VARICELLA

(Chickenpox)Divideofgastroenterologyandinfectiousdiseases,Children’shospitalWangYutingVARICELLA

(Chickenpox)Divideo1Overview

Varicella(chickenpox)istheprimaryinfectioncausedbyvaricella-zostervirus(VZV).Varicellaischaracterizedbytheappearanceontheskinandmucousmembranesofsuccessivecropsoftypicalvesicles,generallyaccompaniedbyamildconstitutionalreaction.Overview2Varicella-zostervirus(VZV)Family:HerpesviridaeSubfamily:AlphaherpesvirinaeSerotype:Onlyonelatentinfection---reactivation

EtiologyEtiology3(兒科學(xué)英文課件)17-chickenpox4(兒科學(xué)英文課件)17-chickenpox5Routesoftransmission:

Respiratorytransmission:spreadbydroplet、Directcontact、Mother-to-fetusEpidemiologyRoutesoftransmission:Epidemi6Populationsusceptibility：

90%ofreportedpatientsareunder10-yrofage.Thepeakageofincidenceis2-6yr.Peakseasons:winterandspringEpidemiologyPopulationsusceptibility：Epid7respiratorysecretionsorskinlesion

respiratorymucosaregionallymphnodes

viremiamononuclearcells

viremiarespiratorymucosa,skin,organs

Pathogenesis

V-z-vrespiratorysecretionsorskin8characteristic

change

ofpathology：

Multinucleatedgiantcellsandintranuclearinclusions

Pathologycharacteristic

change

ofpatho9Pathology1.Maculopapule2.Vesicles3.Cloudyvesicles(pustules)4.CrustAngiotelectasisindermisBallooningdegenerationincelllayerApocytesinvadeinvesiclefluidvesiclefluidabsorbedPathology1.MaculopapuleAngiote10ClinicalManifestations

1.Typicalvaricella1)Incubationperiod:theincubationperiodvariesfrom10-21days,buttheaverageis13-17days.2)Prodromalperiod:

short,mild

theremaybeslightfever,malaise,oranorexia.ClinicalManifestations11RashFeatures:1.rashdevelopmentprocess:

maculopapule--“tear-drop”vesicles--cloudyvesicles(pustules)--crusts2.rashcharacteristics:appearinbatches(developmentofseveralcropsofrash)fourkindsofrashatthesametimeconcentricdistributionmucosainvolvement3.rashsequence:trunk--faceandscalp--extremitiesrashpruritusClinicalManifestationsRashFeatures:ClinicalManife12ClinicalManifestations1.Severevaricella:2.neonatalvaricella3.

congenitalvaricellaClinicalManifestations2.neona131)Seconderybacterialinfection

theskinlesionsisthemostcommoncomplication.Suchasimpetigo,erysipelas,cellulitis、surgicalscarfletfeverComplications1)Seconderybacterialinfecti142)Centralnervoussystemcomplications

①Varicellaencephalitisthemostcommoncentralnervoussystemcomplication.Overallmortalityratesvaryfrom5-25%.About15%ofsurvivorshavepermanentsequelaeofseizures,mentalretardation,orbehaviordisturbances.Complications2)Centralnervoussystemcomp15②OthernervoussystemcomplicationsGuillain-BarresyndromeReyesyndromeTransversemyelitisFacialpalsyOpticneuritis,ect.Complications②Othernervoussystemcomplica16Complications3)Varicellapneumonia4)Others:MyocarditisLeukocytopeniaNephritis,ect.Complications3)Varicellapneu17Bloodroutine:

amildleukocytopenia

Multinucleatedgiantcells:itcanbedemonstratedinscrapingsfromthefloorsoffreshvesicles.serologicalstudy

Virusisolation:viruscanbeisolatedinhumantissueculturecelllines.LaboratoryData

Bloodroutine:LaboratoryData18EpidemiologicdataAgeSeasonsHistoryofcontactwithpatientHistoryofinoculationClinicaldata:

Typicalrash

Thediagnosisisusuallymadefromthecharacteristicclinicalpicture,andlaboratoryconfirmationisrarelyneeded.DiagnosisEpidemiologicdataDiagnosis19Differentialdiagnosis

1.Hand-foot-and-mouthdisease2.UrticariapapulosaDifferentialdiagnosis1.Hand-20Treatment1.SymptomatictreatmentWearmittensandkeepingnailsshortDailychangesofclothes2.Antiviraltherapy:AcyclovirInterferon-α3.Complicationtreatment:antibiotictherapyifthereisasuperinfectionwithbacteriaCorticalhormoneisforbiddedSalicylicacidagentisnotbeusedaspossibleTreatment1.Symptomatictreatme21Prevention1)ControlofsourcesofinfectionsThepatientwillbeisolateduntilalllesionsarecrustedThesusceptiblecontactswillbeisolatedforclinicalobservationfor3weeksafterexposure.

