Course Of Varicella Research Articles

Raising awareness about the importance of chickenpox vaccination in children

Introduction: Varicella is an acute infectious disease caused by the Varicella zoster virus. It is among one of the most contagious infectious diseases. The main symptoms of the disease are an itchy, papular and vesicular rash on the trunk, face, scalp, extremities, mucous membranes. In addition, there is fever, malaise, headache and muscle aches, enlargement of lymph nodes. In most cases, varicella is mild, but 2-6% of patients may develop dangerous complications. The most common complications include bacterial skin infections, neurological symptoms and acute thrombocytopenia.
 Aim: The purpose of this study is to present the severe and complicated course of varicella in a 12-month-old patient.
 Results: On the day of admission, the patient presented symptoms of an exacerbation of the course of varicella. The main symptoms were smallpox eruptions, increasing fever track, and enlarged and painful lymph nodes. During his stay, the patient's condition indicated a severe course of varicella. It was complicated by infection of the skin, subcutaneous tissue and lymph nodes. In addition, tests showed Epstein-Barr virus (EBV) infection and positivity for cat scratch disease. He also developed zoster during his hospitalization. Throughout his stay in the hospital, many tests and consultations were carried out to clarify his symptoms. With appropriate treatment, the patient's condition improved and he was able to be discharged home after a 3-week hospitalization.
 Conclusions: The presented case shows the severe course of varicella. Due to recommendations and the patient's too young age, he could not be vaccinated against VZV. In each patient, the course of the disease is unpredictable. Vaccination protects against severe symptoms, and also reduces the risk of developing zoster in the future. In addition, long-term immunity can be acquired through vaccination.

Apendicite necrosante como complicação da varicela: relato de caso e revisão da literatura

In immunocompetent children, complications of varicella are rare. Acute appendicitis (AA) is one of the most exceptional complications of chickenpox. In this report we describe a case of a 6-year-old girl with a perforated AA in the course of varicella. We intend with this clinical case to remember an extremely rare complication of varicella, which is at the same time the most common cause of abdominal surgery in children.

ЗНАЧЕНИЕ СОДЕРЖАНИЯ ВЕЩЕСТВ НИЗКОЙ И СРЕДНЕЙ МОЛЕКУЛЯРНОЙ МАССЫ И ОЛИГОПЕПТИДОВ В ПАТОГЕНЕЗЕ ВЕТРЯНОЙ ОСПЫ

Endogenous intoxication syndrome is an important link in the pathogenesis of many infectious diseases. The role of low and medium molecular weight substances and oligopeptides acting as indicators of endogenous intoxication syndrome in the pathogenesis of varicella was studied, depending on the period of the disease, the severity of the course and the presence of complications. Based on this goal, 125 patients with varicella aged 18 to 49 years were examined. Determination of the content of substances of low and medium molecular weight in biological body fluids (blood plasma, red blood cells and urine) was carried out by the method of M. Ya.Malakhova (1995) on a spectrophotometer SF-46. The Lowru (1951) method was used to determine the level of oligopeptides in body fluids. The maximum level of substances of low and medium molecular weight was observed in patients with a complicated course of varicella during the height of the disease, as well as in patients with a severe course of the disease during the height. When determining the oligopeptides, the highest values were also obtained at the height of the disease in the severe course, as well as in the complicated course at admission. During the examination, the dependence of the studied indicators on the period of the disease, the severity, as well as the presence of complications was revealed. Thus, the most pronounced changes in the level of low and medium molecular weight substances and oligopeptides were observed in severe, and the least – in the mild course of varicella in all the studied media. In patients with developed complications, the disease was more severe, while the changes in the studied parameters were more pronounced.

