Chickenpox natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Aravind Reddy Kothagadi M.B.B.S[2]

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## Overview

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Primary varicella presents with pruritic macules, papules, vesicles, pustules, and crusts, usually on the back, chest, face, and abdomen. Reactivation of the virus can present as shingles. Common complications of chickenpox are bacterial infections of the skin and soft tissues in children and pneumonia in adults. Chickenpox is rarely fatal. Pregnant women and immunocompromised patients are at a higher risk of developing varicella pneumonia.

## Natural History

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If left untreated, in healthy children varicella manifestations develop within 15 days post exposure and typically present as: [1]

* Generalized vesicular rash develops within 24 hours
* Fever
* Malaise
* Pharyngitis
* Loss of appetite

* Infection in adults can cause VZV pneumonia

## Complications

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The disease is usually mild, although serious complications sometimes occur. Two of the most common complications are bacterial infections of the skin and soft tissues in children and pneumonia in adults.[2][3][1]

### Complications in Immunocompetent

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Common complications associated with chickenpox in immunocompetent individuals include:[2][4][5][3][6][7]

* Toxic shock syndrome
* Viral pneumonia
* Zoster paresis
* Post-herpetic neuralgia)
* VZV meningoencephalitis
* VZV vasculopathy
* VZV and giant cell arteritis
* VZV-induced stromal keratitis
* Necrotizing fasciitis
* Septicemia
* Osteomyelitis
* Bacterial pneumonia
* Cerebellar ataxia
* Encephalitis
* Hemorrhagic conditions
* Septic arthritis

### Complications in Immunocompromised

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Common complications associated with chickenpox in immunosupressed individuals include:

* Hemorrhagic complications
* Febrile purpura
* Malignant chickenpox with purpura (mortality rate of greater than 70%)
* Anaphylactoid purpura

## Prognosis

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* Chickenpox is rarely fatal except if the patient develops varicella pneumonia.
* Prognosis in the immunocompromised is poor.
* Varicella zoster virus remains dormant in nerves which can be reactivated later in life, resulting in shingles. It is most commonly seen in the immunocompromised and the elderly.

## References

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1. ↑ 1.0 1.1 Straus SE, Ostrove JM, Inchauspé G, Felser JM, Freifeld A, Croen KD; et al. (1988). "NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention". Ann Intern Med. 108 (2): 221–37. PMID 2829675.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
2. ↑ 2.0 2.1 Gnann JW (2002). "Varicella-zoster virus: atypical presentations and unusual complications". J Infect Dis. 186 Suppl 1: S91–8. doi:10.1086/342963. PMID 12353193.
3. ↑ 3.0 3.1 Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX; et al. (2008). "Varicella among adults: data from an active surveillance project, 1995-2005". J Infect Dis. 197 Suppl 2: S94–S100. doi:10.1086/522155. PMID 18419417.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
4. ↑ Laupland KB, Davies HD, Low DE, Schwartz B, Green K, McGeer A (2000). "Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group". Pediatrics. 105 (5): E60. PMID 10799624.CS1 maint: Multiple names: authors list (link)
5. ↑ de Benedictis FM, Osimani P (2008). "Necrotising fasciitis complicating varicella". Arch Dis Child. 93 (7): 619. doi:10.1136/adc.2008.141994. PMID 18567772.
6. ↑ Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D; et al. (2015). "Varicella zoster virus infection". Nat Rev Dis Primers. 1: 15016. doi:10.1038/nrdp.2015.16. PMC 5381807. PMID 27188665.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
7. ↑ Clark P, Davidson D, Letts M, Lawton L, Jawadi A (2003). "Necrotizing fasciitis secondary to chickenpox infection in children". Can J Surg. 46 (1): 9–14. PMC 3211661. PMID 12585787.CS1 maint: Multiple names: authors list (link)

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