Prevention1)Controlofsource22Prevention2)Abruptthewaysoftransmission3)Protectthesusceptiblepassiveimmunization

zosterimmuneglobulin(ZIG).givenwithin72hrofexposure.125-625U/10kgactiveimmunization

VaricellaAttenuatedLiveVaccineEfficacy: 85%-95%,morethantenyearsPrevention2)Abruptthewayso23TheprognosisisusuallygoodFatalitiesoccurfromthecomplicationsPrognosisTheprognosisisusuallygoodP24SummarySummary25ClinicalManifestationsoftypicalvaricellaComplicationsofvaricellaDiagnosisanddifferentialdiagnosisofvaricellakeypointsClinicalManifestationsoftyp26ThanksThanks27VARICELLA

(Chickenpox)Divideofgastroenterologyandinfectiousdiseases,Children’shospitalWangYutingVARICELLA

(Chickenpox)Divideo28Overview

Varicella(chickenpox)istheprimaryinfectioncausedbyvaricella-zostervirus(VZV).Varicellaischaracterizedbytheappearanceontheskinandmucousmembranesofsuccessivecropsoftypicalvesicles,generallyaccompaniedbyamildconstitutionalreaction.Overview29Varicella-zostervirus(VZV)Family:HerpesviridaeSubfamily:AlphaherpesvirinaeSerotype:Onlyonelatentinfection---reactivation

EtiologyEtiology30(兒科學(xué)英文課件)17-chickenpox31(兒科學(xué)英文課件)17-chickenpox32Routesoftransmission:

Respiratorytransmission:spreadbydroplet、Directcontact、Mother-to-fetusEpidemiologyRoutesoftransmission:Epidemi33Populationsusceptibility：

90%ofreportedpatientsareunder10-yrofage.Thepeakageofincidenceis2-6yr.Peakseasons:winterandspringEpidemiologyPopulationsusceptibility：Epid34respiratorysecretionsorskinlesion

respiratorymucosaregionallymphnodes

viremiamononuclearcells

viremiarespiratorymucosa,skin,organs

Pathogenesis

V-z-vrespiratorysecretionsorskin35characteristic

change

ofpathology：

Multinucleatedgiantcellsandintranuclearinclusions

Pathologycharacteristic

change

ofpatho36Pathology1.Maculopapule2.Vesicles3.Cloudyvesicles(pustules)4.CrustAngiotelectasisindermisBallooningdegenerationincelllayerApocytesinvadeinvesiclefluidvesiclefluidabsorbedPathology1.MaculopapuleAngiote37ClinicalManifestations

1.Typicalvaricella1)Incubationperiod:theincubationperiodvariesfrom10-21days,buttheaverageis13-17days.2)Prodromalperiod:

short,mild

theremaybeslightfever,malaise,oranorexia.ClinicalManifestations38RashFeatures:1.rashdevelopmentprocess:

maculopapule--“tear-drop”vesicles--cloudyvesicles(pustules)--crusts2.rashcharacteristics:appearinbatches(developmentofseveralcropsofrash)fourkindsofrashatthesametimeconcentricdistributionmucosainvolvement3.rashsequence:trunk--faceandscalp--extremitiesrashpruritusClinicalManifestationsRashFeatures:ClinicalManife39ClinicalManifestations1.Severevaricella:2.neonatalvaricella3.

congenitalvaricellaClinicalManifestations2.neona401)Seconderybacterialinfection

theskinlesionsisthemostcommoncomplication.Suchasimpetigo,erysipelas,cellulitis、surgicalscarfletfeverComplications1)Seconderybacterialinfecti412)Centralnervoussystemcomplications

①Varicellaencephalitisthemostcommoncentralnervoussystemcomplication.Overallmortalityratesvaryfrom5-25%.About15%ofsurvivorshavepermanentsequelaeofseizures,mentalretardation,orbehaviordisturbances.Complications2)Centralnervoussystemcomp42②OthernervoussystemcomplicationsGuillain-BarresyndromeReyesyndromeTransversemyelitisFacialpalsyOpticneuritis,ect.Complications②Othernervoussystemcomplica43Complications3)Varicellapneumonia4)Others:MyocarditisLeukocytopeniaNephritis,ect.Complications3)Varicellapneu44Bloodroutine:

amildleukocytopenia

Multinucleatedgiantcells:itcanbedemonstratedinscrapingsfromthefloorsoffreshvesicles.serologicalstudy

Virusisolation:viruscanbeisolatedinhumantissueculturecelllines.LaboratoryData

Bloodroutine:LaboratoryData45EpidemiologicdataAgeSeasonsHistoryofcontactwithpatientHistoryofinoculationClinicaldata:

Typicalrash

Thediagnosisisusuallymadefromthecharacteristicclinicalpicture,andlaboratoryconfirmationisrarelyneeded.DiagnosisEpidemiologicdataDiagnosis46Differentialdiagnosis

1.Hand-foot-and-mouthdisease2.UrticariapapulosaDifferentialdiagnosis1.Hand-47Treatment1.SymptomatictreatmentWearmittensandkeepingnailsshortDailychangesofclothes2.Antiviraltherapy:AcyclovirInterferon-α3.Complicationtreatment:antib