearance of pustules. This is one of the reasons for the high prevalence of chickenpox in the world - the prodromal period is almost impossible to recognize. In addition, they note a very high susceptibility of people to the herpes virus type 3 - everyone in contact becomes infected with it.

Chickenpox is transmitted only from person to person; it does not survive in the external environment or, for example, in the body of domestic animals. The source of the primary infection can also be a patient with herpes zoster in the acute stage. In rare cases, infection can occur through contact with the contents of pustules.

Diagnosis and symptoms of chickenpox

A specific symptom of chickenpox is a rash that appears only in the second or third week after infection and on the second or third day after a person becomes infectious.

Firstly, a distinctive feature is the widespread localization of the rash - it is found even on the scalp, mucous membranes, and conjunctiva. The rash is characterized by moderate to severe itching.

Secondly, the chickenpox rash is quite heterogeneous in appearance, as it appears in fits and starts over 1-7 days. There are also fresh formations on the patient’s body - small pink spots; and papules, and vesicles with purulent contents, and scarring crusts.

Diagnosis of chickenpox, with the exception of rare complicated cases, is not difficult and is carried out on the basis of examination, but there are also laboratory tests that detect the Herpes Zoster virus in the blood and rashes during an exacerbation.

Chickenpox photo

What does chickenpox look like in children in the early stages?

Drying of chickenpox and formation of crusts

Treatment of chickenpox in children and adults

Chickenpox in children and adults requires the prescription of special medications to alleviate the course of the disease. In our country, the standard therapy is the prescription of antihistamines to relieve itching, antipyretic drugs and antiseptics (usually aniline dyes).

A solution of brilliant green (brilliant green) is used for chickenpox as a standard antiseptic for disinfection. However, in world practice this approach has long been abandoned, since antihistamines and antiallergic drugs have a strong systemic effect on the body of a child or adult and have a number of side effects, and brilliant green or iodine are not always acceptable from an aesthetic point of view.

Since chickenpox is caused by a virus, antibiotic therapy is ineffective for it, including when it is complicated by chickenpox pneumonia. In addition, during the normal course of the disease, specific treatment is not required - the body’s immune system recognizes and destroys the virus in the blood and skin cells within a few days. But the Herpes Zoster virus, which has invaded nerve cells, as a rule, cannot be dealt with either by our immunity or by medications.

Therapeutic treatment of chickenpox in children has several directions:

• Relief of symptoms, including itching. For this purpose, systemic antihistamines are used, which, however, are becoming less popular today, since inhibition of the immune response is believed to lead to complications. For general symptoms of inflammation, they also try to alleviate the patient’s condition - relieve pain and fever, for which paracetamol or ibuprofen are recommended.
• Reducing the acute period, especially in cases of high risk of complications. For this purpose, antiviral drugs are used, primarily acyclovir and interferon, which suppress the reproduction of the virus and stimulate the immune system.
• Preventing complications, including secondary infections. To do this, the elements of the rash are treated with antiseptics and bed rest is prescribed.

During the period when the rash appears, it is necessary to limit contact with the patient; in addition, persons who have not had chickenpox and who communicated with the patient 1-2 days before the appearance of the rash are subject to quarantine.

Prevention of chickenpox

The issue of chickenpox prevention remains very controversial. A number of experts still do not consider it necessary, despite the possible side effects, including delayed ones. Due to the fact that preschoolers, as a rule, tolerate chickenpox more easily than other age groups, sometimes parents and doctors even specifically try to infect the child so that he will suffer the disease earlier.

Meanwhile, since the 70s of the last century, a very effective vaccine against chickenpox has been successfully used in civilized countries, which provides lasting immunity for decades, according to studies of the blood of adults who were vaccinated in childhood. This vaccine, including its modified versions, is also available in Russia; it is especially recommended for people at high risk of complications - women planning pregnancy, cancer patients, HIV-infected people, and so on.

Remember that it is impossible to predict the course of the disease even in a healthy child, so when deciding to prevent chickenpox, consult with several specialists!

