Diagnosis Of Varicella Research Articles

Economic burden of varicella in Bangkok, Thailand: A multicenter medical chart review study.

Our multicenter, medical chart review, cost-of-illness study used a micro-costing approach to evaluate the economic burden associated with varicella in Bangkok, Thailand, from a societal perspective. We reviewed medical charts of adults and children with a primary diagnosis of varicella (2014-2018) from 4 hospitals in Bangkok. Reported healthcare resource utilization and missed school or workdays were extracted from medical charts. Mean direct, indirect, and total costs per patient were estimated for overall, adult, and pediatric patients (2020 USD). Of the 200 children and 60 adults, 99.6%, 5.4%, and 5.4% had a varicella-related outpatient visit, emergency department visit, and hospitalization, respectively. The mean direct medical cost was 33 USD for pediatric and adult patients. The mean cost of outpatient visits (8 vs 13 USD, P<0.001) and medications (7 vs 9 USD, P<0.001) was significantly lower among pediatric patients. Forty-eight children reported a mean of 5.8 school days lost, and 32 adult patients reported a mean of 7.4 workdays lost. The mean total cost per varicella patient was 89 USD, with the mean total cost higher for adult than pediatric patients (145 vs 72 USD, P<0.001). Indirect cost accounted for 63% of the total cost per patient (54% for pediatric patients and 77% for adult patients). There is a substantial economic burden associated with patients seeking varicella-related healthcare in Thailand, including considerable indirect costs.

THE LONG ARM OF COVID-19

Chickenpox is often described as a benign disease. However, patients with varicella and coinfection with COVID-19 may develop severe respiratory infection. The interest in the presented case arose from the unusual fast progress of the chickenpox which led to a lethal outcome in a patient with unsuspected COVID-19, proven by PCR after his death. The underlying disease – cancer of the tongue was in remission and wasn’t a cause for immunosuppression which could be a reason for the clinical course of the disease. Aim: To present an interesting case of a 44-year-old man with a previous diagnosis of oral cancer who died after he was diagnosed with varicella and tested positive postmortem for COVID-19. Patient and method: A 44-year-old patient was admitted to the hospital urgently and stayed for 3 and a half hours in the clinic of infectious diseases of UMHAT "St. George", Plovdiv, with a diagnosis of varicella. The patient has accompanying diseases like oral cancer (root of the tongue) and hypertension. Epidemiological data are for contact and fresh infection with varicella, progressing rapidly and beginning of symptoms of respiratory insufficiency and lethal outcome. Due to the fulminant course and the short period of time, the positive PCR result for COVID-19 was proved after the patient died. Conclusions: Unsuspected comorbidity of COVID-19 and varicella without any other reason for immunosuppression could induce unusual severe course of the chickenpox.

Purpura Fulminans Secondary to Varicella-Zoster Virus Infection

Background. Purpura fulminans (PF) is a rare, life-threatening condition involving consumptive coagulopathy and intravascular thrombosis, causing purpura and necrosis in the skin and soft tissue. Case Report. A 4-year-old Tajik girl with PF secondary to varicella-zoster virus (VZV) infection presented with purplish red, diffuse, painful lesions localized to the entire right leg. Her vaccination status was unknown, and she did not have concurrent chronic illness. Ten days before admission, the girl was admitted to another hospital in Tajikistan with a diagnosis of chickenpox and PF. She was then transferred to the hospital of the authors of the current report due to the enlargement of lesions to the gluteal region, a change in the color of lesions from red to black, and the detection of arterial thrombosis via Doppler ultrasonography. Multiple surgical debridements were performed to manage tissue necrosis, and the patient’s right leg was amputated at the 18th week of admission. The patient was discharged after 26 weeks of hospitalization. Conclusion. Although VZV infections mostly cause mild and self-limiting eruptive disease, they can progress, with life-threatening complications, including PF. To prevent VZV infection and resulting complications, immunization with live attenuated vaccines and maintaining population immunity above a certain threshold are the most important strategies to prevent the circulation of the virus.

The Clinical and Economic Burden of Antibiotic Use in Pediatric Patients With Varicella Infection: A Retrospective Cohort Analysis of Real-World Data in England.

