What is it
In the collective imagination, chickenpox is considered, wrongly, a benign disease that is almost an obligatory step in the context of the “infectious experiences” of the child, in the mistaken belief that it even contributes to strengthening his defensive abilities.
Chickenpox is instead a viral infection that can give very serious complications. It is an exanthematous disease, as it gives rise to a rash which, in this case, is characterized by itchy vesicles destined to evolve into ribs.
If you want to know more about exanthematous diseases read these articles: Measles Measles: what to do if the child gets sick Scarlet fever
Causes
The infectious agent is a herpetic virus, called VZV (varicella-zoster virus) whose only target is the human body. It is equipped with easy interpersonal transmissibility by direct contact or by respiratory route.
Once penetrated through the nasal mucous membranes and after the incubation period (about 2 weeks), this pathogen reaches the blood and replicates rapidly, giving rise to the classic rash.
Most common symptoms
General symptoms (malaise, headache, feeling tired, fever, decreased appetite and sometimes abdominal pain) may precede the rash by a couple of days and persist in the acute phase of the disease.
The vesicles of chickenpox are surrounded by a reddened edge that from the scalp and face spread, in later times, to the trunk and limbs, also affecting the mucous membranes (in particular lips, oral cavity and genital area).
Their content, rich in infectious viral particles, is initially clear but tends in the following days to acquire a turbid appearance and then be reabsorbed or, in case of rupture of the vesicle, poured outside. When the lesions are crusted, the individual is no longer contagious.
Complications
The most frequent complication is bacterial superinfection of the skin, which can be the starting point of generalized forms of infection. Chickenpox pneumonia is a severe complication.
It is rare in children, but more frequent in adolescents/adults with increasing age, as well as in immunocompromised individuals and pregnant women.
Secondary involvement of the central nervous system can lead to temporary impairment of cerebellum function, aseptic meningitis or encephalitis.
The first, which is the most frequent neurological complications (one child in 4,000), is characterized by disturbances of gait and coordination of movements, which can persist for a few months despite the benign course. Encephalitis (inflammation of brain tissue) is more prevalent in adulthood and often fatal.
Reye’s syndrome, which is a serious hepatic involvement associated with encephalopathy, has a high fatality rate and, as shown by several studies, is more likely in children treated with aspirin or salicylates, whose use is therefore not recommended in case of chickenpox.
Other complications of chickenpox are the reduction in the number of platelets (idiopathic thrombocytopenic purpura), which can occur several weeks after the disease and in a minority of cases can lead to sometimes severe and lethal bleeding, hepatitis, otitis media, keratitis, pancreatitis, orchitis, nephritis, myocarditis and pericarditis.
Care
The treatment in uncomplicated cases is symptomatic and uses antipyretics and antihistamines, for the control of itching (in this sense topical preparations can also be useful).
In the most severe cases, antivirals such as acyclovir, famacyclovir and valacyclovir are used, not always correctly, which block viral replication.
Vaccination of all children after the first year of life would be the most effective preventive strategy to reduce the incidence of the disease and the mortality associated with it.
In Italy, vaccination against chickenpox has been included in the national plan and is among the recommended vaccinations. Children who have never had chickenpox should receive 2 doses of vaccine:
First dose | Second dose |
---|---|
12th-15th month | 6th year |
When to consult your doctor
The doctor should always be consulted at the onset of the rash: chickenpox is a disease subject to mandatory and potentially dangerous reporting (for example for non-immune pregnant women) as well as very contagious, so it is important to evaluate any risks at family level. In addition, timely specific care can stop the course.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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