Overview
What are the reservoirs of VZV ?
Humans are the only reservoir for VZV.
What are the common modes of transmission of VZV infection ?
The virus is extremely labile and is unable to survive for a long period in scabs or fomites. Therefore, transmission via inanimate objects is unlikely. The infection is usually transmitted through inhalation of infectious respiratory secretions from an infected person (droplet infection), direct physical contact with vesicular lesion and by vertical transmission during pregnancy.
What are the clinical manifestations of VZV infection in children?
The primary VZV infection results in chickenpox, which has characteristic clinical manifestation. It presents with a rash, low-grade fever and malaise. Few patients may have prodromal symptoms for 1-2 days prior to the appearance of the exanthem. The rash usually starts on the face, scalp or trunk. It is often the first manifestation of illness.
Lesions that are hidden by hair can often be detected by running the hands along the scalp, before the appearance of large number of lesions in other areas. Occasionally a group of two to three lesions appear on the trunk a day or two before the generalized eruption. The skin manifestations, the hallmark of infection, consist of maculopapules, vesicles and scabs in varying stages of evolution. The lesions initially contain clear vesicular fluid, but over a short period of time they pustulate and scab. Most lesions are small having an erythematous base with a diameter of 5-12 mm.
The lesions can be round or oval. As healing progresses, central umbilication occurs in them. Successive crops of lesions generally appear over a period of 2-4 days as the rash spreads centripetally. These successive crops are responsible for lesions of various stages of evolution. The crusts completely fall off within a week or two after the onset of infection, leaving behind a slightly depressed scar over skin.
What are the manifestations and complications of chickenpox in adults?
As is true of many viral diseases, chickenpox may be much more severe in adults than in children. The lesions are frequently confluent and systemic symptoms such as myalgia, arthralgia and malaise are much more common. The complication of chickenpox are usually more severe too and occur more frequently than in children. Respiratory complications like pneumonitis manifesting with cough, fever, dysnea and sometimes, pleuritic pain and hemoptysis within 5 days of the appearance of the rash; are especially common. Varicella infection in adult is associated with a 15-fold rise in mortality than that seen in children.
What are the effects of varicella infection in immunocompromised individuals ?
Immunocompromised children and adult are prone to severe form of varicella infection. The constellation of manifestations is referred to as "progressive varicella syndrome ". It has a shorter incubation period than usual. The rash is severe, confluent, involves even palms and soles and is likely to last longer. The fever and constitutional symptoms are more severe and complication rate is much higher. Almost one-third of these individuals have involvement of multiple organs including the lungs, liver and central nervous system. The fatality rate is higher (15-18%) and accounts for 70% of deaths due to varicella.
What are the effects of varicella infection during pregnancy ?
A woman who develops varicella during pregnancy is more prone to develop pneumonitis. Some authorities believe that pregnant women usually tend to have more have a more severe from of varicella.
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