Varicella is a highly infectious disease, particularly affecting children, that can lead to complications requiring antibiotics or hospitalization. Antibiotic use for varicella management is poorly documented. This study assessed antibiotic use for varicella and its complications in a pediatric population in England. Data were drawn from medical records in the Clinical Practice Research Datalink and Hospital Episode Statistics data sets. The study included patients <18 years old with varicella diagnosed during 2014-2018 and 3-month follow-up available. We determined varicella-related complications, medication use, healthcare resource utilization, and costs from diagnosis until 3 months after diagnosis. We identified 114 578 children with a primary varicella diagnosis. Of these, 7.7% (n = 8814) had a varicella-related complication, the most common being ear, nose, and throat related (37.1% [n = 3271]). In all, 25.9% (n = 29 706 of 114 578) were prescribed antibiotics. A higher proportion of patients with complications than without complications were prescribed antibiotics (64.3% [n = 5668 of 8814] vs 22.7% [n = 24 038 of 105 764]). Mean annualized varicella-related costs were £2 231 481 for the study cohort. Overall, antibiotic prescriptions cost approximately £262 007. This study highlights high antibiotic use and healthcare resource utilization associated with varicella management, particularly in patients with complications. A national varicella vaccination program in England may reduce varicella burden and related complications, medication use, and costs.

Laryngeal carcinoma with hemorraghic varicella : a rare case report

Background : Hemorrhagic varicella is a complication that usually occurs in patients with immune disorders or those on immunosuppressive therapy or hematologic malignancies such as leukemia. Purpose: This case report aimed to further examine the complications of a rarely found hemorrhagic varicella in neck head malignancies / laryngeal carcioma. Case report : This is a case report of laryngeal carcinoma with hemorrhagic varicella in a 44-year-old man. Examination of dermatological status revealed hemorrhagic, polymorphic vesicles, generalized pustular psoriasis, erosion and, crusting. Tzanck test of the scrapes of the base of lesion of the vesicles is helpful in establishing the diagnosis of varicella and discovered multinucleated giant cells (MGCs) and epithelial cells with acidophilic intranuclear inclusion bodies The patient died after 3 days of treatment in the isolation room. A previous study also reported cases of hemorrhagic varicella in a 3-year-old girl with the main complaint of pus-filled red spots throughout the body. A previous history of chickenpox was denied. The physical examination showed dark red, polymorphic lession, generalized pustular psoriasis, erosion and crusting. Hemorrhagic varicella in the head and neck malignancy is a very rare form of varicella. Clinical question: In patient with immunocompromised during chemotheraphy suffer from varicella, is it necessary to have a comprehensive diagnostic examination panel, and therapy? Review methods: Evidence-based literature search with keywords “immunocompromised” AND “Hemorrhagic varicella” was performed through Cochrane, PubMed and Medline database. Result : The literature search obtained 318 articles in PubMed, 11 articles in Medline,and none in Cochrane, which were relevant with the topic. Only 1 article screened with inclusion and exclusion criteria. A research was conducted by Elizabeth et al in Philipina (2011) on Pediatric Infectious Disease and Hematology-Oncology Services. Out of 26 immunocompromised patients who developed varicella during the study period, only 22 charts were available for review. Of these patients, 13 were male and 9 were female. The highest incidence occurred from 0 to 5 years old (41%). Twenty patients had an underlying malignancy in the form of leukemia (14%) and solid organ tumors (6%) including nasopharyngeal cancer. Diagnosis based on the characteristic generalized papulovesicular rashConclusion : This requires a comprehensive diagnostic panel test for the delivery of appropriate therapy and improved outcome.

Syndrome of Inappropriate Antidiuretic Hormone Secretion - A Rare Initial Presentation of Lyme Neuroborreliosis (P9-10.005)

