Chickenpox (Varicella)

It is an acute and highly contagious disease of viral etiology, characterized by vesicular eruptions on the skin and mucous membrane with mild constitutional symptoms.

Infectious Agent: Herpesvirus varicellae – a DNA containing virus

Incubation Period:10-21 days or maybe prolonged after passive immunization.

Mode of Transmission

• Direct contact – shedding of the virus from the vesicles
• Indirect contact – through linens or fomites
• Airborne (droplet infection)

Period of Communicability

• The patient is capable of transmitting the disease about a day before the eruption of the first lesion up to about five days after the appearance of the last crop.

Diagnostic Tests:

• Complement Fixation Test – to determine the V-Z virus
• Electron Microscopic Exam of the vesicular fluid

Clinical Manifestations
pre-eruptive manifestations are mild fever & malaise
Eruptive Stage
a. Rash starts from the trunk, then spread to other parts of the body.
b. Initial lesions are distinctively red papules where contents become milky and a pus-like within 4 days.
c. In adult and bigger children, the lesions are more widespread and more severe.
d. Vesicular lesions are very pruritic.
e. “Celestial map” – scabs
f. Stages of lesions:
*Macule – lesion that is not elevated above the skin surface.
*Papule – lesion that is elevated above the skin surface with a diameter of about 3 mm.
*Vesicle – pop-like eruption filled with fluid.
*Pustule – vesicle that is infected or filled with pus.
*Crust – scab or eschar. Secondary lesion caused by the secretion of vesicle drying on the skin. The scars are superficial, depigmented and take time to fade out.

Complications

• Secondary infection of the lesions – furuncles, cellulitis, skin abscess, erysipelas
• Meningoencephalitis
• Pneumonia
• Sepsis

Treatment Modalities

• Zoverax
• Oral acyclovir
• Oral antihistamine
• Calamine lotion
• Antipyretic

Nursing Management

1. Respiratory Isolation is a must until all vesicles have crusted.
2. Prevent secondary infection of the skin lesion through hygienic care of the patient.
3. Linens must be disinfected under the sunlight or through boiling.
4. Cut fingers nails short and wash hands more often.
5. Provide activities to keep child occupied to lessen pruritus.