[Pathogenesis]
The virus belongs to the Herpesviridae family, spherical, 150-200 nm in diameter, with a double-stranded DNA center and a 20-sided nucleocapsid outer shell, which is coated with a lipoprotein envelope containing complement-binding antigens, and does not contain hemagglutinins or hemolysins.
There is only one serotype of this virus, which can multiply in human embryonic fibroblasts and thyroid cells, producing focal cellular lesions, eosinophilic inclusion bodies and multinucleated giant cells in the nucleus. Humans are the only host.
VZV is weakly viable, intolerant of heat, does not survive in scabs, and is easily inactivated by disinfectants. However, it can survive in herpes fluid at -65°C for 8 years.
The virus first multiplies in the upper respiratory tract, a small amount of virus invades the blood to multiply in the mononuclear phagocytosis system, and again a large amount of it enters the blood circulation, forming a second viremia, invading the skin and internal organs, causing morbidity.
[Epidemiology]
Varicella is highly infectious. Patients as the main source of infection, 1 ~ 2 days before the rash to 5 days after the rash are infectious. Children and herpes zoster patients can also occur in contact with chickenpox, because of the same etiology. Transmission is mainly respiratory droplet or direct contact infection. Can also be contact with contaminated objects between the reception of infection.
The disease develops mainly in winter and spring, mainly in children aged 2 to 10 years. The population is generally susceptible to the disease, but a single attack can be lifelong immunity.
(a) Source of infection Varicella patients as the main source of infection, since the chickenpox rash 1 ~ 2 days before to the rash dry scab, are infectious. Susceptible children in contact with patients with herpes zoster, can also occur chickenpox, but rare.
(ii) transmission mainly through droplets and direct contact. In close proximity, a short period of time can also be transmitted indirectly through healthy people.
(3) susceptible people Universal susceptibility. However, the most pre-school children. 6 months of infants due to maternal antibodies, the incidence of less, chickenpox during pregnancy can infect the fetus. After the disease to obtain lasting immunity, but can occur herpes zoster.
(4) Epidemiological features can occur throughout the year, winter and spring are more common. The disease is highly contagious, susceptible to contact with the patient about 90% morbidity, so kindergartens, elementary school and other children's collective institutions are prone to cause epidemics.
[Pathogenesis and pathological anatomy]
The virus invades from the respiratory tract, grows and reproduces in the mucous membranes and then enters the blood and lymph fluid, proliferates again in the reticuloendothelial cell system, and invades the bloodstream to cause a second viremia and systemic lesions, with the main site of damage being in the skin, and the rash appearing in blisters related to intermittent viremia. Subsequently, a specific immune response occurs, viremia disappears, and symptoms are relieved. Severe systemic varicella occurs when immunocompromised. In some cases the lesions may involve internal organs. Part of the virus is imported along sensory nerve endings. Long-term latent in the spinal nerve posterior root ganglion and other places, the formation of chronic latent infection. When the body's immunity decreases (such as malignant tumors, irritation) the virus is activated, resulting in ganglionitis, and along the nerves down to the corresponding skin segments, resulting in clusters of herpes and neuralgia, known as herpes zoster.
Varicella lesions are primarily in the epidermal acanthocytes. Cell degeneration, edema to form vesicular cells, the latter liquefaction and tissue infiltration to form a blister, its surrounding and base with congestion, monocytes and multinucleated giant cell infiltration, multinucleated giant cell nuclei with eosinophilic inclusion bodies. The blister contains a large number of viruses. The blisters are transparent at the beginning, then become cloudy due to epithelial cell shedding and leukocyte invasion, and may turn into pustules after secondary infection. Skin damage is superficial and does not leave a scar after scab removal. Mucous membrane herpes is easy to form ulcers, also easy to heal. Varicella individual cases of lesions can involve the lungs, esophagus, stomach, small intestine, liver, adrenal glands, pancreas, etc., causing local congestion, hemorrhage, inflammatory cell infiltration and focal necrosis. Inflammatory cell infiltration, hemorrhage, focal necrosis and fibrous changes can occur in ganglia involved in herpes zoster.
[Clinical manifestations]
The incubation period of the disease is about 14 to 15 days. The onset of the disease is rapid, with mild to moderate fever and a rash, which first appears on the scalp and the compressed part of the trunk, with a centripetal distribution. The rash appears in successive batches over a period of 1 to 6 days. The skin lesions show the evolution of small red macules → paraneoplastic rash → symptomatic rash → desquamation, leaving no fatigue scars after desquamation. Scarring period pain and itching is obvious, if due to scratching secondary infection can leave a mild indentation. The frail can appear high fever, about 4% of adults can occur dissemination of chickenpox, chickenpox pneumonia.