<h3>Objective:</h3> NA <h3>Background:</h3> Lyme disease is the most common vector-borne disease in the northern hemisphere. Lyme neuroborreliosis can be diagnostically challenging due to its diverse manifestations. Early disseminated stage may exhibit a neurological spectrum that includes cranial neuropathy, radiculoneuritis, and lymphocytic meningitis. Cranial neuropathy is a typical initial manifestation. We present a case of Lyme neuroborreliosis with SIADH and thoracic radiculopathy as a first presentation followed by cranial neuropathy. <h3>Design/Methods:</h3> NA <h3>Results:</h3> <h3>Case Report:</h3> A 66-year old man with past medical history of laryngeal cancer status post radiation presented with band-like pain across the right chest and abdomen in July 2021. Lab workup revealed hypotonic hyponatremia (119 mmol/L). It was thought to be multifactorial due to SIADH and the use of hydrochlorothiazide. It was managed with fluid restriction. The patient was also treated for a presumed diagnosis of varicella without rash. Five days later, he returned with a right facial droop and right vision changes. Examination showed peripheral right facial weakness. A repeat lab workup revealed hypotonic hyponatremia (123mmol/L). He was diagnosed with SIADH. MRI brain and orbit were consistent with right cranial nerve VII enhancement. The Lyme antibody panel was positive. He was retrospectively diagnosed with thoracic radiculoneuritis in the setting of Lyme disease. Ultimately, he was treated with doxycycline and discharged home. <h3>Conclusions:</h3> Lyme neuroborreliosis rarely presents with SIADH and thoracic radiculoneuritis as the first manifestation. This case further adds to the growing evidence of the association of Lyme neuroborreliosis with SIADH. The mechanism of this phenomenon remains unclear; likely related to the inflammation cascade induced by CNS infection. Prompt recognition is critical for timely diagnosis and treatment. <b>Disclosure:</b> Dr. Singh has nothing to disclose. Dr. Zahra has nothing to disclose. Dr. Chu has nothing to disclose. Dr. Kokash has nothing to disclose. Dr. Varrato has nothing to disclose.

Antimicrobial use for the management of varicella in Thailand: a retrospective observational study

Objective To describe the clinical characteristics of varicella patients seeking medical consultation and the use of antimicrobials for their management in Thailand in the absence of universal varicella vaccination (UVV). Methods A multicenter, retrospective chart review of 260 children and adults with a primary diagnosis of varicella was conducted at one private and three public hospitals in Bangkok, Thailand. Charts of varicella patients (inpatient or outpatient) were randomly selected over a 5-year period. Key outcomes included clinical complications and the use of antibiotics, antivirals, and other medications. Results Charts of 200 children (mean age 5.7 years, range 0.3–16 years) and 60 adults (mean age 27.9 years, range 18–50 years) were reviewed. Fourteen patients (including 8 children) were hospitalized. Five percent of the children and none of the adults were immunocompromised. At least 1 varicella-related complication was reported by 7.3% (7% of children, 8.3% of adults, p = .778) of all patients, including 57.1% (62.5% of children, 50% of adults) of inpatients (p < .001, compared with outpatients). Skin/soft tissue infection (47.7%) and dehydration (47.4%) were the most common complications. Antivirals (mainly oral acyclovir) were prescribed to 46.5% of patients (31.5% of children, 96.7% of adults, p < .001). Antibiotics were prescribed to 20.8% of patients (19% of children, 26.7% of adults, p = .199). Topical, oral, and intravenous antibiotics were prescribed to 12.3%, 8.5%, and 1.2% of patients, respectively. Antimicrobial prescriptions were higher among adults (p < .001) and immunocompromised patients (p = .025). Apart from antimicrobials, acetaminophen (62.3%) and oral antihistamines (51.5%) were the most prescribed. Conclusion A considerable number of varicella patients, both children and adults, seeking medical consultation in Thai hospitals are prescribed antibiotics and antivirals, with one-fifth of patients being prescribed an antibiotic and almost half prescribed an antiviral. The study may be of interest to policymakers in Thailand and other Asia-Pacific countries considering UVV implementation.

Analysis of the reliability of rapid diagnostic tests for varicella, including breakthrough cases.

In the era of universal varicella vaccination, diagnosis of varicella is challenging, especially for breakthrough cases. We sought to clarify the reliability of direct varicella-zoster virus (VZV) loop-mediated isothermal amplification (LAMP) and DermaQuick® VZV using the immunochromatography technique as rapid diagnostic tests for varicella. In addition, the usefulness of saliva as a sample type for direct LAMP was investigated. Among the 46 enrolled patients with suspected VZV infection, 31 patients (67.3%) were positive for the nucleic acid test based on real-time PCR from skin swab samples. Direct LAMP of skin swabs was positive in 29 (63.0%) of 46 patients. DermaQuick® VZV was positive in 25 (54.3%) of 46 patients. VZV DNA was detected in only 48.4% of oral swabs with the direct LAMP method. With real-time polymerase chain reaction (PCR) as the standard for diagnosing varicella, the sensitivity and specificity of DermaQuick® VZV were 80.7% and 100%, respectively. The sensitivity and specificity of direct LAMP from skin swabs were 93.6% and 100%, respectively. The sensitivity and specificity of real-time PCR for DNA extracted from oral swabs were 74.2% and 93.3%, respectively. Thus, oral swab samples are not suitable for breakthrough varicella diagnosis. Although DermaQuick® VZV is considered the most convenient point-of-care test for varicella, its sensitivity and specificity were lower than those of direct VZV LAMP.

