Chicken pox and others. Signs and symptoms of the disease

– an acute infectious disease of viral etiology, characterized by the appearance of a characteristic blistering rash against the background of general intoxication syndrome. The causative agent of chickenpox is the herpes virus type 3, transmitted from a patient by airborne droplets. Chicken pox is one of the most common childhood infections. It is manifested by characteristic abundant itchy blistering rashes that appear at the height of fever and general infectious manifestations. A typical clinic allows you to diagnose the disease without conducting any additional research. Treatment of chickenpox is mainly symptomatic. To prevent secondary infection, antiseptic treatment of rash elements is recommended.

General information

– an acute infectious disease of viral etiology, characterized by the appearance of a characteristic blistering rash against the background of a general intoxication syndrome.

Characteristics of the pathogen

Chickenpox is caused by the Varicella Zoster virus of the herpesvirus family, also known as human herpes virus type 3. This is a DNA virus that is poorly resistant to external environment, capable of replication only in the human body. Inactivation of the virus occurs quite quickly when exposed to sunlight, ultraviolet irradiation, when heated, dried. The reservoir and source of chickenpox are sick people within the last 10 days incubation period and the fifth to seventh day of the rash period.

Chickenpox is transmitted through the aerosol mechanism by airborne droplets. Due to the weak resistance of the virus, contact-household transmission is difficult to implement. The spread of the virus with a fine aerosol released by patients when coughing, sneezing, talking, is possible over a sufficiently large distance within the room; it is likely to be carried by air currents into adjacent rooms. There is a possibility of transplacental transmission of infection.

People have a high susceptibility to infection; after suffering from chickenpox, intense lifelong immunity remains. Children in the first months of life are protected from infection by antibodies received from the mother. Chickenpox most often affects children of preschool and junior age. school age attending organized children's groups. About 70-90% of the population gets chickenpox before the age of 15 years. The incidence in cities is more than 2 times higher than in rural areas. The peak incidence of chickenpox occurs in the autumn-winter period.

Pathogenesis of chickenpox

The entry point for infection is the mucous membrane respiratory tract. The virus invades and accumulates in epithelial cells, subsequently spreading to regional lymph nodes and further into the general bloodstream. The circulation of the virus in the bloodstream causes symptoms of general intoxication. The varicella zoster virus has an affinity for the epithelium of integumentary tissues. Replication of the virus in an epithelial cell contributes to its death; in the place of dead cells, cavities remain, filled with exudate (inflammatory fluid) - a vesicle is formed. After opening the vesicles, crusts remain. After peeling off the crust, the newly formed epidermis is revealed underneath. Chickenpox rashes can form both on the skin and on the mucous membranes, where the vesicles quickly progress to erosion.

Chicken pox in people with a weakened immune system occurs in a severe form, contributes to the development of complications, secondary infection, and exacerbation of chronic diseases. During pregnancy, the probability of transmitting chickenpox from mother to fetus is 0.4% in the first 14 weeks and increases to 1% until week 20, after which the risk of infection of the fetus is practically absent. As an effective preventative measure Pregnant women with chickenpox are prescribed specific immunoglobulins that help reduce the likelihood of transmitting the infection to the child to a minimum. Chicken pox that develops a week before childbirth and in the month following childbirth is more dangerous.

Persistent, lifelong immunity reliably protects the body from re-infection, however, with a significant decrease in the body’s immune properties, adults who had chickenpox in childhood can become infected with it again. There is a phenomenon of latent carriage of the varicella zoster virus, which accumulates in the cells of the nerve ganglia and can be activated, causing herpes zoster. The mechanisms of viral activation during such carriage are not yet clear enough.

Chickenpox symptoms

The incubation period for chickenpox ranges from 1-3 weeks. In children, prodromal phenomena are weakly expressed or not observed at all, in general - the course is mild with a slight deterioration in general condition. Adults are prone to a more severe course of chickenpox with severe symptoms of intoxication (chills, headache, body aches), fever, and sometimes nausea and vomiting. Rashes in children can occur unexpectedly due to the absence of any general symptoms. In adults, the period of rashes often begins later; fever when elements of the rash appear may persist for some time.

The rash with chickenpox has the character of bullous dermatitis. Rashes are single elements that appear on any part of the body and spread without any pattern. The elements of the rash initially appear as red spots, progressing into papules, and then into small, even, single-chamber vesicles with clear liquid, which collapse when punctured. Opened vesicles form crusts. Chickenpox is characterized by the simultaneous existence of elements on different stages development and emergence of new ones (addition).

The chickenpox rash causes intense itching; scratching may cause infection of the vesicles with the formation of pustules. When pustules heal, they can leave behind a scar (pockmark). Uninfected vesicles do not leave scars, and once the crusts are removed, healthy new epithelium is revealed. When rash elements suppurate, the general condition usually worsens and intoxication worsens. The rash in adults is usually more profuse, and in the vast majority of cases pustules form from the vesicles.

The rash spreads over almost the entire surface of the body with the exception of the palms and soles, mainly localized in the scalp, face, and neck. Falling asleep (the appearance of new elements) is possible for 3-8 days (in adults, as a rule, they are accompanied by new feverish waves). Intoxication subsides simultaneously with the cessation of sleep. The rash may appear on the mucous membranes oral cavity, genitals, sometimes on the conjunctiva. Bulk elements on the mucous membranes progress to erosion and ulcers. In adults, the rash may be accompanied by lymphadenopathy; for children, involvement of the lymph nodes is not typical.

Besides typical course, there is an erased form of chickenpox, occurring without signs of intoxication and with short-term rare rash, as well as severe forms, distinguished by bullous, hemorrhagic and gangrenous. The bullous form is characterized by a rash in the form of large flabby blisters, leaving long-healing ulcerative defects after opening. This form is typical for people with severe chronic diseases. Hemorrhagic form accompanied by hemorrhagic diathesis, minor hemorrhages are observed on the skin and mucous membranes, and nosebleeds may occur. The vesicles have a brownish tint due to hemorrhagic contents. In persons with a significantly weakened body, chickenpox can occur in a gangrenous form: rapidly growing vesicles with hemorrhagic contents open to form necrotic black crusts, surrounded by a rim of inflamed skin.