Clinical and epidemiological patterns of chickenpox in adults in the Primorsky territory

Objective: to establish clinical and epidemiological patterns of chickenpox in adults in the Primorsky Territory to improve treatment and prevention work. Materials and methods: The study used statistics on the incidence of chicken pox in the Primorsky Territory from 2009 to 2017 and demographic data on the population for the specified period. A clinical characteristic of 102 cases of varicella in patients hospitalized in the infectious disease ward of Primorsky Regional Clinical Hospital No. 2 (Vladivostok) in 2015-2017 is given. Results: From 2009 to 2017, the incidence of chickenpox in the Primorsky Territory was consistently high, with an average of 636.2 per 100,000 population. Analysis of the structure of patients showed that the maximum proportion of cases of chicken pox occur in organized children 3-6 years old (55.9%), schoolchildren (19.1%) and children 1–2 years old (11.6%). The proportion of 15–17 year olds was 3.0%. Adults, from 18 years old – 4.9%. The proportion of unorganized children 3–6 years old (2.9%) and children in the first year of life (2.6%) is not high. High risk of infection was detected in Vladivostok (57.8 per 100.000), Yakovlevsky (52.1% ooo), Olginsky (45.9% ooo), Lazovsky (42.8% ooo) and Shkotovsky (40, 2% ooo) areas. In the annual dynamics, a pronounced spring-summer seasonal rise was formed. The clinical course of varicella in the group of adults was characterized by an average duration of the initial period of the disease of 1.4 ± 0.7 days. For clinical diagnosis, an important time was the appearance of the rash, which varied within four days. The phenomenon of “spillage” was noted in 97% of patients. The rash was polymorphic, with the formation of crusts. The period of height was characterized by the presence of catarrhal manifestations. The granularity of the posterior pharyngeal wall was observed in all patients without exception. In 84.3% of patients there was a bright hyperemia of the pharynx. In 14.7% of cases, enantema was detected on the soft palate, palatine arches, and posterior pharyngeal wall. Dry cough was detected in 28 of 103 patients, which probably increased their epidemiological significance. Findings: The clinical picture of varicella was typical and was represented by a combination of intoxication, exanthema, and catarrhal syndrome. The epidemic process of varicella in adults in Primorsky Krai was characterized by relative autonomy of manifestations in adults, children up to one year old, and unorganized children. When implementing chickenpox epidemiological surveillance, priority should be given to interventions in epidemic foci.

MODERN FEATURES OF CHICKEN POX COURSE IN ADULTS

The article presents the epidemiological and clinical data of the modern course of chickenpox. A high incidence among adults with a bright manifestation of the clinical picture was shown. Recurrent episodes of chicken pox were marked. The modern course of varicella in Ukraine is characterized by an increase in the incidence among the adult population. Infection is manifested by a long prodromal period, a pronounced intoxication syndrome, lymphadenopathy, and an abundant polymorphic rash. At the same time, the rash had a pustular character in 54.3 % of patients; exanthema was observed with scleritis and conjunctivitis in 45 % of cases. There are repeated cases of chickenpox, the interval between these episodes ranged from 5 to 12 years. Taking into account the epidemiological situation in the country it remains relevant to study main features of the course of chickenpox in individuals against the background of pulmonary tuberculosis, depending on the age and duration of the underlying disease.

Too young to be vaccinated: hospitalizations caused by varicella among children in the first year of life

AimThe aim of this study was to analyse the causes of hospitalization in the course of varicella in children during the first year of life. MethodsAn analysis was performed of the medical documentation of 359 children hospitalized for varicella on the infectious diseases ward at the Children’s Hospital in Poznan (Poland) between January 2007 and August 2015. ResultsOf the 359 children in the study group, 96 were younger than 1 year old. The most common cause of hospitalization was respiratory infections, found in 31 (32%) children. A severe course of varicella was observed in 38 (14%) children, and 21 (22%) developed skin infections, while 11 (11%) exhibited more than one complication. Treatment with acyclovir was implemented in 90 cases and parenteral antibiotic therapy was applied in 49 children. Contact with siblings suffering from varicella was confirmed in 46 children; for 16, the source of the infection was the mother. ConclusionsThe main source of varicella virus among hospitalized children in the first year of life is home contact. An infant may become infected from its mother suffering from zoster. Children who are exclusively breastfed and are born of mothers who have previously had varicella may develop varicella with a severe course during the first year of life.

Clinical course and therapeutic approach to varicella zoster virus infection in children with rheumatic autoimmune diseases under immunosuppression.