372. Analysis of the reliability of rapid diagnostic tests for varicella patients, including breakthrough cases

Abstract Background In the era of universal varicella vaccination, diagnosis of varicella is challenging, especially for breakthrough cases. We sought to clarify the reliability of direct varicella-zoster virus (VZV) loop-mediated isothermal amplification (LAMP) and DermaQuick® VZV using the immunochromatography technique as rapid diagnostic tests for varicella. In addition, the usefulness of saliva as a sample type for direct LAMP was also investigated. Methods Between April 2019 and January 2021, 46 patients suspected VZV infection were enrolled in this study. Written informed consent was obtained from the parents of all participants. This study was approved by the institutional review board of Fujita Health University (No. 15–247). Samples were collected from skin eruptions using two different swabs. one swab which was soaked in 1 mL of isotonic saline was used for direct VZV LAMP and the other swab which was immersed in 500 µL of DermaQuick® VZV reaction buffer was used for DermaQuick® VZV. The isotonic saline solution used to wash the oral swab sample was used for direct VZV LAMP. The DNA extracted from the solutions were used for real-time PCR analysis. Results Thirty one patients (67.3%) were diagnosed with varicella based on real-time PCR of skin swabs. Direct LAMP of skin swabs was positive in 29 (63.0%) of 46 patients. DermaQuick® VZV was positive in 25 (54.3%) of 46 patients. The sensitivity for direct LAMP of skin swabs, DermaQuick® VZV, direct LAMP of oral swabs, and real-time PCR of oral swabs was 93.6% (95% confidence interval [CI], 79.3–98.9%), 80.7% (95% CI, 63.7–90.8%), 48.3% (95% CI, 32.0–65.1%), and 74.2% (95% CI, 56.8–86.3%), respectively. The sensitivity and specificity of real-time PCR for DNA extracted from oral swabs was 74.2% (95% CI, 56.8–86.3%) and 93.3% (95% CI, 79.8–99.7%), respectively. Conclusion Although DermaQuick® VZV is the most convenient point-of-care test for varicella, the sensitivity and specificity of this method were slightly lower than those of direct VZV LAMP. Disclosures All Authors: No reported disclosures.

Clinical Manifestations of Varicella: Disease Is Largely Forgotten, but It's Not Gone.

After 25 years of varicella vaccination in the United States, classic varicella and its complications have become an uncommon occurrence. The clinical manifestation of varicella among vaccinated persons is usually modified, with fewer skin lesions, mostly maculopapular, and milder presentation. However, the potential for severe manifestations from varicella still exists among both vaccinated and unvaccinated persons, and thus healthcare providers should keep varicella in the differential diagnosis of a maculopapular or vesicular rash. The prompt recognition and diagnosis of varicella is important because when confirmed, clinical and public health measures need to be taken swiftly.

A case of chickenpox with multiple bacterial complications requiring surgical treatment

Chickenpox is a controlled infection, even a single vaccination effectively prevents the development of severe forms (up to 98%).Purpose — to demonstrate a case of severe chicken pox in a child aged 3.8 years with secondary infection of the skin of the right subscapular region and subcutaneous fat (phlegmon of the trunk) of streptococcal etiology.The diagnosis of varicella was confirmed by the detection of Varicella-Zoster virus DNA by PCR from the skin. Surgical treatment was performed — opening and drainage of phlegmon, purulent-serous discharge was obtained, sowing was performed, Streptococcus pyogenes was isolated.The child received antibiotic therapy — cefepime sulbactam, amikacin, acyclovir, infusion therapy, local treatment.Conclusions. The given clinical case demonstrates the development of a severe bacterial complication of chicken pox, which required surgical treatment and substantiates the need for vaccination against chicken pox and its possible complications.