Complications of chickenpox

In the vast majority of cases, the course of chickenpox is benign; complications are observed in no more than 5% of patients. Among them, diseases caused by secondary infection predominate: abscesses, phlegmon, and in severe cases, sepsis. A dangerous, difficult-to-treat complication is viral (chickenpox) pneumonia. In some cases, chickenpox can provoke keratitis, encephalitis, myocarditis, nephritis, arthritis, and hepatitis. Severe forms of diseases in adults are prone to complications, especially with concomitant chronic pathologies and a weakened immune system. In children, complications are observed in exceptional cases.

Diagnosis of chickenpox

Diagnosis of chickenpox in clinical practice made on the basis of a characteristic clinical picture. General analysis blood for chickenpox is nonspecific, pathological changes may be limited by the acceleration of ESR, or signal about inflammatory disease with an intensity proportional to the general intoxication symptoms.

Virological research involves identifying virions by electromicroscopy of vesicular fluid stained with silver. Serological diagnosis is retrospective and is performed using RSC, RTGA in paired sera.

Treatment of chickenpox

Chickenpox is treated on an outpatient basis, except in cases of severe disease with intense general intoxication manifestations. Etiotropic therapy has not been developed; in case of pustule formation, antibiotic therapy is resorted to for a short course in medium dosages. Persons with immune deficiency can be prescribed antiviral drugs: acyclovir, vidarabine, interferon alpha (new generation interferon). Early administration of interferon contributes to a milder and shorter-term course of the infection, and also reduces the risk of complications.

Chickenpox therapy includes skin care measures to prevent purulent complications: the vesicles are lubricated antiseptic solutions: 1% solution of brilliant green, concentrated - potassium permanganate (“brilliant green”, “potassium permanganate”). Ulcerations of the mucous membrane are treated with hydrogen peroxide at a 3% dilution or ethacridine lactate. Intense itching in the area of ​​the rash is relieved by lubricating the skin with glycerin or wiping with diluted vinegar or alcohol. Prescribed as a pathogenetic agent antihistamines. Pregnant women and patients with severe forms are prescribed a specific anti-chickenpox immunoglobulin.

Forecast and prevention of chickenpox

The prognosis is favorable, the disease ends in recovery. Vesicles disappear without a trace, pustules can leave smallpox scars. Significant deterioration in prognosis in persons with immunodeficiency and severe systemic diseases.

Prevention of chickenpox consists of preventing the introduction of infection into organized children's groups, for which quarantine measures are taken when cases of the disease are detected. Patients are isolated for 9 days from the moment the rash appears, children who have been in contact with sick people are separated for 21 days. If the day of contact with the patient is precisely determined, the child is not allowed into the children's group from 11 to 21 days after contact. Contact children who have not previously had chickenpox and with weakened immune systems are prescribed anti-chickenpox immunoglobulin as a preventive measure.

Recently, vaccination against chickenpox has begun to be used. For this purpose, the vaccines Varilrix (Belgium) and Okavax (Japan) are used.

Chicken pox (varicella, varicella) is an acute, highly contagious anthroponotic (only in humans) viral infection, transmitted by airborne droplets and contact, accompanied by a vesicular rash and associated intoxication.

Chickenpox has been known since ancient times, but only from the end of the 18th century (1800) it began to be separated as an independent disease, separate from smallpox, thanks to the work of Vogel. 1911 - Aragao H. described small inclusions in the contents of vesicles - elementary bodies, considering them pathogens. The virus itself was isolated in 1940; 1958 and 1972 – proof of the identity of the pathogen in patients with chickenpox and herpes zoster!

Varicella zoster virus model

The causative agent of chickenpox

Chickenpox virus (Varictlla-herpes zoster is the 3rd type of herpes viral infection) is a DNA-containing virus, the capsid of which is surrounded by a lipid membrane, which possibly determines its lifelong presence in the body.

Features of the chickenpox virus: quickly spreads through cell cultures (forms intracellular inclusions in epithelial cells) with their subsequent destruction, is able to exist in a latent form through lifelong residence in the neurons of the spinal ganglia, as well as the facial and trigeminal nerve.

The chickenpox virus is not very stable in the external environment, it quickly dies at low and high temperatures, UV rays and disinfectants, and can survive at room temperature for up to several hours.

Susceptibility to the chickenpox virus is high (because it is very volatile - it travels distances of up to 20 m, from floor to floor, through ventilation), especially for those who have not had chickenpox before or have not been vaccinated. Chickenpox infection occurs even through fleeting contact with a sick person. The seasonality of the disease is autumn-winter, and epidemic outbreaks are recorded once every 5 years. Children aged 5-9 years often suffer from chickenpox; children under 6 months usually do not get sick due to antibodies received from the mother (if the mother had chickenpox in childhood). Adults also rarely get sick.

After an infection, lifelong immunity is formed, but in 3% of cases re-infection is observed. It should also be mentioned that previously infected people become not only carriers, but also sources when the infection worsens; their disease occurs in the form of herpes zoster (shingles).

Causes of chickenpox infection

The source is a patient with chickenpox and herpes zoster. Patients are contagious a day before the onset catarrhal symptoms(i.e. before the prodromal period) and within 5 days from the onset of the rash. Routes of transmission: airborne droplets (during talking, coughing, loud crying, screaming), household contact (infection with saliva or discharged vesicles) and contact (by direct touch), transplacental (passage of the virus through the placental barrier).

Chickenpox symptoms

Incubation period of chickenpox(from the moment of introduction to the first signs of chickenpox) 11-23 days. During this period, the pathogen penetrates through the mucous membrane of the upper respiratory tract, then multiplies and accumulates this virus in the epithelial cells of these mucous membranes.

After the maximum accumulation of the chickenpox pathogen, it spreads through the lymphatic and blood vessels, causing the occurrence of the following periods - prodromal or rashes.

