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The chickenpox A family story Index Case Michaelmas Term Year 2
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The case Little Lizzie (aged 3) caught chickenpox at nursery school
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Her 44 year old father gave her a cuddle:
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Then…. 2 weeks later he started to feel unwell with a headache and temperature Shortly afterwards he developed a generalised maculo-papular rash The rash developed into numerous vesicles, particularly on the face and trunk He also developed a cough T39C, P120/min His wife told him not to pick his spots, even though they were itchy
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Then.. After 4 days his temperature began to fall. A woman from the man’s office is worried as she is ten weeks pregnant and was working with the man on the day he became ill
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What is chickenpox?
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chickenpox Primary infection with varicella zoster (DNA virus). Caught from respiratory droplets and fomites
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pathology Caught through respiratory mucosa 10-12 day prodromal stage Virus spreads from lungs to lymphocytes and monocytes 2 nd viremia occurs and virus travels to epithelial surfaces Papules contain multinucleated cells with intracellular inclusions Spread from respiratory tract or ruptured papillae: contagious 12-14 days after infection
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Why did the man get it but not his wife?
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She was immune, he wasn’t Previous infection provides a high degree of immunity
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Why should he avoid picking his spots, and why did they itch?
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Scratching breaks the skin and encourages secondary infection with bacteria such as staph. Aureus. This promotes scarring Itch is a symptom related to any inflammatory response. Itching can be caused by a variety of skin disorders (e.g. eczema) Also generalised medical conditions, e.g renal failure; liver failure
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Could the man die of his infection?
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yes Around 50 deaths/year in USA. Usually secondary to pneumonia Risk higher in immunosuppressed
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What could be done to treat him?
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Management of chickenpox Supportive VZIG: varicella zoster immunoglobulin Acyclovir: reduces duration of fever if given within 24 hours of developing a rash Avoid contact with others at risk until last vesicle crusted over
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What should the pregnant woman do?
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Exposure to HZ in pregnancy Has she already had chickenpox? Most women in UK have If uncertain measure antibodies If not immune give ZIG Small risk of teratogenesis 1-2% in first 20 weeks pregnancy Infection near fullterm- risk of neonatal encephalitis
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Will the man have any further problems from chickenpox?
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shingles A vesicular rash in dermatomal distribution Reactivation of varicella zoster in dorsal root or cranial nerve ganglia More common in elderly, immunosuppressed or with concurrent illness
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Is there a case for vaccination?
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HZ vaccination Live attenuated virus Available in USA May be a case in seronegative if planning pregnancy?
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And finally- why is vaccination called vaccination?
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In 1796 Edward Jenner injected cowpox from Sarah Nelmes into James Philip
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