Gene Polymorphism of Toll-Like Receptors in Chickenpox Patients: Observational Cohort Study

Background. Toll-like receptors (TLR) play a key role in the innate immune system, as they are the fi rst to recognize a foreign agent and initiate the human body defense mechanism. At present, the role of toll-like receptors in predicting infectious diseases requires further investigation.Objectives. To study TLR3 (Phe412Leu), TLR9 (A2848G) and TLR9 (T1237C) polymorphisms in healthy individuals and chickenpox patientsMethods. An observational cohort study involved 201 conscripted soldiers of Caucasian race, aged between 18 and 24, who was born in) and served in Zabaykalsky Krai. All of them agreed to participate voluntarily. The main group was represented by 105 males who received treatment at a military hospital with a diagnosis of chickenpox in 2019. The control group consisted of 96 healthy conscripts. The study was carried out on the basis of Chita State Academy of Medicine, Russia, and included a physical examination, anthropometry, determination of SNP genes by PCR. Amplifi cation of TLR3 and TLR9 gene fragments was carried out by means of thermocycler BIS-М111. IBM SPSS Statistics 25.0 (International Business Machines Corporation, License No. Z125-3301-14, USA) was used for statistical processing of the results.Results. A total of 354 people were screened, 87 of them did not meet the inclusion criteria and 19 refused to participate in the study. 134 males were excluded in the process, 47 of which appeared to have an exacerbation of chronic diseases, 21 were not of Caucasian race, 64 were not born in Zabaykalsky Krai, and 2 did not meet the age criteria. Totally, the study included 201 conscripted soldiers. The study groups were established as follows: chickenpox patients (n = 105) and healthy individuals (controls, n = 96). The -412Leu allele was 1.8 times less frequent in the chickenpox group, with a frequency of 0.138, compared with 0.250 in healthy controls (Ȥ 2 = 8.11; p = 0.004). In the main group, allele -412Phe prevailed with a frequency of 0.862, whereas in the control group its frequency was 0.750 (χ2 = 8.11; p = 0.004). In patients group, the genoype Phe412Phe prevailed (75.2%), the genotype Leu412Leu was less common — 2.9% (Ȥ 2 = 7.09; p = 0.03). In the group of healthy individuals, the distribution of genotypes was as follows: Phe412Phe — 60.4%, Phe412Leu — 30.2%, Leu412Leu — 9.4% (Ȥ 2 = 7.09; ɪ = 0.03). Carriers of allele -412Phe (OR = 2.08 [CI95%: 1.25–3.47]) and genotype Phe412Phe (OR = 2.08 [CI95%: 1.14–3.80]) are more likely to develop chickenpox. The probability of developing the disease for persons having the major allele A of the genotype TLR9 (Ⱥ2848G) is 0.29 [CI95%: 0.19– 0.43], for individuals with the mutant allele G of the genotype TLR9 (Ⱥ2848G) — 3.50 [CI95%: 2.32–5.29]. The prevalence of TLR9 (T1237C) in the main group was not signifi cantly different from that in the control group (p &gt; 0.05). The probability of developing the disease for persons having the major allele A is 0.29 [95% CI 0.19–0.43], for carriers of the mutant allele G — 3.50 [95% CI 2.32-5.29]. When analyzing SNP TLR9 (A2848G), it was found that allele G prevailed with a frequency of 0.614, and allele A — with a frequency of 0.386, which is 1.9 times less than in the control group (Ȥ 2 = 36.67; p &lt; 0.001). In patients group, homozygotes AA were found in 9.5% of cases, heterozygotes AG — in 58.1%, the rest cases were homozygous variants GG (Ȥ 2 = 40.11; p &lt; 0.001). In the control group, all possible genotypes with a predominance of the heterozygous genotype AG were identifi ed and comprised 47.9%. When assessing the relative risk of gene variation associations connected with the development of chickenpox, we found that the polymorphism of genes TLR9 (A2848G) AG/GG increases the risk of the development of disease caused by varicella virus in the studied category by 3.4 times, and the polymorphism TLR3 (Phe412Leu) Phe/ Phe — by 1.42 times. The ROC analysis was carried out, the area under curve was 0.77 (95% CI0.70–0.83); p &lt; 0.001; specifi city — 0.62; sensitivity — 0.8. The developed model, being a relatively good identifi er, has satisfactory properties as a discriminator.Conclusion. Our study suggests that allele -412Phe and homozygous variant Phe412Phe of gene TLR3 (Phe412Leu), as well as allele G and homozygous variant GG of gene TLR9 (A2848G) predispose to chickenpox development. Meanwhile, the allele -412Leu of gene TLR3 (Phe412Leu), allele A, and homozygous variant AA of gene TLR9 (A2848G) reduce the probability of chickenpox development.