Chickenpox prodrome– (this period may not exist) occurs only in a small part of people and lasts 1 day. It is characterized by a scarlet-like rash that persists for several hours and then disappears, a rise in temperature to 37-38⁰C and intoxication. More often this period is a reaction to viremia.

Period of rash– with chickenpox, it begins acutely (or immediately after the prodromal period) and lasts for 3-4 days or more. More often than not, there is no time boundary between them at all. Just like the prodromal period, it is a reaction to viremia and is characterized by the following symptoms:

Enlargement of regional lymph nodes (may not be),

Fever of 37-39°C persists throughout the entire period of the rash and each new burst of rash is accompanied by a rise in temperature,

A rash with chickenpox appears on the 1st day of the onset of intoxication, with additional rashes occurring over the course of 5 days - some are already going away, while others are just appearing. Therefore, the impression of false polymyrphism is created (a variety of rashes in the same patient: blisters, spots, and crusts at the same time). There is no favorite localization and stages, like measles (the rash can even be on the scalp - an important differential diagnostic sign, also on the mucous membrane of the mouth, genital organs in girls, conjunctiva/cornea, larynx, with further ulceration and healing within 5 days). Already in 1 day, the red spot turns into a blister and after a couple of days the rash looks on the surface of the body like “dew drops” with transparent contents, which become cloudy after 1-2 days, and after another 1-2 days the blister dries out and turns into a crust that falls off in 1-3 weeks.

A patient with chickenpox ceases to be contagious as soon as the eruptions have stopped and crusts have formed. The rash is accompanied by itching varying intensity. With good antiseptic treatment rashes, they do not leave scars behind, but if these hygiene rules are ignored, secondary infection with bacteria from the surface of the skin occurs, followed by damage to the germinal layer and the formation of scars/scars, as with smallpox, but not so rough.

The recovery period lasts for 3 weeks from the end of the rash and is characterized by the falling off of the crusts and the formation of lifelong immunity. After the crusts fall off, they remain dark spots, but they go away within a few weeks. There are no scars left unless there is a secondary infection.

This classic picture is typical for chickenpox in children with normal immunity.

There are some groups of people for whom chickenpox is most severe and with high risk complications, with a malignant course. This risk group includes: unimmunized pregnant women (danger to the fetus with possible disability), children in the first months of life from unvaccinated mothers, unimmunized adults (not vaccinated and not sick). In these cases, severe forms of chickenpox develop: hemorrhagic, gangrenous, bullous (see complications).

Features of the course of chickenpox in different age groups of children and adults

Chicken pox in pregnant women

Intrauterine infection (possible in those pregnant women who are not immunized - either did not get sick or were not vaccinated):

Infection in the 4th month of pregnancy - pathology of the skin, bones - underdevelopment of the limbs, central nervous system, organ of vision, urinary system, intestines, intrauterine growth retardation, lag in the psychomotor area. And after birth, the mortality rate is 25%.

At 6 months, embryofetopathies similar to those at 4 months do not occur, and after birth there are only symptoms of herpes zoster.

Infection with chickenpox from the beginning of the 9th month of intrauterine stay and during the first 12 days of life leads to a severe course, accompanied by damage to internal organs (lungs, heart, kidneys, intestines) with further infection hemorrhagic syndrome. In this case, the mortality rate reaches 50%

If reinfection occurs (i.e., re-infection in a woman who was once sick or vaccinated), a few days before childbirth (as shown above), then the baby’s symptoms will develop immediately after birth and chickenpox will proceed easily, because antibodies will be passed from the mother to the child in utero, through the placenta.

Chickenpox infection in infants (first 3 months of life)

It is registered extremely rarely, because maternal antibodies are transmitted to the baby in utero through the placenta, but if this does not happen, then the following manifestations are observed:

The prodromal period is extended to 4 days with moderate/severe symptoms of intoxication;
in the background high temperature general cerebral symptoms may join (visible pulsation of the fontanel will indicate increased intracranial pressure, convulsive readiness and other manifestations);
the rashes are abundant and the phasing proceeds more slowly (i.e. the formation of spots, then blisters, after crusts and pigmentation) and the period of the rashes becomes protracted - up to 9 days, instead of 5;
Bacterial complications often occur.

Features of chickenpox in adults

Symptoms of intoxication are more pronounced;
The rash does not appear on the 1st day, but on 2-3. The staged nature and the period of rash itself becomes protracted.
Secondary bacterial infections, the development of pneumonia and other complications are common.
The itching is much more pronounced.

In adults, chickenpox is more likely to cause complications (see below)

Diagnosis of chickenpox

1. Virological method– isolation of the chickenpox pathogen from blisters and exfoliating skin lesions. But it takes time and is used only in controversial cases.

2. Express method - RIF (immunofluorescence reaction), which is used to detect viral antibodies.

3. Serological - ELISA ( enzyme immunoassay) – aimed at detecting specific IgM antibodies and G to varicella zoster virus; M-appear during the incubation period (4-7 days from the moment of infection) and persist for 2 months. Their presence indicates acute period; G – appear at 2-3 weeks and persist for life, they indicate immunization, i.e. protection.

4. Genetic method - the use of PCR (polymerase chain reaction) is aimed at detecting the DNA of the virus.

5. General clinical tests: CBC (↓Lc, Lf, normal ESR). Immunological examination: ↓T-lymphocytes, violation of the B-cell link, activity of Nf and macrophages, CIC (circulating immune complexes).

In fact, the listed diagnostic methods are not often used by doctors; the diagnosis is often made on the basis of complaints and examination, during which the nature of the rash is assessed, which is generally not correct, and tests are prescribed only in case of complications.

Treatment of chickenpox

Often, out of old habit, the doctor, having diagnosed chickenpox, does not prescribe any treatment other than antipyretic drugs and lubricating the rash with brilliant green - at the stage modern development medicine is not entirely correct. This set of medications can be limited only if chicken pox is mild, there is little rash, the child eats well and feels satisfactory. In other cases in children and during the treatment of chickenpox in adults, etiotropic treatment aimed at destroying the virus is mandatory! Remember that the chickenpox virus, after an illness, remains in the body for life and can subsequently manifest itself as herpes zoster, therefore, the more effective etiotropic treatment is, roughly speaking, the more virus that dies, the less chance of developing health problems in the future.