Complications of chickenpox

Approximately 5% of chickenpox cases resolve with various complications. Traditionally, the disease is more severe in people with weakened immune systems, in patients over 12 years of age (with primary infection), as well as in infants.

During pregnancy, chickenpox can harm the fetus; the greatest risk (about 2%) is observed when infected from 12 to 20 weeks. In this case, treatment with immunoglobulin specific to Herpes Zoster is effective - it significantly reduces the risk of congenital developmental abnormalities. Infecting a pregnant woman in the last week before giving birth is also quite dangerous, since the immune system does not have time to respond and the newborn develops congenital chickenpox, which is very severe.

In total, there are about 200 complications of Varicella-Zoster from the nervous system alone; the skin, lungs and other internal organs can also be affected. Let's look at some cases of severe chickenpox.

1. Secondary infection
   Most often, secondary infection enters the skin when papules and vesicles are scratched. That is why young children with chickenpox are advised to cut their nails short. Interestingly, a secondary infection can both complicate the course of chickenpox and alleviate it - for example, Herpes Zoster behaves very ambiguously in scarlet fever. According to observations, if scarlet fever infection occurred at the beginning of the chickenpox rash, then both diseases can proceed more easily. But in most cases, secondary infection aggravates the course of chickenpox, lengthens the recovery period, and worsens the general condition. The most severe scenario for secondary infection is blood sepsis, an emergency, life-threatening condition. In addition, skin abscesses and other inflammatory processes can be very unpleasant.
2. Chickenpox pneumonia
   It is a common complication in adults who get chickenpox for the first time. In children - in second place after secondary infection. It is quite difficult to diagnose - symptoms may be absent for a long time, the pathological process is detected by X-ray examination. Symptoms include shortness of breath, chest pain, deterioration in general condition, and in advanced cases, sputum with blood. Treatment with antiviral drugs only after confirmation of the diagnosis - it is necessary to distinguish between bacterial pneumonia, which can occur in parallel with chickenpox and require antibiotic therapy.
3. Visceral chickenpox
   It is a lesion of the mucous membrane of internal organs, similar to a skin rash. It occurs in infants, as well as in persons with severely weakened immune systems, the mortality rate is very high, the prognosis depends on timely diagnosis and the extent of the lesions.
4. Chickenpox encephalitis
   Brain damage by the Herpes Zoster virus. Manifestations are very diverse and depend on the location of the affected tissues - the disease can be asymptomatic for many years, and may be accompanied by disturbances in movement, behavior, and nerve pain. In some cases, chickenpox encephalitis occurs in the acute period against the background of a severe course of the disease due to intoxication of the body. The prognosis is usually favorable, but the patient requires urgent medical attention.
5. Hemorrhagic chickenpox
   It occurs in individuals with bleeding disorders, and is also considered normal if the pattern is observed only on individual rare papules. If throughout the acute period the rash contains ichor, bruises appear on the skin - they speak of a severe form of hemorrhagic chickenpox. Such cases require urgent medical attention, as there is a risk of internal bleeding and death.
6. Gangrenous chickenpox
   A very severe complication of chickenpox, accompanied by necrosis of tissue areas under the inflamed papules and vesicles. It occurs rarely, in individuals with a very weakened immune system or, conversely, a pathologically strong immune response (including an allergic reaction or some skin diseases).

Dr. Komarovsky about chickenpox

And, as a rule, children suffer from it.

Description of the disease

Chickenpox is an acute viral disease transmitted by airborne droplets from person to person. It is characterized by the appearance of a rash in the form of small blisters and high fever.

The causative agent is considered to be the third type of herpes virus. It enters the blood through the upper respiratory tract and affects the skin. Outside the human body, it loses its viability within 10 minutes. The microbe dies when heated, exposed to ultraviolet radiation and sunlight.

Susceptibility to chickenpox is 100%; it is most often diagnosed in children aged 6 months to 7 years. It is quite rare in adults, since most of them experience the disease in childhood without complications. The strong immunity developed after an infection lasts throughout life.