Mostly found in children aged 1-10 years, incubation period of 2-3 weeks. The onset of the disease is more acute, there may be fever, headache, generalized lethargy and other prodromal symptoms. Within 24 hours of the onset of the rash, quickly turned into a rice to pea-sized rounded nervous blisters, surrounded by a clear red halo, the center of the blisters was umbilical fossa. After about 2-3 days, the blisters dry up and crust, and the scabs come off and heal without leaving scars. The skin lesions are distributed centripetally, starting from the front of the face, and then seen on the trunk and limbs. The number of lesions is variable, with the trunk being the most common, followed by the face and head, the limbs being less common, and the palms and metatarsals being even less common. Mucous membranes are also often invaded, seen in the oral cavity, pharynx, conjunctiva, vulva, anus and other places. The lesions often occur in batches, so that papules, blisters and scabs are often present at the same time, and the course of the disease lasts 2-3 weeks. If the child's resistance is low, the lesions can be progressive systemic dissemination, forming disseminated chickenpox. The clinical heterogeneity of chickenpox manifestation: herpetic chickenpox, hemorrhagic chickenpox, neonatal chickenpox, adult chickenpox and so on.
Need to distinguish with smallpox: smallpox systemic reaction heavy, the beginning of the 39-40 degrees of high fever, heat drop after the rash, lesions in the center of the obvious umbilical concave, face increased, after the healing of the legacy of depressed scars. There is should pay attention to the difference with impetigo and papular urticaria.
[Diagnosis]
[Treatment]
There is no specific treatment for this disease, mainly symptomatic treatment to prevent secondary skin infections, keep clean to avoid itching. Herpes rupture or secondary infection can be coated with 1% methyl violet, unbroken can be coated with glycerite lotion. In the early stage, the use of acephate cytoxan 10mg/kg/day or cyclic guanosine 8mg/kg/day for 5-7 days, or the addition of interferon, which can inhibit the replication of the virus. Daily intramuscular injection of vitamin B12500~1000ug, also has a certain efficacy. There are secondary infections can choose effective antitoxin, chickenpox should not use hormones to avoid causing viral dissemination.
[Prognosis]
[Prevention]
The prevention of this disease focuses on the management of the source of infection, isolation of the patient until all the symptoms of the rash. Highly susceptible individuals with a history of exposure can be injected with varicella zoster immunoglobulin or high-valency herpes zoster immune plasma within 3 days to reduce the risk of morbidity.
Isolate patients until all rashes are crusted over or 7 days after rash emergence. Their contaminants and utensils can be sterilized by boiling or exposure to sunlight. Susceptible persons exposed to chickenpox should be retained for examination for 3 weeks, or early application of gammaglobulin (0.4-0.6 ml/kg) or herpes zoster immunoglobulin 5 ml can significantly reduce the incidence of chickenpox and alleviate the symptoms. The live varicella virus vaccine developed in recent years is effective for prevention in normal susceptible children.
Reference:
Prevention and treatment of chickenpox
Chickenpox is an acute respiratory infectious disease with a rash caused by chickenpox viruses. ～Chickenpox is a rash of acute respiratory infections caused by the chickenpox virus. Mainly through the air droplets through the respiratory tract, but also due to contact with the child herpes herpes plasma through clothing, utensils, toys infectious, highly contagious. It is highly contagious. It can occur throughout the year, mostly in winter and spring.
After a child is infected with chickenpox virus, it takes 2 to 3 weeks of incubation before symptoms appear. Generally, the first fever for a day, accompanied by headache, anorexia, crying, irritability, general discomfort or cough, and then there is a rash appeared, mostly scattered in the head and face, trunk and armpits, occurring in the limbs, palms, soles of the feet is rare, was centripetal distribution. At the beginning of the skin appeared rice grain to bean size bright red rash or macules, within 24 hours to form a round or oval blisters, surrounded by a red halo, blisters are very easy to rupture and ulcerated. 3 ~ 5 days later, the blisters gradually dry, first by the center of the atrophy, and then scabs, and then after a few days or 2 ~ 3 weeks, the scabs are completely off and cured, generally do not leave traces. The conjunctiva of the eyes, the mucous membranes of the mouth and pharynx, and the mucous membranes of the vagina can be damaged during the onset of the disease. Lifelong immunity can be obtained after the disease. A small number of children with weak resistance and poor immune function will develop hemorrhagic blisters and secondary bacterial infections, which can lead to encephalitis, pneumonia, myocarditis or other organ diseases.
