26 Questions
What is the characteristic of the rash in scarlet fever?
Maculopapular and respects palms and soles
What is the order of the rash development in measles?
D1 face → D2 trunk → D3 extremities
What is a complication of varicella that can occur if the patient scratches the lesions?
Bacterial superinfection
What is the characteristic of the rash in rubella?
Very discrete and pink-coloured
Which of the following patients is recommended to receive antiviral treatment?
Patients aged >12 years with severe cases
What is the dose of acyclovir for adults with varicella?
800mg x 5/day
What is the complication of varicella in adults, pregnant patients, and immunodeficient patients?
Pneumonia
What is the laboratory diagnosis of varicella?
Tzanck test
What is the duration of antiviral treatment for varicella?
7 days
What is the route of administration for specific anti-VZV immunoglobulins in prophylaxis?
Intravenous
What is the characteristic of the rash in varicella?
Not itchy and maculopapular
What is the differential diagnosis of scarlet fever?
Varicella, measles, and rubella
What is the time frame for administering specific anti-VZV immunoglobulins in prophylaxis?
Within 72-96 hours after contact
What is the characteristic of the rash in measles?
Becomes brownish after a few days
What is a neurologic complication of varicella?
Meningitis
What is a risk factor for developing Reye syndrome?
Administration of aspirin
What is the sign seen in rubella?
Forscheimer dots
What is the complication of measles?
Conjunctivitis
How long does the incubation period for varicella typically last?
10-21 days
What is the primary method of diagnosing varicella?
Clinical presentation
What is the characteristic of the rash in varicella?
Polymorphic, including macules, papules, vesicles, umbilicated vesicles, and crusts
What is the risk of scarring in varicella?
Low risk of scarring unless the patient scratches the lesions
When is a patient with varicella contagious?
From 1-2 days before the onset of symptoms until the rash crusts
What is a key feature of the epidemiology of varicella?
Highly contagious and can spread through contact with an infected individual
What is NOT a typical symptom of varicella?
Joint pain
What is the purpose of laboratory testing in varicella?
Only in atypical presentations
Study Notes
Varicella (Chickenpox)
- Isolation of VZV on cell cultures is not used anymore.
- Tzanck test is used for diagnosis.
Differential Diagnosis
- Scarlet fever
- Measles
- Rubella
Scarlet Fever
- Rash is maculopapular, "sandpaper"-like, and not itchy.
- Respects palms and soles.
- Fades on the 24-48h after palms and soles.
- Filatov Mask and Grozovici-Pastia sign may be present.
Measles
- Rash develops on the face on Day 1, trunk on Day 2, and extremities on Day 3.
- Rash is maculopapular, not itchy, and becomes brownish after a few days.
- Conjunctivitis is present.
- Koplik sign may be present.
Rubella
- Rash is very discrete, pink-colored, and begins on the face but only lasts for a day.
- Forscheimer dots may be present.
- Lymphadenopathies persist for weeks.
Complications of Varicella
- Pneumonia, often seen in adults, pregnant patients, ID patients, and newborns.
- Bacterial superinfection, neurologic complications (meningitis, encephalitis, etc.), and other organs can be affected.
- Reye syndrome, an acute encephalopathy associated with hepatic dysfunction, can occur if aspirin is administered.
Treatment of Varicella
- Antiviral treatment is recommended for patients aged >12 years, severe cases, ID patients, newborns, pregnant patients, and those with chronic treatment with aspirin/corticosteroids or atopic dermatitis.
- Acyclovir is the antiviral drug of choice, with doses depending on the severity of the case.
- Valacyclovir is an alternative treatment.
- Immunocompetent children with mild varicella can be treated with symptomatic treatment only.
Prophylaxis
- Passive immunization with specific anti-VZV immunoglobulins (anti-VZV IgG) can be used in pregnant patients, newborns, and those who come into contact with a confirmed case.
- Must be administered within 72-96h after contact.
Epidemiology of Varicella
- Incubation period is 10-21 days.
- Prodrome lasts 1-2 days.
- Eruption lasts 10-15 days.
- Asymptomatic cases can occur.
Clinical Presentation of Varicella
- Rash is polymorphic, very itchy, and develops in crops.
- Each element goes through the following stages: macule, papule, vesicle, umbilicated vesicle, and crust.
- The elements don't scar unless they become superinfected.
This quiz covers the diagnosis and differentiation of varicella (chickenpox) from other diseases such as scarlet fever, measles, and rubella. It includes the Tzanck test and characteristic rash symptoms.
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