Stages

There are 4 stages of the disease:

• Incubation– asymptomatic period. The average is 11–21 days;
• Prodromal– characterized by headaches or muscle pain, a significant rise in temperature. It does not always appear in children; in adults it occurs quite often and occurs with complications. This period begins 1–2 days before the first rash is detected;
• Stage of rash characterized by the massive appearance of a rash and a wave-like increase in temperature. Most often, the febrile state persists for 2–5 days, sometimes the temperature lasts up to 10 days. The rash is observed for 2–9 days. Usually they do not affect the deep layers of the skin and disappear without a trace after recovery.
• Restorative– lasts 1 month after recovery. During this period, it is necessary to limit physical activity and take vitamin complexes.

What causes chickenpox and how can you get it?

The source of the disease is a person infected with the chickenpox virus. The danger of infection remains throughout the entire incubation period until the crusts disappear. The disease is transmitted by airborne droplets, but the maximum concentration of the virus is found in the fluid contained in the blisters typical of chickenpox.

The infection enters the body through the upper respiratory tract and penetrates the mucous membranes. Then it enters the circulatory system and spreads to the skin. There is an expansion of blood vessels, accompanied by redness, then the formation of papules - nodules raised above the surface of the skin - and vesicles - bubbles with liquid. The first rashes usually appear on the torso and limbs, later on the face and under the hair. Sometimes the mucous membranes become covered with a rash.

Due to the active reproduction of the virus, body temperature rises, and other nonspecific reactions are noted. After an infection, a person develops strong immunity.

The virus can remain viable in the human body, and in the presence of a combination of provoking factors, it can cause shingles.

Chicken pox in children

Chickenpox has a long incubation period, ranging from 7 to 21 days. From the moment of infection to the appearance of the first symptoms, as a rule, at least a week passes. The child is already a source of infection for other children, but this does not manifest itself outwardly. Motor activity and good appetite are usually maintained.

Symptoms

A day or two before the appearance of clinical signs, the child may experience:

• headache;
• lethargy, drowsiness;
• lack of appetite;
• nausea;
• a sharp increase in temperature to 38-40°C.

The above symptoms are similar to those of a common ARVI, and only the appearance of a rash allows one to reliably establish the disease.

Rashes usually appear no later than 24 hours after the temperature rises. First, single flat spots of pinkish color are noted on the skin, then their number increases sharply, they become convex and transform into fluid-filled blisters. Their appearance is accompanied by severe itching; children often scratch problem areas, facilitating the penetration of infection into the body. The rash may cover the upper and lower limbs, back, abdomen, face and scalp. There are usually no spots on the feet and palms.

The disease is often accompanied by enlargement of the ear and cervical lymph nodes.

The rash begins to dry out 3 days after it appears, becoming covered with a red crust. However, chickenpox occurs in waves, so every 2 days new lesions appear on the skin, accompanied by another rise in temperature and headache. Only after 7–10 days do all the blisters become crusty, and the child ceases to be a source of infection.

Diagnostics

For an experienced doctor, diagnosing chickenpox is not difficult. A clear clinical picture in most cases makes it possible to accurately determine the disease:

• the rash stage begins 7–21 days after contact with an infected person;
• undulating course of this period;
• the simultaneous presence on the surface of the child’s skin of all forms of rash development - pink spots, dense nodules, blisters with yellowish liquid, dried crusts;
• The infection manifests itself primarily on the torso and limbs, then moves to the face and scalp. The presence of a rash on the feet and palms is atypical.

If the symptoms are not clearly expressed, specialists resort to the following laboratory tests:

• general blood analysis. An increase in ESR indicates the presence of an infectious process. An increase in the number of neutrophils indicates a bacterial complication;
• a serological blood test for antibodies is carried out in atypical cases; an excess of 4 times or more reliably indicates chickenpox;
• examination under a microscope or immunofluorescent analysis of the contents of the vesicles.