Neurological performance after central nervous system complication of childhood chickenpox

Varicella-zoster virus is an exclusively human pathogen of an acute exanthematous illness usually linked with childhood. Although the disease is commonly considered benign, varicella-zoster virus bears the potential of causing a wide range of different complications, including central nervous system manifestations. In this paper, an assessment of long-term sequelae and the quality of life in a cohort of patients with neurological complications who survived an acute episode is discussed. We enrolled a total of 71 patients aged two months to 16 years with the diagnosis of varicella complicated by central nervous system disease into the study. Data were collected after their discharge from the hospital by mail and by telephone call interviews using standardised questionnaires. The time from the discharge to the filling of the survey varied between the patients, with a median time of 5.4 years. The collected data were analysed, and the results were compared with the literature. The diagnosis of ischaemic stroke and encephalitis was linked to the most unfavourable outcome, as opposed to acute cerebellar ataxia associated with the most favourable prognosis. Neuropsychological performance should be further monitored to prevent a decrease of independence in everyday performance.

Assessing the use of antibiotics and the burden of varicella in Belgium using a retrospective GP database analysis

BackgroundVaricella is a highly contagious infection that typically occurs in childhood. While most cases have a generally benign outcome, infection results in a considerable healthcare burden and serious complications may occur.ObjectivesThe objective of this study was to characterize the burden of varicella in a real-world primary care setting in Belgium, including the rate of varicella-related complications, medication management and general practitioner (GP) visits.MethodsThe study was a retrospective observational study using data from a longitudinal patient database in a primary care setting in Belgium. Patients with a GP visit and a varicella diagnosis between January 2016 and June 2019 were eligible and data one month prior and three months after the diagnosis were included. Outcomes included varicella-related complications, antibiotic use, antiviral use, and GP follow-up visits. Antibiotic use could be specified by class of antibiotic and linked to a diagnosis. Complications were identified based on concomitant diagnosis with varicella during the study period.Results3,847 patients with diagnosis of varicella were included, with a mean age of 8.4 years and a comparable distribution of gender. 12.6% of patients with varicella had a concomitant diagnosis of a varicella-related complication. During the follow-up period, 27.3% of patients with varicella were prescribed antibiotics, either systemic (19.8%) and/or topical (10.3%). The highest rate of antibiotic prescriptions was observed in patients with complications (63.5%) and in patients younger than 1 year (41.8%). Nevertheless, 5.3% of the patients were prescribed antibiotics without a concomitant diagnosis of another infection. The most commonly prescribed systemic antibiotics were amoxicillin alone or combined with beta-lactamase inhibitor, and thiamphenicol. Fusidic acid and tobramycin were the most prescribed topical antibiotics. Antivirals were prescribed for 2.7% of the study population. 4.7% of the patients needed a follow-up visit with their GP.ConclusionsThis study reports a substantial burden of varicella in a primary care setting in Belgium, with high rates of complications and antibiotic use.

Застосування екстракту з листя Hippophae rhamnoides у терапії вітряної віспи в дітей