BackgroundTo analyze the clinical presentation and complications of varicella zoster virus (VZV) infection in children with rheumatic diseases treated with immunosuppressive medication such as biological disease-modifying antirheumatic drugs (bDMARDs) and/or conventional disease-modifying antirheumatic drugs (cDMARDs), and to analyze the therapeutic approach to VZV infections with respect to the concomitant immunosuppressive treatment.MethodsRetrospective multicenter study using the Swiss Pediatric Rheumatology registry. Children with rheumatic diseases followed in a Swiss center for pediatric rheumatology and treated with cDMARD and/or bDMARD with a clinical diagnosis of varicella or herpes zoster between January 2004 and December 2013 were included.ResultsTwenty-two patients were identified, of whom 20 were treated for juvenile idiopathic arthritis, 1 for a polyglandular autoimmune syndrome type III, and 1 for uveitis. Of these 22 patients, 16 had varicella and 6 had herpes zoster. Median age at VZV disease was 7.6 years (range 2 to 17 years), with 6.3 years (range 2 to 17 years) for those with varicella and 11.6 years (range 5 to 16 years) for those with herpes zoster. The median interval between start of immunosuppression and VZV disease was 14.1 months (range 1 to 63 months). Two patients had received varicella vaccine (1 dose each) prior to start of immunosuppression. Concomitant immunosuppressive therapy was methotrexate (MTX) monotherapy (n = 9) or bDMARD monotherapy (n = 2), or a combination of bDMARD with prednisone, MTX or Leflunomide (n = 11). Four patients experienced VZV related complications: cellulitis in 1 patient treated with MTX, and cellulitis, sepsis and cerebellitis in 3 patients treated with biological agents and MTX combination therapy. Six children were admitted to hospital (range of duration: 4 to 9 days) and 12 were treated with valaciclovir or aciclovir.ConclusionThe clinical course of varicella and herpes zoster in children under immunosuppression is variable, with 4 (18 %) of 22 children showing a complicated course. Thorough assessment of VZV disease and vaccination history and correct VZV vaccination according to national guidelines at diagnosis of a rheumatic autoimmune disease is essential to minimize VZV complications during a later immunosuppressive treatment.

Acute appendicitis, a rare complication of varicella: A report of three cases

Acute appendicitis is a very rare complication of varicella, and is rarely reported in studies of complications of varicella or appendicitis. This report describes three cases of acute appendicitis in the course of varicella, diagnosed in Clinical Department of Infectious Diseases at Split University Hospital, Croatia between 1998 and 2010. Varicella was diagnosed clinically, and in two cases confirmed by positive serological tests for varicella-zoster virus (VZV). In addition to routine histopathological examination, testing for viral antigens or DNA in the appendix, omentum and peripheral blood by genetic and immunohistochemistry methods may be important to confirm whether VZV and appendicitis are etiopathogenetically connected.

How frequent is varicella-associated pneumonia in children?

Varicella is a frequent though mild infection in children, but it can cause important morbidity in adults. The most frequent complication in adults is varicella pneumonia. However, lower airway complications associated to varicella have been scarcely studied in children. We retrospectively reviewed the clinical records of the children hospitalized for varicella-associated pneumonia in the three public hospitals on the Island of Mallorca. We discovered that 17/213 (8%) children hospitalized for varicella were diagnosed of pneumonia. The rate of hospitalization for varicella complication due to pneumonia was 4.3 cases per 10,000 varicella infections. Only one patient was diagnosed of varicella pneumonia, which accounts for 0.3 cases per 10,000 varicella infections. Nine of 17 (53%) cases were classified as bacterial pneumonia. Statistical differences (p < 0.05) in the median time from rash (5.9 vs. 2.4days) and fever (4.1 vs. 2.2 days) to admission were observed between bacterial and viral pneumonia. However, outcome differences measured by the median length of stay, need for oxygen, and admission to the intensive care unit were not observed. Varicella pneumonia is a very rare complication of varicella in children. Most of the lower airway infections in the course of varicella are associated to other co-infections.