1. Etiotropic treatment of chickenpox

Viricidal drugs directed specifically against herpes viruses:
acyclovir = Zovirax = Virolex (from 2 years);
valciclovir (from 12 years old),
famciclovir (from 17 years old), isoprinosine; Acyclovir ointment is also used for rashes and conjunctivitis (eye damage).

Immunomodulators: interferon, viferon

Immunostimulants: cycloferon, anaferon

Antibiotics are used for secondary bacterial complications, and the drug of choice is 3rd generation cephalosporins.

In severe cases of chickenpox, immunoglobulins are used intravenously. All of the above drugs should be used in age-specific dosages. If a child of the first year falls ill, treatment is only under the supervision of a doctor with possible hospitalization, as the course infectious processes in young children it occurs with a tendency to generalization, frequent and severe complications and high mortality!

2. Pathogenetic treatment of chickenpox

Bed rest for 3-5 days (longer in complicated cases)

Careful care of the skin and mucous membranes:

Hygienic baths/showers, after which do not rub the skin, but lightly blot with a towel,
treating the rash with brilliant green to prevent secondary infection,
treatment of the oral mucosa - rinsing with furacillin and/or sodium sulfacyl, or sodium hydrocarbonate;
for conjunctivitis, you can use acyclovir ointment to prevent bacterial complications - albucid 20%, chloramphenicol ointment or tetracycline.

Drinking plenty of alkaline drinks

In severe cases, use stronger immunomodulators (thymolin, thymogen, IRS-19) and cytokine drugs (ronkeilikin),

Multivitamins, probiotics (bifidum-lactobacterin, linex), enterosorbents (smecta), metabolic therapy drugs according to indications (riboxin, cocarboxylase), mucolytics/expectorants (ambroxol, bromhexine, thyme decoction, chest collection No. 1) and anti-inflammatory aerosols for dry cough ( Erespal), antiplatelet agents (Actovegil, Cavinton, etc.), antihistamines (for severe itching, fenistil gel or histan, or other antihistamine ointments are used topically; and antihistamines suprastin, tavegil, etc. are used internally); antipyretics (ibuprofen, nurofen, or physical cooling methods - wrapping).

3. Symptomatic treatment prescribed from the ranks of pathogenetic groups of drugs or for more serious complications - cardiac glycosides.

Treatment lasts on average up to 2 weeks (including medication).

Rehabilitation after chickenpox

A month after recovery, the doctor examines the person who has been ill, with an appointment for an immunological examination and specialist examination,

Protective regime for 2 weeks after recovery (exemption from physical activity),

Exemption from preventive vaccinations for 2 months,

Prescription within a month: multivitamins and/or vitamin-mineral complexes, metabolic therapy and herbal adaptogens.

Complications of chickenpox

Complications of chickenpox are often associated with the addition of bacterial microflora, in addition, this is facilitated by the immunosuppressive function of the varicella-zoster virus, resulting in the development of: gingivitis, stomatitis, purulent mumps, conjunctivitis, keratitis, otitis, sepsis, pneumonia, glomerulonephritis, encephalitis, myelitis, nephritis, myocarditis , keratitis, Reye's syndrome, arthritis, laryngitis.

But the most dangerous complication is hemorrhagic form of chickenpox, in which the vesicles are filled with hemorrhagic contents (blood) = “bloody dew”, multiple hemorrhages in the skin / mucous membranes / nosebleeds / hemoptysis / gastrointestinal tract and other organs.

Gangrenous form characterized by the appearance of large flabby blisters, with a zone of necrosis, a scab. After the blisters fall off, ulcers form, which quickly become infected, as a result of which sepsis often develops and death soon occurs. But all severe complications develop against the background of immunodeficiency, taking glucocorticosteroids (GCS) or hormones.

Reye's syndrome may also result in death. The syndrome is based on fatty infiltration of the liver with the development of hypoglycemia, a significant increase in the level of transminases, coagulopathy, an increase in ammonia content and levels fatty acids, the formation of toxic metabolites that cause direct damage to neurons, demyelination, and cerebral edema. Symptoms of the syndrome are nausea, vomiting, delirium, epileptic seizures with the development of coma. Due to the danger of Reye's syndrome, aspirin should not be prescribed to children under 11 years of age for any viral infections, including chickenpox, in which the risk of this complication is already increased. Reye's syndrome occurs exclusively before the age of 15 years.

If you have any symptoms of an atypical course of chickenpox, call a doctor immediately.

Prevention of chickenpox

In the absence of contraindications (immunodeficiency states (IDS), recent treatment with corticosteroids/immunosuppressants/hormones, acute diseases or exacerbation of chronic ones) at 2 years you can get vaccinated against chickenpox - Varilrix, Okavax, Prevenar or Pneumo-23 vaccines (the last 2 are also against pneumococcal infection);

Passive immunoprophylaxis is used by administering “Varicella-Zoster-immunoglobulin” - VZIG, it is necessary for: persons with IDS; all newborns whose mothers did not have chickenpox or became infected a few days before birth; all premature babies up to 1 kg, regardless of the mother’s infectious history.

Nonspecific prevention of chickenpox is quarantine (isolation of the patient) for 5-7 days from the onset of the rash, with periodic ventilation and wet cleaning of the premises. All non-immunized contacts are isolated for up to 21 days.

In case of mass incidence of chickenpox, kindergartens and schools are usually not closed for quarantine.

General practitioner Shabanova I.E.

? ?According to statistics, more than 800 thousand people under the age of 12 suffer from this infectious disease in Russia every year. Chicken pox, which seems harmless at first glance in children, can cause serious complications, life-threatening. In case of illness, antiviral treatment is not required; you just need to apply various kinds of therapeutic measures aimed at alleviating the condition. The development of lifelong immunity reduces the incidence of disease among adults.