Treatment

In the vast majority of cases, chickenpox in children is mild and does not require hospitalization. If you follow all the doctor’s recommendations, a guaranteed cure for this disease occurs at home. Standard therapy includes:

• taking antipyretic drugs. For children, paracetamol and panadol are recommended (in a dosage calculated based on weight and amounting to 20 mg/kg 3 times a day), as well as Nurofen in suspension (5–10 mg/kg up to 4 times a day). These medications can quickly and effectively reduce fever and improve general condition. Taking aspirin, which causes liver damage in chickenpox, is strictly prohibited;
• use of antihistamines, reducing itching and preventing the development of allergic reactions. Children are usually prescribed suprastin (the dosage, depending on age, is from ¼ to ½ tablets per day) or fenistil (taken 3 times a day, 3-10 drops);
• treatment of skin rashes. Traditionally, a solution of brilliant green is used to lubricate the elements of the rash, which allows you to thoroughly treat each spot. The product promotes the rapid formation of crusts and briefly reduces itching. More effective is a 5% solution of potassium permanganate (potassium permanganate) or Castellani liquid, which have a slight antibacterial effect. The rash in the mouth and genitals is lubricated with hydrogen peroxide or an aqueous solution of brilliant green;
• compliance with the drinking regime. Increased fluid intake is necessary to remove toxins from the body.

If the disease progresses in a severe form, the doctor prescribes additional specific treatment: taking antiviral, immunomodulating and sedative drugs.

FAQ

What is the incubation period for chickenpox?

The period of time from the moment the virus enters the body until the first symptoms of the disease appear is called incubation period. For chickenpox, its duration ranges from 7 to 21 days and depends on the state of the immune system. Microbes that enter the respiratory tract penetrate the mucous membranes and begin to actively multiply there, accumulating throughout the incubation period. Having reached a critical mass, the infection enters the circulatory system and spreads throughout the body, thereby moving into the prodromal stage.

In most cases, a person is non-infectious during the incubation period. However, with chickenpox, 1–3 days before its end and the appearance of the first clinical symptoms of the disease, the infection is already spreading.

How long does quarantine last in kindergarten or school?

Chickenpox is an extremely contagious disease. In the absence of immunity upon contact with an infected person, it is impossible to protect yourself from the disease.

In kindergartens and schools quarantine is announced for 21 days since the last case was identified. This period is explained by the maximum duration of the incubation period.

Children who have been in contact with a sick person are not prohibited from attending kindergarten or school. Those students who have not interacted with an infected person for more than 3 weeks are advised to move to another group, class, or refrain from attending classes.

Quarantine is declared in a specific group or class after the final diagnosis. During the entire period, pupils are examined daily by medical personnel. If a sick person is identified, he is isolated from other children and his parents are immediately informed.

There is no need to stop the work of the kindergarten or school as a whole. There are a number of measures to help avoid mass infection:

• regular ventilation and wet cleaning;
• using different entrances to move healthy children and quarantined groups;
• ban on visiting physical education and music halls.

Specific measures for disinfection of premises when cases of chickenpox are detected are not taken, since the virus has low viability outside the human body.

How to lubricate the rash with chickenpox?

For many decades, it was customary to smear chickenpox blisters with brilliant green. It was believed that this was the only way to achieve the fastest formation of crusts and reduce unbearable itching. Currently, experts question this method, since brilliant green does not affect the rate of crust formation and the healing process, and also does not cope with itching at all.

The following drugs are suggested as alternative methods:

• calamine lotion– quickly relieves itching and redness, promotes active skin regeneration. Suitable for children, does not stain the skin;
• potassium permanganate solution– used from a very early age. Application requires special care, since exceeding the concentration can cause burns. To prevent this, it is necessary to dissolve several crystals of potassium permanganate in a glass of boiled water until a pale pink solution forms;
• suspension "Tsindol" has drying and disinfecting properties. Can be used up to 6 times a day.
• gel "Fenistil" promotes active healing of the skin and effectively eliminates itching. However, its use is recommended only for severe chickenpox after consultation with your doctor.

What are the possible complications?

Chickenpox infection, especially in adults, often leads to the development of complications. The most serious are:

• chickenpox pneumonia;
• secondary infections - abscess, sepsis.

Chicken pox in adults

If a person did not have chickenpox in childhood, there is a high probability of infection in adulthood.