S. Pyogenes invasive disease in a paediatric hospital: 1996-2009.

S. pyogenes is among the most common bacteria in Pediatrics, and is associated with a wide variety of infections and large range of severity. The aim was to evaluate trends of Group A Streptococcal invasive disease in a paediatric tertiary hospital. Retrospective analyses of the medical records of all children with group A streptococcal invasive disease (positive culture obtained from sterile sites), from January 1996 to December 2009 (14 years). There were 24 cases, with a maximum of four cases/year. Eighteen cases (75%) ocurred in the second half of the study. Sixty-seven percent were boys and the median age was three years. The most frequent clinical manifestations were fever (79%), rash (54%) and arthalgia/limbs' pain (46%). The diagnoses were bacteriemia (six), osteoarticular infection (five), celulitis (three), pyomyositis, mastoiditis, surgical wound infection, toxic shock syndrome (two each), necrotizing fasciitis and pneumonia (one each). Four cases occurred during the course of varicella. Other risk factors were present in six cases. Median neutrophyl count was 10.690 x 105/L (2.013-19.180 x 105/L) and median C reactive protein was 146 mg/L (3-425 mg/L). Bacteria were isolated mainly from blood (71%). The outcome was good for most cases but there were two deaths due to toxic shock syndrome. M typing and the presence of virulence factors genes were not assessed. Although the number is small, there was an increase of S. pyogenes invasive disease in the second half of the study. Several cases occurred in the course of varicela or in the presence of other risk factors. Fatal outcome was associated with two toxic shock syndrome cases. Microbiological investigation is essential to understand which M types or virulence factors genes are involved.

Empyema caused by optochin sensitive Streptococcus mitis in the course of varicella

in a child, acase not reported earlier to our knowledge.A previously healthy 5-year-old boy with varicellainfection presented seven days later to our emergencydepartment with high grade fever, productive cough,dyspnoea and mild swelling of left side of chest. Onadmission, he had signs of respiratory distress, poorperfusion and severe dehydration. He was pale anddyspnoeic, with a temperature of 41.2°C.The PaO

Absence of Circulating Natural Killer and Primed CD8+Cells in Life‐Threatening Varicella

Five pediatric patients with no history of immunodeficiency had a life-threatening course of varicella. Strikingly, natural killer (NK) cells were absent from the circulation in all children, and, despite active viral infection, up to 98% of the CD8(+) cells were naive. Primary immunodeficiencies were excluded--NK cells and primed CD8(+) cells reappeared in the circulation, granzymes were detectable in plasma early during infection, and no abnormalities could be detected in interleukin-15 receptor function. Our data indicate that varicella-zoster virus (VZV) has a unique capability to seclude primed CD8(+) cells and NK cells from the circulating lymphocyte pool. This may be the consequence of an overwhelming immune response to VZV that is influenced by factors such as infectious dose, age, and the presence of maternal antibodies during infancy. Because both homozygous twin sisters in the study had a severe course of varicella, particular genetic factors may contribute to severe varicella.

Current pharmacological approaches to the therapy of varicella zoster virus infections: a guide to treatment.

Varicella zoster virus (VZV), a member of the herpesvirus family, is responsible for both primary (varicella, chickenpox) as well as reactivation (zoster, shingles) infections. In immunocompetent patients, the course of varicella is generally benign. For varicella zoster, post-herpetic neuralgia is the most common complication. In immunocompromised patients (particularly those with AIDS), transplant recipients and cancer patients, VZV infections can be life-threatening. For these patients and also for immunocompetent patients at risk such as pregnant women or premature infants, the current treatment of choice is based on either intravenous or oral aciclovir (acyclovir). The low oral bioavailability of aciclovir, as well as the emergence of drug-resistant virus strains, have stimulated efforts towards the development of new compounds for the treatment of individuals with VZV infections. Among these new compounds, penciclovir, its oral prodrug form famciclovir and the oral pro-drug form of aciclovir (valaciclovir), rank among the most promising. As with aciclovir itself, all of these drugs are dependent on the virus-encoded thymidine kinase (TK) for their intracellular activation (phosphorylation), and, upon conversion to their triphosphate form, they act as inhibitors/alternative substrate of the viral DNA polymerase. Therefore, cross-resistance to these drugs may be expected for those virus mutants that are TK-deficient and thus resistant to aciclovir. Other classes of nucleoside analogues dependent for their phosphorylation on the viral TK that have been pursued for the treatment of VZV infections include sorivudine, brivudine, fialuridine, fiacitabine and netivudine. Among oxetanocins, which are partially dependent on viral TK, lobucavir is now under clinical evaluation. Foscarnet, which does not require any previous metabolism to interact with the viral DNA polymerase, is used in the clinic when TK-deficient VZV mutants emerge during aciclovir treatment. TK-deficient mutants are also sensitive to the acyclic nucleoside phosphonates (i.e. [s]-1-[3-hydroxy-2-phosphonylmethoxypropyl]cytosine; HPMPC); these agents do not depend on the virus-encoded TK for their phosphorylation but depend on cellular enzymes for conversion to their diphosphoryl derivatives which then inhibit viral DNA synthesis. Vaccination for VZV has now come of age. It is recommended for healthy children, patients with leukaemia, and patients receiving immunosuppressive therapy or those with chronic diseases. The protection induced by the vaccine seems, to some extent, to include zoster and associated neuralgia. Passive immuniatin based on specific immunoglobulins does not effectively prevent VZV infection and is therefore restricted to high risk individuals (i.e. immunocompromised children and pregnant women).