What is chicken pox

This is a highly contagious (contagious) infectious disease that is prevalent primarily among children under 12 years of age. The causative agent of chickenpox is the Varicella-herpes zoster virus, which is capable of quickly moving through the air for many hundreds of meters, but is not able to survive without the human body and dies after 10 minutes under the influence of environmental factors (high or low temperature, ultraviolet rays).

The chickenpox virus is volatile and is transmitted primarily by airborne droplets. People who have not previously had this disease and have not been vaccinated are 100% likely to become infected. After suffering the disease, a person remains immune for life, but an inactive form of the virus is present in the spinal ganglia and cranial nerves. If in the course of life a person’s immune system weakens greatly (oncology, stress, blood diseases), latent form Varicella-Zoster begins to activate, and herpes zoster (shingles) develops.

Chickenpox can only be contracted from a sick person, and the virus penetrates through the mucous membranes of the mouth or respiratory tract. A patient infected with the virus is dangerous within 2 days before the appearance of a skin rash and the next 5 days after the last rash. Transmission of infection through the placenta from a sick mother to the fetus is possible. The high-risk group is children in groups (kindergartens, schools).

Stages and course of chickenpox in children

Chickenpox in children manifests itself in several stages, which are accompanied by characteristic features . The main stages of the disease:

1. The incubation period of chickenpox (1-3 weeks) - during this time the virus multiplies in the nervous system of an infected person without external clinical manifestations.
2. Prodromal period (1 day) - in young children the clinical picture may be absent, in adults minor manifestations similar to the common cold appear. Main symptoms:

• increase in body temperature to 37.5°C;
• headaches;
• weakness, malaise;
• loss of appetite, nausea;
• short-term red spots on the body;
• sore throat sensation.

1. The period of rash begins with a sharp rise in body temperature to 39-39.5°C. The higher the hyperthermia, the more severe the disease with profuse rashes. In a mild form, the disease is accompanied only by the appearance of a rash on some parts of the body.

Forms of chickenpox

Chickenpox in children can be typical or atypical, depending on the nature of the clinical picture.. A typical one can occur in several ways:

• Mild (satisfactory condition, temperature is normal or does not rise above 38 degrees, the period of rash lasts 4 days, skin manifestations are minor).
• Moderate (intoxication of the body begins in the form of headache, weakness, drowsiness; hyperthermia above 38 degrees, profuse rash, ending after 5 days).
• Severe (severe intoxication, manifested by nausea, repeated vomiting, loss of appetite, body temperature up to 40 degrees; the period of rash is 9 days, the rash spreads throughout the body, to the mucous membranes, merging of lesions with each other is observed).

Atypical forms of chickenpox include rudimentary and aggravated. Rudimentary occurs easily with isolated rashes, normal or low-grade fever bodies. The aggravated one is characterized by a pronounced clinical picture. This form includes the following types of disease, treatment of which is carried out in a hospital setting:

• Hemorrhagic - manifested by high temperature, severe intoxication, damage to internal organs, blood appears in rashes in the form of bubbles. Subsequently, hemorrhages occur under the skin and tissue, in the mucous membranes and internal organs.
• Visceral - affects premature newborns and children with various immunodeficiencies. Intoxicating long-term syndrome, profuse rash, critical hyperthermia with damage to the central nervous system, kidneys, lungs, liver, heart.
• Gangrenous - diagnosed very rarely (more often in people with HIV infection). It is characterized by severe intoxication, huge blisters on which a crust and a zone of tissue necrosis quickly forms. After it falls off, deep and slowly healing ulcers remain on the skin.

Chicken pox in infants

Chickenpox in infants is rare. Infection occurs if maternal antibodies to the herpes virus do not enter the child’s body during the process of intrauterine development of the fetus. This occurs when the mother did not have this disease before pregnancy. The course of infection in infants:

• high temperature up to 40°C;
• severe intoxication;
• anxiety, weakness of the child;
• poor appetite;
• profuse rashes with slow healing;
• prolonged manifestation of the disease (10-14 days).

Features of the rash with chickenpox in children

There are several successive stages in the development of skin rashes in children. They appear in different days diseases. The main stages of rash formation:

1. Pimples (the first signs of chickenpox), which look like mosquito bites.
2. Spots that develop into clear fluid-filled blisters with red skin around the edges. Gradually they become cloudy and burst.
3. Drying of the bubbles is accompanied by the formation of a crust that cannot be removed.
4. There are situations when the symptoms of chickenpox in children appear simultaneously in the form of spots, blisters, and crusts without a specific sequence.

Complications of chickenpox in children

Chickenpox in most cases goes away without complications, but there are exceptions. Children with different types immunodeficiencies are subject to more severe disease. To the main undesirable consequences diseases can be attributed to:

• Secondary infection occurs when the skin is damaged by staphylococcus and streptococcus with the development of purulent dermatitis, amenable only to antibiotics.
• Suppression immune function. When the virus suppresses the body's defenses, diseases develop: otitis media, gingivitis, laryngitis, pneumonia, stomatitis, arthritis, nephritis, myocarditis.
• Hemorrhagic form of chickenpox. High probability of death due to the increased risk of bleeding under the skin, into the mucous membranes, nasal and pulmonary hemorrhages.
• Gangrenous chicken pox. Papules become large flabby blisters with elements of necrosis. As a result, huge ulcers develop with the risk of sepsis.
• Chickenpox encephalitis is an inflammation of the brain, which is manifested by high fever and unbearable headaches.
• Scars and cicatrices remain on the skin after severe scratching of wounds or secondary infection of the skin with the development of a purulent process.

Treatment of chickenpox in children

More often, chickenpox goes away on its own within 1 – 1.5 weeks. It is most easily tolerated by children from 1 to 7 years old. Treatment of chickenpox in children is best done at home; you need to drink more fluids and eat right (exclude fatty, salty, spicy foods). The patient's room should be cool to prevent excessive sweating, which will cause severe itchy skin, irritation.