Symptoms

The symptoms are practically the same, but in adults the disease, as a rule, is severe and manifests itself with the following symptoms:

• high temperature for a long period;
• pronounced prodromal signs - headaches and muscle pain, loss of appetite, general toxic manifestations;
• profuse rash, late formation of crusts;
• The mucous membranes are often affected and the lymph nodes become enlarged.

Infection with chickenpox during pregnancy, especially in the early stages, can aggravate the course of the disease in a woman and lead to infection and even death of the fetus. After 20 weeks the risk to the baby is negligible.

Treatment

Treatment methods depend on the form of the disease, the state of the immune system and the age of the person.

As a rule, when the disease occurs in mild and moderate forms, treatment is carried out on an outpatient basis. Infectious disease specialists recommend:

• compliance with bed rest in the presence of elevated temperature;
• drink plenty of fluids to quickly remove toxins from the body;
• balanced diet. It is optimal to follow a protein-plant diet;
• treating the skin with disinfectants. Instead of traditional brilliant green, potassium permanganate, Tsindol, Fukortsin, and Calamine suspensions can be used. Each element of the rash is treated separately using a cotton swab. Calamine can be used up to 4 times a day, fucorcin and cindol - up to 6, potassium permanganate - without restrictions;
• carrying out special drug therapy.

• paracetamol;
• panadol;
• Nurofen;
• efferalgan.

Do not use aspirin to avoid side effects.

If a severe form of the disease is observed, doctors prescribe antiviral drugs. The recommended dose of acyclovir is 800 mg 5 times a day for a week. In especially severe cases, intravenous administration of the drug 3 times a day at a dosage of 10 mg/kg body weight is practiced.

Antihistamines help relieve itching and swelling. Showed themselves well:

• tavegil;
• Claritin;
• suprastin.

Their daily dose should not exceed 4 tablets.

It is allowed to treat the skin with special preparations that reduce itching and other skin manifestations. For example, “Fenistil-gel” can be used repeatedly during the day.

Chickenpox vaccinations

An effective method of combating chickenpox is vaccination. In a number of countries - Japan, Australia, USA, Austria, vaccination against chickenpox is included in the national vaccination calendar. This procedure allows you to build immunity to the disease for life.

WHO representatives and vaccine manufacturers recommend immunization against chickenpox for children over one year of age. Russian experts do not recommend performing the procedure on children under 2 years of age. Adults have no age restrictions.

For vaccination, a live vaccine and specific immunoglobulin are used.

When a live, attenuated Varicella Zoster virus is injected into the body, an asymptomatic mild form of chickenpox develops. Antibodies are formed, which provide stable long-term immunity.

The following vaccines are allowed to be used in Russia:

• « Okavax» (Japan) is used to vaccinate children from 12 months of age and adults. It is administered once intramuscularly. Used as emergency prophylaxis no later than 3 days after contact with an infected person. The minimum cost of the drug is 1900 rubles;
• « Varilrix» (Belgium) is administered twice with an interval of 6–10 weeks. Allowed for vaccination of children starting from 9 months and adults. The average price in pharmacies is 2,200 rubles.

The drug "Zostevir" is a specific immunoglobulin for the varicella zoster virus. It helps ease the course of the disease and speed up the healing process. The medication is administered intramuscularly once a day in a dosage of 1 to 3 ml, depending on the indications. Does not contain live virus and does not provide lifelong immunity.

Infectious disease specialists in a number of countries do not see the need for universal immunization against chickenpox in childhood, since in most cases the course of this disease is mild before adolescence. Vaccination is prescribed only if there are objective indications, for example, weakened immunity.

British infectious disease specialists have identified a link between immunization in childhood and shingles, caused by the same virus, in adulthood.

For a person who has not had chickenpox in childhood, vaccination is 100% the right decision.

Prevention

The only reliable way to protect against chickenpox infection is vaccination. Other methods do not provide a 100% guarantee. However, the likelihood of infection if one of your family members becomes ill can be reduced by taking the following precautions:

• complete isolation of the sick person;
• use of separate utensils;
• use of cotton-gauze dressings;
• taking antiviral drugs or timely vaccination.

Knowing and following preventive measures allows you to avoid infection with chickenpox or survive it without complications.

You can find out what experts think about chickenpox by watching the video.