Reliability of a History of Previous Varicella Infection in Adults

Apparent second episodes of varicella are reported in immunocompetent hosts, but laboratory confirmation of prior immune status has rarely been possible. To evaluate adult patients with varicella who claimed to have had previous varicella to determine whether they had true second episodes or primary cases with inaccurate clinical histories. Adult subjects with varicella who enrolled in an antiviral treatment trial were interviewed about a history of varicella. The clinical course of varicella was documented prospectively in all subjects. Serum samples that predated the acute illness were obtained from the US Navy's central serum storage facility for subjects who reported a previous episode of varicella. These stored samples were tested in parallel by enzyme-linked immunosorbent assay, latex agglutination, and Western blot for IgG antibodies to varicella-zoster virus (VZV). Twenty military personnel with varicella and a history of the disease. A military hospital in San Diego, Calif. Presence or absence of antibodies to VZV. Twenty (10.8%) of 184 adults with serologically confirmed acute varicella reported a prior history of varicella. The clinical course of these 20 patients did not differ from those with no history of varicella. Serum samples that had been collected a mean of 12.4 months (median, 12 months; range, 3 days to 34 months) before the incident episode were available for 19 subjects. All 19 serum samples lacked IgG antibodies to VZV. A history of previous varicella infection in adults with varicella may not be reliable. True second episodes of varicella are probably rare in immunocompetent adults.

Comparison of the antiviral efficacy of acyclovir and penciclovir in topically treated HSV-infected HRS/J mice: D.W. Selleseth. Wellcome Research Laboratories, Research Triangle Park, North Carolina, U.S.A.

Varicella zoster virus (VZV), a member of the herpesvirus family, is responsible for a primary infection (varicella, chickenpox) as well as a recurrent disease (zoster, shingles). The course of varicella is generally benign in immunocompetent patients. For zoster, post-herpetic neuralgia is the most common complication. In immunocompromised patients, particularly patients suffering from the acquired immune deficiency syndrome (AIDS), transplant recipients and cancer patients, VZV infections can be life-threatening. For these patients and also for immunocompetent patients at risk, such as pregnant women or premature infants, the current treatment of choice is based on acyclovir (ACV) by either intravenous or oral route. The low oral bioavailability of ACV, as well as the emergence of drug-resistant virus strains, have stimulated efforts towards the development of new compounds for the treatment of VZV infections. Among these new compounds, penciclovir (PCV) and its oral prodrug form, famciclovir (FCV), 882C87, BVDU, BVaraU and the oral prodrug form of acyclovir (valacyclovir) rank among the most promising. Like ACV itself, all these drugs are dependent on the virus-encoded thymidine kinase (TK) for their intracellular activation (phosphorylation), and, therefore, cross-resistance to these drugs may be expected for those virus mutants that are TK-deficient and thus resistant to ACV. However, such TK− VZV mutants are still sensitive to the acyclic nucleoside phosphonates (i.e. HPMPC), which for their phosphorylation do not depend on the virus-encoded TK. The molecular targets within the viral replicative cycle, with which these different compounds interact, are discussed, as are the in vitro activity and in vivo efficacy of the most promising compounds. Other aspects, such as vaccination and passive immunization, are briefly mentioned.