The condition of children with chickenpox is generally mild, with few complications, no special treatment is required, and it can often be cured naturally within 7 to 10 days. However, careful care should be taken to prevent infection. Fever and rash period to bed rest, give the child drink more water, and supply nutritious, easy to digest food such as milk, eggs, fruits, vegetables, etc., avoid eating spicy fish and shrimp and other foods; to prevent cold and flu, especially do not blowing the wind; often wash your hands and wash your face, change your clothes often, to keep the skin clean; pay attention to the cleanliness of the clothing and utensils disinfection, hygiene. The room should be ventilated frequently, and the temperature and humidity should be appropriate. Cut short nails to avoid children scratching the rash and cause infection. If the itching is serious, you can rub the stove dry stone lotion to stop itching, you can also take drugs such as paracetamol; herpes ulcer can be coated with gentian violet, there are infections can be coated with some local anti-inflammatory ointment, if necessary, you can take safranin, sulfonamides; do not use the skin light, prednisone, a class of ointment, so as not to cause systemic chickenpox. If there is a persistent high fever, cough, headache, chest pain or herpes intensive, red, red, blister fluid turbid and has occurred diffuse abscesses, cellulitis or lymphadenitis of the child, it is necessary to send to the hospital for treatment.
In order to prevent the transmission of chickenpox, the child should be isolated until the rash is all scabbed, the best for children who have been in contact with the chickenpox patient should also be isolated and observed for 3 weeks, the frail can be injected with gammaglobulin within 4 days after contact. During the epidemic as little as possible to take children to public **** place.
Chickenpox is an acute infectious disease caused by varicella zoster virus. Children are common, highly contagious, the main means of transmission for droplets. It is characterized by a rash first seen on the trunk, and then spread to the face, and finally up to the limbs, was polymorphic rash: spots, papules, herpes, scabs. Chickenpox patients should be strictly isolated, rest, eat a nutritious and easily digestible diet. Wet compresses of 2%-5% NaHCO3 should be applied to broken skin, hand scratching should be avoided, and antibiotic ointment should be applied to pus-filled areas. Antiviral treatment for immunodeficiency. Adrenocorticotropic hormones are contraindicated.
Chickenpox
What is chickenpox?
Chickenpox is a highly contagious disease caused by the varicella zoster virus. It affects almost everyone, usually in childhood. If you don't get the disease in childhood, you can still be susceptible and infected in adulthood.
How is it contracted?
Contact with a person in the infectious stage. The virus is spread through the air by coughs and sneezes of the patient, or by contact with cloths and bedding used by the patient, while scabbing in the later stages of the disease is not infectious.
What are the symptoms?
A low-grade fever, headache, and loss of appetite are followed by 1-2 days of scratchy, itchy blisters on the skin, often starting on the trunk and spreading to the face and other parts of the body. In severe cases, blisters may appear on the head, armpits, eyelids, and mouth, then rupture and crust over. Symptoms tend to be more severe in adults than in children.
When do symptoms appear?
Usually 2 weeks after exposure to the virus, but can be 11-21 days.
How long does the infection last?
1-2 days before blisters appear to 5 days after the first blisters appear. It is considered non-infectious when all blisters are dry.
Is isolation required?
Yes. Patients should be isolated from work or school for 5 days after the first blisters appear, or until all blisters are dry and crusted.
How is it treated?
Usually no specific treatment is necessary; glycerite lotion is often used to stop the itching, but if this is not effective, medical attention should be sought.
Is there a vaccine?
Yes. The varicella vaccine is approved for use in the United States. Check with your doctor.
How can I protect myself from infection?
Avoid contact with the patient and, if at risk, get vaccinated as early chickenpox is almost impossible to diagnose. Patients should be isolated until 5 days after the appearance of the first blisters, or until all chickenpox has dried and crusted over.
Chickenpox
(Varicella)
Chickenpox is a highly acute, contagious disease of children, with occasional occurrence in adults. There is lifelong immunity. It is a primary infection caused by the herpes complex DNA virus, varicella zoster virus. It is characterized by fever and circumscribed red maculopapular rash, herpes, and crusting.
Etiology and pathogenesis
Varicella zoster virus (VZV), brick-shaped, 150-200 nm in diameter, nucleic acid is DNA, has a three-dimensional symmetrical capsid, and reproduces intracellularly. The patient is the only source of infection.VZV is present in the patient's respiratory secretions, herpes, and blood, and is transmitted by droplets or direct contact with the herpes, and it is known to be transmitted by medical devices.VZV invades mainly through the respiratory tract, grows and multiplies in the mucous membranes, and then enters the bloodstream and lymphatic fluids, where it multiplies a second time in the reticuloendothelial cells to cause viremia and systemic lesions. The main site of damage is the skin, occasionally involving internal organs.
Clinical manifestations
Treatment
Children should be isolated early until all rashes are crusted. Children who have had contact with chickenpox should be isolated and observed for 3 weeks.
Systemic treatment
The main thing is to strengthen the care and prevent secondary infection and complications. Bed rest should be provided during the febrile period, and adequate nutritional support and water supply should be given. Clinical symptomatic medication is the main. Those with high fever can be given topical glycerite lotion to stop itching. Those with blister breakage can be coated with 2% gentian violet solution, and broad-spectrum antibiotics are needed if there are complications such as diffuse pustules, cellulite or acute lymphadenitis. In severe cases, gammaglobulin can be injected intramuscularly. Corticosteroids are contraindicated to prevent generalization and exacerbation of chickenpox.
