Clinical Findings of Varicella-Zoster virus
المؤلف:
Stefan Riedel, Jeffery A. Hobden, Steve Miller, Stephen A. Morse, Timothy A. Mietzner, Barbara Detrick, Thomas G. Mitchell, Judy A. Sakanari, Peter Hotez, Rojelio Mejia
المصدر:
Jawetz, Melnick, & Adelberg’s Medical Microbiology
الجزء والصفحة:
28e , p482-484
2025-11-11
142
A. Varicella Subclinical varicella is unusual. The incubation period of typical disease is 10–21 days. Malaise and fever are the earliest symptoms, soon followed by the rash, first on the trunk and then on the face, the limbs, and the buccal and pharyngeal mucosa in the mouth. Successive fresh vesicles appear in crops, so that all stages of macules, papules, vesicles, and crusts may be seen at one time (Figure1). The rash lasts about 5 days, and most children develop several hundred skin lesions.
Complications are rare in normal children, and the mortality rate is very low. Encephalitis does occur in rare cases and can be life threatening. Survivors of varicella encephalitis may be left with permanent sequelae. In neonatal varicella, the infection is contracted from the mother just before or after birth but without sufficient immune response to modify the disease. Virus is often widely disseminated and may prove fatal. Cases of congenital varicella syndrome after maternal cases of chickenpox during pregnancy have been described.
Varicella pneumonia is rare in healthy children but is the most common complication in neonates, adults, and immunocompromised patients. It is responsible for many varicella related deaths.
Immunocompromised patients are at increased risk of complications of varicella, including those with malignancies, organ transplants, or HIV infection and those receiving high doses of corticosteroids. Disseminated intravascular coagulation may occur that is rapidly fatal. Children with leukemia are especially prone to developing severe, disseminated VZV disease.
Fig1. Multiple stages or “crops” of varicella skin lesions. (Reproduced with permission from Gelb LD: Varicella-zoster virus. In Fields BN, Knipe DM [editors-in-chief]. Virology, 2nd ed. Raven Press, 1990.)
B. Herpes Zoster
Herpes zoster usually occurs in persons immunocompromised as a result of disease, therapy, or aging, but it occasionally develops in healthy young adults. It usually starts with severe pain in the area of skin or mucosa supplied by one or more groups of sensory nerves and ganglia and is often unilateral. Within a few days after onset, a crop of vesicles appears over the skin supplied by the affected nerves. The trunk, head, and neck are most commonly affected, with the ophthalmic division of the trigeminal nerve involved in 10–15% of cases. The most common complication of zoster in elderly adults is postherpetic neuralgia—protracted pain that may continue for months. It is especially common after ophthalmic zoster. Visceral disease, especially pneumonia, is responsible for deaths that occur in immunosuppressed patients with zoster (<1% of patients).
Varicella zoster central nervous system disease, most frequently meningitis, can present with or without a typical zoster rash.
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