Chemotherapy of varicella zoster virus infections

Varicella zoster virus (VZV), a member of the herpesvirus family, is responsible for a primary infection (varicella, chickenpox) as well as a recurrent disease (zoster, shingles). The course of varicella is generally benign in immunocompetent patients. For zoster, post-herpetic neuralgia is the most common complication. In immunocompromised patients, particularly patients suffering from the acquired immune deficiency syndrome (AIDS), transplant recipients and cancer patients, VZV infections can be life-threatening. For these patients and also for immunocompetent patients at risk, such as pregnant women or premature infants, the current treatment of choice is based on acyclovir (ACV) by either intravenous or oral route. The low oral bioavailability of ACV, as well as the emergence of drug-resistant virus strains, have stimulated efforts towards the development of new compounds for the treatment of VZV infections. Among these new compounds, penciclovir (PCV) and its oral prodrug form, famciclovir (FCV), 882C87, BVDU, BVaraU and the oral prodrug form of acyclovir (valacyclovir) rank among the most promising. Like ACV itself, all these drugs are dependent on the virus-encoded thymidine kinase (TK) for their intracellular activation (phosphorylation), and, therefore, cross-resistance to these drugs may be expected for those virus mutants that are TK-deficient and thus resistant to ACV. However, such TK − VZV mutants are still sensitive to the acyclic nucleoside phosphonates (i.e. HPMPC), which for their phosphorylation do not depend on the virus-encoded TK. The molecular targets within the viral replicative cycle, with which these different compounds interact, are discussed, as are the in vitro activity and in vivo efficacy of the most promising compounds. Other aspects, such as vaccination and passive immunization, are briefly mentioned.

Postvaricella Suppurative Meningitis

Suppurative meningitis should be recognized as being a complication of varicella. The clinician must assiduously exclude suppurative meningitis that at times may be clinically indistinguishable from the typical postinfectious encephalomyelitis of varicella. Misdiagnosis of the cause of CNS alterations during the course of varicella is possible.

Viremia Caused by Varicella-Zoster Virus: Association with Malignant Progressive Varicella

Three groups of patients were evaluated to determine the relation between viremia caused by varicella-zoster virus and the type of varicella course the patient had. The groups were: (1) children with varicella who had no known underlying disease, who were not receiving immunosuppressive therapy, and who had a typical course of varicella (normal children); (2) children who were considered to be at risk of developing progressive varicella because of preexisting disease or because they were receiving immunosuppressive therapy and who had a typical course of varicella; and (3) patients who were at risk of developing progressive varicella and who had a progressive varicella course. Viremia in association with exanthem occurred in patients who had a progressive varicella course, but it was not observed, either during incubation or exanthem, in normal children or in patients at risk of progressive infection who had a typical varicella course. The viremia was cell-associated in three patients.

Fatal Graft-Versus-Host Disease After a Small Leukocyte Transfusion in a Patient With Lymphoma and Varicella

A child with a poorly differentiated lymphoma developed varicella while being treated with maintenance chemotherapeutic agents. He received a transfusion of nonirradiated leukocytes from 1 unit of whole blood donated by a healthy volunteer who had recently recovered from varicella. The clinical course of varicella was aborted, but a classic graft-versus-host reaction developed and ultimately proved fatal. The host may have presented a large population of antigen-bearing cells to an infusion of presensitized immunocompetent donor cells, leading to an overwhelming aggressor lymphocyte reaction. We speculate that a modified approach using irradiated donor cells could be of benefit in the treatment of varicella infections in the immunosuppressed host.

VARICELLA-ZOSTER VIREMIA: ASSOCIATION WITH PROGRESSIVE VARICELLA

In retrospect, progressive varicella (the clinical involvement of organ systems other than the skin, the prolonged appearance of vesicles, or clinically significant hemorrhage) is usually not difficult to distinguish from typical varicella. However this often fatal complication of varicella is difficult to anticipate even in children at high risk. During the course of varicella, viral culture of buffy coats in human fibroblast tissue cultures were performed on 13 normal children and 15 children at risk of developing progressive varicella. Eight patients who developed progressive varicella had viremia in association with exanthem whereas no child who had a typical varicella course demonstrated viremia. In 6 patients with a progressive course, viremia was present prior to the clinical appreciation of a progressive course of the varicella infection. The viremia appeared to be cell-associated and thus may be amenable to rapid diagnosis by immunofluorescence or electron microscopy. The documentation of viremia preceeding the clinical manifestations of progressive varicella infection may allow the early recognition of those children in whom antiviral therapy may be beneficial.