Актуальність. В Україні щороку на вітряну віспу хворіє близько 150 тис. дітей. При всіх формах вітряної віспи показане симптоматичне й підтримуюче лікування. Мета: оцінка ефективності й переносимості екстракту Hippophae rhamnoides (Еребра) в комплексній терапії вітряної віспи в дітей. Матеріали та методи. Дизайн дослідження: проспективне відкрите контрольоване. До дослідження залучались діти, які перебували на стаціонарному лікуванні з діагнозом «вітряна віспа» впродовж 2017–2018 рр. Пацієнти основної групи отримували в комплексній терапії вітряної віспи екстракт Hippophae rhamnoides, пацієнтам контрольної групи призначалась стандартна симптоматична терапія. Результати. Під спостереженням перебували 64 дитини, основну групу становили 34 пацієнти, контрольну групу — 30 пацієнтів. На фоні терапії в усіх пацієнтів спостерігалась позитивна динаміка клінічних симптомів. На 5-й день спостереження лихоманка частіше спостерігалась у групі контролю (23,5 % дітей основної групи й 50,0 % дітей контрольної групи, p &lt; 0,05 за критерієм χ2). Порушення загального стану на 3-й день спостереження відмічалось у 55,8 % дітей основної групи й 86,7 % хворих групи конт­ролю (p &lt; 0,05 за критерієм χ2). Висновки. Застосування препарату екстракту Hippophae rhamnoides у комплексній терапії в дітей із вітряною віспою прискорює нормалізацію клінічних симптомів. Препарат екстракту Hippophae rhamnoides має високий профіль безпеки й добре переноситься.

A knowledge based System for diagnosis of Varicella (Chickenpox) and Measles diseases in children at kindergarten age based on IOT

In childhood diseases, the varicella (chickenpox) and measles diseases considered an important condition. In this research we have designed and implemented an expert knowledge-based system utilizing IOT for early diagnosis of these diseases for children in kindergarten. The system was developed according to an object-oriented software engineering paradigm using UML tools. Also it developed based specific roles in web domain using IoT environment. Furthermore the system able to send a message contains all details on the infection type and description on the disease to the parents. This system can be used by kindergartens or parents as a domestic application for early diagnosis of the disease through the symptoms that appear on the affected child. The knowledge – based system was implemented using python 3.8. The results observe a significant response for detecting and diagnosis the Varicella (Chickenpox) and Measles diseases.

#6: Varicella Outbreak Investigation in a Cancer Hospital

Abstract Background Primary varicella infection is usually self-limited in immunocompetent hosts, whereas it can be quite severe in immunocompromised hosts. Atypical presentations of varicella in immunocompromised hosts can be diagnostically challenging, without laboratory testing. Varicella is an occupational hazard for susceptible healthcare providers (HCP). It assumes importance in infection prevention and control, due to the possibility of spread to other susceptible coworkers and patients. Methods This outbreak investigation report is from a 300-bed cancer care hospital in South India. A 62-year-old male patient with lymphoplasmacytic non-Hodgkin’s lymphoma was admitted on October 1 with features of bronchopneumonia and extensive skin lesions, 2 months after his last chemotherapy cycle. The patient was received in the emergency department (ED) and later shifted to the intensive care unit (ICU) due to worsening clinical condition. The clinical picture was more in favor of Stevens–Johnson syndrome, but oral acyclovir therapy was given considering a differential diagnosis of varicella. His condition deteriorated further requiring ventilator support and on the 19th day of admission, the patient succumbed to his illness and passed away. From October 14 to 19, eight HCP presented with vesicular eruptions and fever, clinically diagnosed as having varicella. This aroused the suspicion of an outbreak. An emergency outbreak control group meeting was convened to assess and address the situation. Results All outbreak cases were confirmed as varicella, clinically. Contacts, including patients assigned to HCP involved in the outbreak were traced, and their varicella immune status was assessed. Nonimmune contacts were given oral acyclovir prophylaxis as per CDC recommendations. Other HCP in the hospital were offered first dose of varicella vaccine based on their varicella immune status. With these infection prevention and control measures in place, no additional cases were identified. Being a hospital in low- to middle-income country, it was not routine practice to vaccinate susceptible HCP, after screening of varicella immune status at the time of recruitment. In the wake of the outbreak, assessment of immunity against varicella, and vaccination of susceptible HCP, is being followed up meticulously. Conclusion Varicella can present with atypical symptoms, especially in the immunocompromised host. Suspected cases should be isolated until sensitive PCR studies are done. Varicella immune status of HCP should be assessed at recruitment and vaccination should be offered to susceptible individuals. Implementation and infection prevention and control measures can help prevent and mitigate varicella outbreaks within healthcare facilities.

Use of health care resources for varicella in the paediatric population, Jordan.

