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Questions and Answers
What is the overall risk of congenital varicella syndrome when maternal varicella occurs during the first 20 weeks of gestation?
What is the overall risk of congenital varicella syndrome when maternal varicella occurs during the first 20 weeks of gestation?
Which statement regarding perinatal varicella is accurate?
Which statement regarding perinatal varicella is accurate?
What complications are commonly associated with severe varicella in immunocompromised patients?
What complications are commonly associated with severe varicella in immunocompromised patients?
Acute cerebellar ataxia is noted in what proportion of varicella cases?
Acute cerebellar ataxia is noted in what proportion of varicella cases?
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Which of the following is a rare complication of varicella?
Which of the following is a rare complication of varicella?
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What is the most common complication of varicella in children?
What is the most common complication of varicella in children?
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What percentage of invasive group A streptococcal infections were associated with varicella before widespread vaccination?
What percentage of invasive group A streptococcal infections were associated with varicella before widespread vaccination?
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Which symptom is NOT typically associated with varicella pneumonia in adults?
Which symptom is NOT typically associated with varicella pneumonia in adults?
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How does varicella pneumonia affect mortality rates in adults?
How does varicella pneumonia affect mortality rates in adults?
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What risk does varicella pose during pregnancy?
What risk does varicella pose during pregnancy?
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Study Notes
Varicella Complications in Children
- Rarely complicated in healthy children; most common complication is secondary bacterial infection of skin lesions.
- Staphylococci and Streptococci can lead to conditions like impetigo, cellulitis, and erysipelas; rare cases of necrotizing fasciitis.
- Local infections can cause scarring and, in rare instances, septicemia or metastatic infections.
- Bullous lesions may arise from Staphylococcal superinfection of vesicles, producing exfoliative toxins.
- Invasive group A Streptococcus infections are a notable complication, occurring within two weeks of the rash; historically constituted 15%-30% of invasive infections linked to varicella, now reduced to 2% due to vaccination.
Varicella Complications in Adults
- Adults experience more pronounced and extended fever and symptoms; rash is more extensive.
- Varicella pneumonia is a significant severe complication in adults, presenting with cough, dyspnea, tachypnea, high fever, pleuritic chest pain, cyanosis, and hemoptysis within 1 to 6 days post-rash onset.
- Imaging usually shows diffuse nodular densities in lung fields; severity often outweighs physical findings.
- Mortality rate for varicella pneumonia in adults is estimated between 10%-30%, dropping below 10% with prompt antiviral treatment, especially in non-immunocompromised patients.
Varicella During Pregnancy
- Presents threats to both mother and fetus; severe pneumonia can lead to maternal death.
- Incidence and severity of pneumonia do not significantly increase due to pregnancy.
- Fetal risks include premature labor and congenital varicella syndrome, which occurs in about 1% of cases when maternal infection happens in the first 20 weeks, peaking at 2% between 13-20 weeks.
- Perinatal varicella (within 10 days of birth) poses a higher risk compared to infections occurring later in infancy.
Varicella in Immunocompromised Patients
- Higher morbidity and mortality rates due to prolonged viremia and extensive rash.
- Common symptoms include severe abdominal and back pain; complications may include pneumonia, hepatitis, encephalitis, and hemorrhagic conditions like purpura fulminans.
- Neurological complications include acute cerebellar ataxia (occurring in 1 in 4000 cases, generally with good prognosis) and less common encephalitis (1 per 33,000 cases) which may lead to death or long-term neurological issues.
- Clinical hepatitis is rare except in immunocompromised patients; other rare complications include myocarditis, glomerulonephritis, orchitis, pancreatitis, and various allergic vasculitides.
Miscellaneous Complications
- Reye syndrome linked to varicella has become rare due to restriction of salicylate use in children.
- While mildly elevated aminotransferase levels are typical during varicella, significant liver complications are uncommon.
- Possible rare complications also include optic neuritis, keratitis, and ulcerative lesions of the bowel.
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Description
This quiz covers the complications associated with varicella (chickenpox) in both children and adults. It highlights the common and rare complications, including bacterial superinfections and severe respiratory issues in adult patients. Test your knowledge on this important topic related to infectious diseases.