During illness, regular change of bed and underwear is recommended. It is better to choose clothes made from natural fabrics to avoid unnecessary injury to the skin. To prevent the development of a secondary infection, you need to regularly bathe the child in boiled water, take cool baths with an aqueous solution of potassium permanganate or chamomile decoction. Use different types detergents(gels, soaps, shampoos) and rub with a washcloth skin it is forbidden. After water procedures Areas of the body should be blotted with a soft towel and the wounds should be treated with an antiseptic.

Rash treatment

To prevent infection, chickenpox rashes should be treated with antiseptics.. The main disinfectants include:

• 1% alcohol solution of brilliant green (zelenka);
• Castellani liquid;
• aqueous solution fucorcin;
• chamomile decoction and furatsilin solution (for gargling and mouthwash);
• aqueous solution of potassium permanganate (potassium permanganate).

Drug therapy

Chickenpox in children is treated using antiseptics and good hygienic skin care. There are times when it is necessary combination therapy, aimed at reducing the viral load in the body. The main groups of such drugs include:

• Antipyretics ( children's Paracetamol, Ibuprofen or Nurofen).
• Antiviral creams for local application, which are allowed for children from 2 years of age (Zovirax, Acyclovir, Virolex).
• Antibiotics are prescribed when a secondary bacterial infection occurs with the development of purulent and inflammatory process.
• Immunomodulators and immunostimulants to maintain the immune system (Anaferon, Interferon, Viferon).
• Antihistamines to remove severe itching skin (Claritin, Cetrin, Erius, Zyrtec, Terfen).

Prevention of chickenpox

The main preventive measures are aimed at preventing the introduction of the virus and the spread of the disease in children's groups. Main events:

• Isolation of children with chickenpox until the 5th day after the last skin rash.
• Nursery groups of kindergartens are closed for quarantine for up to 20 days from the moment a sick child is identified.
• Children with immunodeficiency undergo passive immunoprophylaxis (single injection of immunoglobulin) in the first 3 days after contact with a sick person.

If a pregnant woman is infected with chickenpox, she is given a specific immunoglobulin to prevent intrauterine infection of the fetus. There is a vaccine against chickenpox, which is indicated for weakened children with chronic diseases. Several drugs have been developed for vaccinations:

• Okawax (Japan);
• Varilrix (Belgium).

Video

Chickenpox is usually transmitted through airborne transmission. After exposure to someone who is sick, it can take 10 to 21 days for symptoms to appear. A person can infect others without even knowing that he is sick. The infectious period begins a couple of days before the characteristic rashes appear on the skin and lasts until new abscesses stop appearing and old ones become crusty.

Symptoms

Chickenpox symptoms begin with shaking, fever, headache and general malaise. A couple of days before this, a rash may appear on the body. The fever may be worse in the first days after the rash (small, itchy, red spots on the face, head, shoulders, chest and back) appears. The rash may also appear in the mouth, eyelids, and genital area. In this case, one patient may have only a few abscesses, while another will be completely covered with them. At first these are red marks with light blisters. They quickly disappear and become covered with a crust, which, in turn, dies within 2 weeks. In the first 4-5 days, new abscesses and blisters continue to appear, so all stages can occur simultaneously.

Complications of chickenpox

As a rule, a person gets chickenpox once in his life. However, a virus is introduced into the immune system, which may not manifest itself in any way, and then become active again in adulthood, causing a rash. Such a rash is called herpes zoster or herpes zoster.

Chickenpox can permanently leave pockmarks on the skin, especially in teenagers. Temporary marks may remain visible for 6 months to a year.

If a pregnant woman gets chickenpox a few days before giving birth, the newborn may get severe form diseases.

Chickenpox can lead to secondary serious bacterial infection, viral (lung infection caused by certain viruses and accompanied by symptoms of fever, cough and shortness of breath); encephalitis. Encephalitis is a viral disease of the brain; is very rare complication chickenpox. However, it is important to know the symptoms: fever, confusion, unconsciousness, fatigue and sudden severe pain, radiating to the limbs (lumbago).

If similar symptoms are detected, it is necessary to immediately take the patient to a doctor.

What can you do

You should consult a doctor immediately. In severe general condition and severe skin manifestations Hospitalization may be required, especially if symptoms from the nervous system appear (pain radiating to the legs, severe headache) or if the patient finds it difficult to breathe. Drink plenty of cool liquids. Paracetamol will help reduce the fever.

Do not use (aspirin). For mouth ulcers, follow a gentle diet. Avoid eating salty foods, as well as citrus fruits and juices.

For painful and itchy rashes in the external genital area, you can use drugs for external use with an analgesic effect. When choosing, it is better to consult a doctor or pharmacy worker.

If signs of an abscess appear at the site of the rash, you can use antibacterial ointment.

It is necessary to consult a doctor again if the temperature above 38 degrees lasts more than 4 days.

Children do not need to stay in bed, but they should be very restful.
When the body temperature drops and the pockmarks crust over, the child can go for a walk. Question about going to school kindergarten or nursery is decided by the doctor.
Trying to pick off the scabs from healing pockmarks can lead to reinfection and even more itching. It is recommended to trim your nails short and wash your hands frequently to prevent infection, and wear cotton gloves at night to reduce the chance of picking off pockmarks while sleeping.

What can a doctor do?

The doctor will prescribe antiviral drugs for an adult patient (children, as a rule, just need rest and peace). To be most effective, treatment should be started as soon as possible after the rash appears (at least within 24-48 hours). If infection recurs, the doctor will prescribe antibiotics and identify any complications early.

Prevention of chickenpox

If you are at risk of getting chickenpox, consult your doctor. Prescribed medications or vaccinations can prevent infection. Avoid contact with other people during the infectious period (until all pockmarks have crusted over).
If people have been exposed to possible infection through contact with you, advise them to monitor possible appearance skin rashes within 2 weeks of contact. It is almost impossible to prevent the spread of the disease within one family. Research shows that in 9 out of 10 cases, the spouse of the infected person will also get sick.

You should definitely consult a doctor if you have had contact with someone who is sick and did not have chickenpox as a child, especially if your immune system is weakened, or if you have undergone a bone marrow transplant.

