VIRAL INFECTION

1. VARICELLA
2. HERPES ZOSTER
3. HERPES SIMPLEKS
4. VERRUCA VULGARIS
5. KONDILOMA ACCUMINATA
6. MOLLUSCUM CONTAGIOSUM

DEFINITION
VARICELLA :
The highly contagious primary infection caused by

Varicella-Zoster Virus (VZV)

Characterized pruritic vesicles pustules & crust
Accompanied by mild constitutional symptoms
Primary infection in adulthood pneumonia &
encephalitis
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EPIDEMIOLOGY

Age of onset 90% < 10 years of age

< 5% > 15 years of age
Transmission airborne droplets & direct
contact

TRANSMISSION
Airbone droplet
Direct contact
Patient are contagious several days
before varicella exanthem appear &
until last crop of vesicles
Crust are not infectious
VZV can be aerosolized from skin of
person with HZ varicella in
susceptible contact

PATHOGENESIS OF PRIMARY INFECTION WITH VZV

PATHOGENESIS

VZV enter through mucosa of respiratory system

& oropharinx Colonies the upper respiratory tract
Replicates in the regional lymph nodes, 4-6 days
later a primary viremia to reticuloendothelial cells
One week a secondary viremia disseminates the
virus to the skin & mucous membranes

PATHOGENESIS
Localization of VZV in the basal cell
layer of epidermis is followed by
virus replication, balloning
degeneration of epithelial cells, and
accumulation of edema fluid with
vessiculation
During the course of varicella, VZV
passes from the skin lession to the
sensory nerve sensory ganglia
establish latent infection

PHYSICAL EXAMINATION
HISTORY
Incubation period
Prodrome
Exanthem appears
Skin symptoms

:
:
:
:

10-21 days
absent or mild.
2-3 days.
pruritic exanthem

PHYSICAL EXAMINATION
Skin lession :
Vesicular lession : papule vesicle
pustule crust erosion (8-12h)
heal (1-3 weeks)
Distribution : face -> scalp trunk
extremities
Mucous membrane palate >>

VARICELLA

A. A full spectrum of lesionsthat is, erythematous papules, vesicles (dewdrops

on rose petals), crusts, and erosions at sites of excoriationis seen in a child
with a typical case of varicella. B. A wider range of lesions, including many large
pustules, is seen in a 21-year-old female who was febrile as well as toxic and
had varicella pneumonitis.

DIFFERENTIAL DIAGNOSIS

Herpes Simplex Virus Infection

Enterovirus infections
Bullous form of impetigo
Exzema herpeticum

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COMPLICATION
Children < 5 years secondary
bacterial infection
Children 5-11 years Varicella
encephalitis Reye syndrome
Fetal varicella syndrome
Immunocompromized : hepatitis,
encephalitis, pneumonia

LABORATORY FINDING

VZV antigen detection (Direct Fluorescein Antibody)

Viral culture (Isolation of virus on virul culture from
vesicular skin lession)
Tzanc smear (Cytology of fluid ar scrapping from base of
vesicle)
Serology

THERAPY

Antiviral therapy
Symptomatic therapy
Treatment of bacterial superinfection
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TREATMENT
IMMUNIZATION
SYMPTOMATIC THERAPY
ANTIVIRAL AGENTS
Decrease severity if given within 24 hours of onset
Neonates : acyclovir 10 mg/kg every 8h for 10 days
Children (2-28 yrs) : Valacyclovir 20 mg/kg every 8h for 5 days or
Acyclovir 20 mg/kg every 6 h for 5 days
Adolescent : Valacyclovir 1 gr PO every 8h for 7 days
Immunocompromised : Valacyclovir 1 gr PO for 7-10 days; or Acyclovir
800mg by mouth 5 times a day or Famciclovir 500 mg by mouth every 8h
for 7-10 days
Severe immunocompromised : acyclovir 10 mg/kg IV every 8h for 7-10
days
Acyclovir resistent : Foscarnet 40 mg/kg IV every 8h until resolution

PROGNOSIS

Healthy children with varicella have excellent prognosis

In adult ; prodromal symptoms are common and may be

severe, with prolonge periode of recovery

Neonatal varicella mortality rates 30%

Complication :
Children < 5 y.o : bacterial superinfection
5-11 y.o : varicella encephalitis and Rey syndrome

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PREVENTION

Vaccination
Varicella-zoster immune globulin

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VARICELLA VACCINE

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TERIMA KASIH