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Exam Cram
Exam Cram
Varizella zoster virus (VZV) = Herpes simplex virus 3 causes Chickenpox with first infection and Shingles with reinfection
Chickenpox presentation: vesciular painfuk rash with mouth ulcers (kolpik spots)
VZV sits in dorsal root ganglion and reactivates to form shingles when old/ immunocompromised
Shingles pc: painful vesicles within a unilateral dermatome distribution
Chicken Pox
Chicken Pox
Background
Background
Chickenpox is a highly contagious transmittable infection, primarily affecting young children
The illness is usually transient as a child but can be more serious as an adult
Once exposure with chickenpox, childhood immunity is granted
Assessment
Assessment
Presentation
Rash lasting 5-10 days
Viral: myalgia, fatigue, sore throat, anorexia
Close contact history
Examination
Vesicular rash throughout body
Koplick spots on oral mucosa
Lymphadenopathy
Investigations
Usually nil required
Diagnosis
Diagnosis
Diagnostic criteria: clinical
Differentials: measles
Management
Management
Acute
Supportive
Pregnancy or Immunocompromised PEP (Post exposure Prophylaxis)
Pregnancy or Immunocompromised PEP (Post exposure Prophylaxis)
Post exposure prophylaxis
Management
If contact < 10 days test VZV IgG: for immunity
If nil IgG give IVIG VZV
PO Aciclovir if signs of chickenpox (ideally within 24hrs of rash)
IV Aciclovir if signs of VZV pneumonitis
VZV vaccine can be considered, however will not affect acute mx of post exposure prophylaxis. If IgG VZV +ve, nil action required- shows immune.
Shingles
Shingles
Background
Background
Shingles occurs in the immunocompromised with a previous chickenpox infection
VZV lies dormant in dorsal root ganglion, causing the dermatonal distriubtion when reactivating
Shingles and post shingles recovery can be very painful
Assessment
Assessment
Presentation
Childhood chicken pox + immunocompromised (elderly, malnutrition, chemotherapy)
Painful rash- skin pain can predate rash, important back pain differential in elderly
Examiation
Painful vesicular rash that does not cross the midline
Pain localised to skin in dermatonal fashion if early presentation pre-rash
Investigations
VZV IgM shows active infection
VZV IgG shows immunity (old infection)
Swab if purulent dc ? staph aureus superimposed infection
Diagnosis
Diagnosis
Diagnostic criteria: largely clinical, VZV IgM antibodies can confirm
Management
Management
Acute
Aciclovir within three days of vesicules
Associated pain: consider steroids in first two weeks
Post herpetic neuralgia
Neuropathic pain: gabapentinoids, amitriptyline
Med Reg Notes
Med Reg Notes
CNS Infection
Varicella meningitis i.e. headache, neck stiffness, fatigue without reduced GCS/ seizure usually doesn't require a lumbar puncture.
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