Chicken pox, well known to everyone under the name chickenpox, belongs to a group of highly contagious infectious diseases and primarily affects children under the age of 12 years.

Relapses of the disease are unlikely, since upon initial contact with its pathogen, the body produces antibodies that circulate in the blood throughout life. In most cases, specific antiviral treatment for chickenpox in a child is not required. All therapeutic measures taken are aimed only at alleviating the patient’s condition and preventing complications.

Pathogenesis

The entry gate of the varicella zoster virus is the mucous membranes of the upper respiratory tract, where the virus replicates, and then the pathogen enters the blood through the lymphatic tract. At the end of the incubation period, viremia develops.

The virus is fixed in cells of ectodermal origin, mainly in epithelial cells of the skin and mucous membranes of the respiratory tract and oropharynx. Possible damage to the intervertebral ganglia, cerebellar cortex and cerebral hemispheres, subcortical ganglia. In rare cases, the generalized form affects the liver, lungs, and gastrointestinal tract. In the skin, the virus causes the formation of vesicles filled with serous contents, in which the virus is in high concentration. In severe generalized forms of the disease, vesicles and superficial erosions are found on the mucous membranes of the gastrointestinal tract, trachea, bladder And renal pelvis, urethra, conjunctiva of the eyes. In the liver, kidneys, lungs and central nervous system, small foci of necrosis with hemorrhages along the periphery are detected.

In pathogenesis, a significant role is played by cellular immunity, mainly the T-lymphocyte system, when suppressed, a more severe course of the disease is observed. After subsiding acute manifestations After primary infection, the virus persists for life in the spinal nerve ganglia.

Epidemiology

The source of the virus is the patient from the last day of the incubation period until the 5th day after the appearance of the last rash. The main route of transmission is airborne droplets. The virus can spread over distances of up to 20 m (through corridors to adjacent rooms of the apartment and even from one floor to another). A vertical mechanism of transmission of the virus through the placenta is possible.

Susceptibility to chickenpox is very high (minimum 90%), with the exception of children in the first 3 months of life, who retain passive immunity.

The incidence is characterized by pronounced seasonality, reaching a maximum in the autumn-winter months. Mostly children are affected. Post-infectious immunity is intense and is supported by the persistence of the virus in the body. When its tension decreases, herpes zoster occurs.

Chickenpox symptoms

The incubation period of chickenpox in children (from the moment of introduction to the first signs of chickenpox) is 11-23 days (see photo). During this period, the pathogen penetrates through the mucous membrane of the upper respiratory tract, then multiplies and accumulates this virus in the epithelial cells of these mucous membranes.

1) After the maximum accumulation of the chickenpox pathogen, it spreads through the lymphatic and blood vessels, causing the occurrence of the following periods - prodromal or rashes.

2) Prodromal period of chickenpox - (this period may not exist) occurs only in a small part of people and lasts 1 day. It is characterized by a scarlet-like rash that persists for several hours and then disappears, a rise in temperature to 37-38⁰C and intoxication. More often this period is a reaction to viremia.

3) The period of rashes - with chickenpox, it begins acutely (or immediately after the prodromal period) and lasts for 3-4 days or more. More often than not, there is no time boundary between them at all. Just like the prodromal period, it is a reaction to viremia and is characterized by the following symptoms:

• enlargement of regional lymph nodes (may not be),
• fever of 37-39°C persists throughout the entire period of the rash and each new burst of rash is accompanied by a rise in temperature,
• The chickenpox rash appears on the 1st day of the onset of intoxication, with additional rashes occurring over the course of 5 days - some are already going away, while others are just appearing. Therefore, the impression of false polymyrphism is created (a variety of rashes in the same patient: blisters, spots, and crusts at the same time). There is no favorite localization and stages, like measles (the rash can even be on the scalp - an important differential diagnostic sign, also on the mucous membrane of the mouth, genital organs in girls, conjunctiva/cornea, larynx, with further ulceration and healing within 5 days). Already in 1 day, the red spot turns into a blister and after a couple of days the rash looks on the surface of the body like “dew drops” with transparent contents, which become cloudy after 1-2 days, and after another 1-2 days the blister dries out and turns into a crust that falls off in 1-3 weeks.

4) A patient with chickenpox ceases to be contagious as soon as the eruptions stop and crusts form. The rash is accompanied by itching of varying intensity. With good antiseptic treatment of the rashes, they do not leave scars behind, but if these hygiene rules are ignored, secondary infection with bacteria from the surface of the skin occurs, followed by damage to the germinal layer and the formation of scars/scars, as with smallpox, but not as rough.

Other signs and forms of chickenpox

Other manifestations and symptoms depend on the form of chickenpox:

• In mild forms, chickenpox occurs without fever, and rashes appear within 2 to 3 days. Most often, such symptoms are characteristic of chickenpox in children under one year of age.
• With moderate severity of the disease, the period of rash lasts 2–5 days and is accompanied by fever. The temperature in children with chickenpox rises to 39 - 40 C. The elements of the rash itch. There is sleep disturbance and moodiness.
• At severe course Fever appears in waves and accompanies each new rash. The temperature rises to 40 C. The rash period lasts 7 – 10 days. Children experience headaches, cough, delusional states. In severe cases of chickenpox, there may be diarrhea and vomiting. These symptoms are more typical for chickenpox in adolescents.

Features of the course of atypical chickenpox:

What does chickenpox look like: photo

The photo below shows how the disease manifests itself in children.

Complications

The most serious and common diseases arising due to the influence of herpes pathogens on children's body, are chickenpox pneumonia and meningitis. Forms of the disease that are difficult to treat include atypical chickenpox:

1. Gangrenous - the appearance of rash elements on internal surfaces esophagus and bladder, which causes bleeding.
2. Bullous - a draining rash throughout the body with obvious signs of purulent infection.
3. Hemorrhagic - the disease occurs along with a bacterial infection.
4. Generalized – chickenpox in weakened children, occurring with damage to the mucous membranes, such as external organs, and internal systems.