The exact burden of varicella is not well quantified in Jordan. This study aimed to estimate the varicella burden in paediatric patients in Jordan who sought care in a hospital-based setting. This was a multicentre, retrospective review of medical records of patients aged 0-14 years with a primary varicella diagnosis in Jordan between 2013 and 2018. The data assessed were: use of health care resources for varicella (outpatient and inpatient visits, tests and procedures, and medication use), and clinical complications of the infection. Estimated costs were based on health care resources used (direct costs) and lost revenue to the child's caregiver (indirect costs) for outpatients and inpatients. In total, 140 children with varicella were included: 78 outpatients, mean age (standard deviation) 4.4 (3.2) years, and 62 inpatients, mean age 4.0 (3.8) years. No outpatients had varicella-related complications, while 32 (52%) inpatients had ≥ 1 complication. The use of health care resources was higher for inpatients than outpatients, including prescription medication use - 94% of inpatients versus 6% of outpatients. Total costs of varicella were estimated at US$ 66.1 (95% CI: 64.1-68.1) per outpatient and US$ 914.7 (95% CI: 455.6-1373.9) per inpatient. Varicella is associated with considerable use of health care resources in Jordan and may be responsible for annual costs of US$ 11.5 million. These results support universal varicella vaccination in Jordan.

NUMBER OF CASES OF VARICELLA AND HOSPITALIZATION IN A PEDIATRIC REFERENCE HOSPITAL IN BRAZIL AFTER INTRODUCING THE VACCINE.

ABSTRACTObjective: To assess the number of cases and the profile of hospitalizations from varicella after the introduction of the measles, mumps, rubella and varicella combination vaccine in the public health system.Methods: Retrospective study in an infectious diseases pediatric hospital of reference in Southeast Brazil. The cases with a clinical diagnosis of varicella, from January 2011 to June 2016, were assessed from pediatricians’ medical records. The hospitalizations were classified into a pre-vaccine group and post-vaccine group, based on the date the vaccine was introduced (September 2013). Both groups were compared by age, sex, time of hospitalization, reason for hospitalization, hospital complications, duration of intensive care, and clinical outcome.Results: A total of 830 hospitalizations were recorded; 543 in the pre-vaccine period and 287 in the post-vaccine period, a reduction of 47.1% (p<0.001). In both periods, a similar profile in the hospitalizations was noticed: majority male; aged between one to five years old; most complications due to secondary causes (mainly skin infections); main outcome was clinical improvement and discharge from the hospital. In the pre-vaccine period, six deaths were recorded and two were recorded in the post-vaccine period.Conclusions: The profile of the hospitalizations was expected to stay the same since this study did not compare vaccinated with unvaccinated children, but hospitalizations before and after the vaccine was introduced. In accordance with the medical literature, we found a significant fall in the number of hospitalizations from varicella.

Various Complications of Chickenpox in Admitted Patients; 2017 Perspective

Background: Chickenpox is a benign disease occurring in both children and adults. Common symptoms of disease include fever, generalized body rash, itching, fatigue, headache and body aches. The complications of the disease include respiratory, gastrointestinal, neurological, hematological and cardiac complications. These complications are more common in adult population. Estimated mortality from chickenpox is 31/100,000 in adults. Chickenpox pneumonia is the most serious complication followed by encephalitis. Objective: To highlight the various complications of chickenpox present in adult population of Faisalabad and its adjoining cities. Study Design: retrospective cross-sectional observational study. Settings: Department of Medicine, Allied Hospital, Faisalabad Pakistan. Duration: One year, January 2017 to December 2017. Methodology: Record of the admitted 350 patients was obtained, and Patients’ charts were reviewed with special emphasis on various complications of chickenpox. The patients included were above the age of 14 years and the diagnosis of chickenpox was made on clinical grounds. The diagnosis of complications was made with the help of laboratory and radiological investigations. Results: In our study 350 patients facing complications from chickenpox, from various regions of Faisalabad. Majority of them suffered from secondary bacterial skin infection i.e. 75 patients. Sepsis and ARDS turned out to be some of the major concerns for patients as well, as 31patients developed Sepsis and 29 patients suffered from ARDS respectively. Hepatitis, Myocarditis and Encephalitis were among the major issues affecting 11, 12 and 9 patients respectively. Conclusion: Chicken Pox can present with life threatening complications in adult population. Awareness of general population about the disease, its prevention, early detection and start of appropriate treatment can prevent development of complications and help reduce mortality and morbidity from the disease.