In any case, if this form of chickenpox is detected or diagnosed, the sick child is sent for examination and treatment in the hospital.

Chickenpox infection in infants (first 3 months of life)

It is registered extremely rarely, because maternal antibodies are transmitted to the baby in utero through the placenta, but if this does not happen, then the following manifestations are observed:

• the prodromal period is extended to 4 days with moderate/severe symptoms of intoxication;
• against the background of high temperature, general cerebral symptoms may occur (visible pulsation of the fontanel will indicate increased intracranial pressure, convulsive readiness, and other manifestations);
• the rashes are abundant and the phasing proceeds more slowly (i.e. the formation of spots, then blisters, after crusts and pigmentation) and the period of the rashes becomes protracted - up to 9 days, instead of 5;
• Bacterial complications often occur.

How to treat chickenpox?

Children with chickenpox are usually treated at home. The first mandatory component of chickenpox treatment is bed rest for the period of fever.

A special diet for chickenpox is not prescribed, but drinking plenty of fluids- an integral part of treatment, since it performs very important function– detoxifying (relieves the body of toxins).

Drug treatment is carried out both general and local. General may include medications of several groups:

• antihistamines – prescribed if the rash is accompanied by intense itching;
• NSAIDs - prescribed to reduce fever (Ibuprofen and Paracetamol are usually used, aspirin in in this case contraindicated due to the risk of a serious complication - Reye's syndrome);
• antiviral drugs (Acyclovir is considered the most effective in this regard, but for mild forms of the disease it is not prescribed);
• in case of purulent complications of the disease - antibacterial drugs.

Local treatment includes careful care of the affected skin, aimed at preventing secondary infection of the rash elements. Typically, a solution of brilliant green, potassium permanganate or Fukortsin is used to treat rashes. To avoid residual marks at the site of the rash, it is strongly recommended not to pick off the crusts. Since the virus is unstable in the external environment, you should regularly carry out wet cleaning and frequently ventilate the room.

How long does chickenpox last?

The first or second day of illness passes without a rash with fever, on days 2–3 the first blisters may already appear, further rashes can last from 2 to 9 days depending on the degree of the disease. The child should be at home for at least 10 days, or even 14, taking into account his contagiousness. Children are discharged even if the scabs on the wounds have not yet fallen off, this can last up to 3 weeks.

When is a person with chickenpox not contagious?

A patient with chickenpox becomes contagious when he does not yet know about it - 2-3 days before the rash appears, and the rash appears about 2 weeks after infection.

A patient with chickenpox ceases to be contagious when no new rashes appear, and the old ones become covered with a crust and the crusts fall off (when the blisters heal, the virus is no longer released into the external environment).

On average, chickenpox quarantine for an individual child is 2-3 weeks from the first rash.

Prevention measures

To prevent chickenpox or its complications, vaccination (injection of a weakened live virus) or administration of immunoglobulins (antibodies specific to the Varicella zoster virus) can be used.

Vaccination is recommended for children after one year of age. It protects the body from chickenpox for 10 years or longer. Although sometimes vaccinated people can still get chickenpox, it will have a mild form. The introduction of vaccines (Okavax, Varivax and Varilrix) is especially important for women planning a pregnancy if they have not had chickenpox before. With their help, you can carry out emergency prevention chickenpox if there has been contact with a carrier of the infection. To prevent the development of the disease, the vaccine must be administered within 48–72 hours after contact with a carrier of the infection.

The introduction of anti-chickenpox immunoglobulin (the drug "Zostevir") is important for people who have been in contact with patients with chickenpox or herpes zoster, who are at high risk of developing severe complications in case of chickenpox. These people include pregnant women, children with oncological diseases, HIV-infected people who have undergone organ transplantation, children with severe chronic systemic diseases, premature babies weighing up to 1 kg, newborns whose mothers did not have chickenpox.

View photos

[collapse]

Answers to questions about chickenpox

The child had a fever and pimples appeared all over his body and in his hair. Is it chicken pox?

• The diagnosis of chickenpox can only be made by an experienced doctor after an in-person examination of the child.

How to distinguish chickenpox from allergies?

• With chickenpox, the temperature usually rises, the child experiences general malaise. Allergic rash smaller, multiple, identical in size, repeated rashes are larger than the previous ones, they do not occur on the mucous membranes. Characteristic features of the chickenpox rash: appears on the second or third day after the fever, has the form of individual blisters that appear in stages, new blisters are smaller than the old ones, covering all parts of the body.

A child was diagnosed with chickenpox simply after being examined by a doctor; is it legal to make such a diagnosis without undergoing tests?

• If a child has a rash characteristic of chickenpox, the diagnosis can be made after examination and collection of complaints. Tests are necessary only in case of protracted or complicated course of the disease.

Do I need to feed my child if he is eating (he has chickenpox)?

• The body fights the infection, and it needs strength to do this, so it certainly needs to be fed. But a lot of energy is also spent on digesting food. Therefore, during chickenpox, if the child refuses the usual food, replace it with chicken broth and jelly.

How many times do you get chickenpox?

• Once a person has had chickenpox, they develop lifelong immunity. Only in rare cases do repeated infections occur; in children under 12 years of age they are mild; in adults, both the first time and the second time are severe, despite having suffered the disease in childhood. There is no information in medical sources about contracting chickenpox for the third time.

The child has chicken pox, what folk remedies can we use it to help him recover faster?

• For any infectious disease, including chickenpox, vitamin berry fruit drinks or fruit drinks would be appropriate to help with the main treatment herbal teas, but you need to be sure that the child is not allergic to them (that is, the child has already tried this tea and no allergies have arisen.

A friend's child has chickenpox. I went to visit them when he first got chickenpox. Can I “bring” chickenpox to my child?

• If you are not infected, then you will not infect your child. Chickenpox is not transmitted through third parties.

In most cases, chickenpox in children is easily tolerated, without consequences. More common in preschoolers and junior schoolchildren. It is seasonal, most often occurring in autumn and winter. On average, epidemic outbreaks of chickenpox occur once every 5 years: children get sick en masse in kindergartens and schools.