For immunocompromised patients with disseminated chickenpox, neonatal chickenpox or chickenpox pneumonia, encephalitis and other serious cases, should be taken early antiviral drug treatment. Adenosine 10mg/kg-d, intravenous drip. Or acyclic guanosine 5-10mg/kg, intravenous injection every 8 hours, the course of 5-7 days, or add a-interferon, in order to inhibit viral replication, prevent the spread of the virus, promote the healing of the skin lesions, accelerate the recovery of the disease, reduce the morbidity and mortality rate.
How does chickenpox occur?
Chickenpox is common in children aged 2 to 10 years old, is a rapid onset, highly infectious infectious disease. Chickenpox occurs in winter and spring, and often causes epidemics in kindergartens or elementary schools.
The causative agent of chickenpox is varicella zoster virus, which is present in the patient's blood, herpes plasma and oral secretions. It is mainly transmitted by droplets through the respiratory tract, and can also be transmitted by contact with virus-contaminated dust, clothing, utensils, etc. In other words, if a healthy child has chickenpox with an infected person, he or she may be infected. That is to say, if healthy children and children with chickenpox often play together, talk, close contact can be infected and develop the disease. Therefore, once you have chickenpox, you should pay attention to isolation and should not go to kindergarten or school until you are completely cured. Even with the chickenpox patient contacted children, should also be isolated for observation for 2 to 3 weeks. Because the infection of the virus is not immediately after the onset of disease, generally after 14 to 17 days of incubation period, the longest up to 3 weeks.
Chickenpox is highly contagious, the patient is the only source of infection, with about 90% of children in contact with the disease. And from the day before the onset of the disease to all the rash is dry and crusted are infectious.
The onset of the disease is more acute, there can be fever, lethargy, loss of appetite and other systemic symptoms, adults are more obvious than children, usually within 1 to 2 days of the rash. The rash starts on the trunk, and gradually extends to the head, face and limbs, with a centripetal distribution, i.e., more on the trunk, less on the face and limbs, and less on the palms of the hands and the metatarsals of the feet. At the beginning of a small red papule, after a few hours into a green bean size blister, surrounded by a red halo. The blisters are clear water droplets, thin walled and easy to break, accompanied by itching. After 2 to 3 days and dry scabs, later scabs off and healing, without leaving scars. In the onset of 3 to 5 days, the rash occurred in batches, so at the same time can be seen papules, blisters, scabs and other different periods of skin lesions, the duration of the disease is about 2 to 3 weeks.
Damage to the mucous membranes of the mouth, eye conjunctiva, pharynx, vulva, etc., can also occur occasionally, often forming ulcers and accompanied by pain.
The rash is not the more the better, as long as in line with the general pattern of rash, more or less is normal. If the blisters scratched secondary bacterial infection, skin gangrene can occur, and even cause sepsis. In addition, a few patients can also appear chickenpox pneumonia, encephalitis, myocarditis and fulminant purpura and other complications.
According to Chinese medicine, this disease is caused by exogenous heat and toxicity, dampness and heat in the skin.
Will chickenpox leave scars?
Chickenpox occurs in a wide range of areas, can be extended to the head and face, and appear in batches, the number of more, so some people are worried about whether it will leave scars, affecting the aesthetic. This worry is unnecessary.
Generally speaking, chickenpox occurs in accordance with the natural course of the disease, subside, even if the blisters are large after the formation of vesicles, will soon be cured, after the healing does not leave scars. But if you do not pay attention to keep the skin clean, repeated scratching and rupture is easy to secondary bacterial infection, or even gangrene, there will be scars after healing. Because the simple chickenpox damage site is very shallow, did not reach the dermal tissue, if the combination of bacterial infection will be down to destroy and lead to scar formation.
It can be seen that chickenpox will not leave a scar. However, there are several special types of chickenpox that should be noted.
(1) herpetic chickenpox is only seen in children under 2 years of age. The blisters of 2-7cm in size occur in batches and form vesicles when they break down, but they heal quickly.
(2) hemorrhagic chickenpox The contents of the blisters are bloody, with high fever and severe systemic symptoms. Prevalent in malnutrition, malignant lymphoma, leukemia and other patients treated with immunosuppressants and corticosteroids.
(3) Neonatal chickenpox is usually infected by the mother during labor and delivery, and the symptoms are usually mild, but systemic damage and death can also occur.
(4) Adult chickenpox The symptoms are more serious than those of pediatrics. The prodromal period is long, high fever, systemic symptoms are more serious, the number of rashes is more, also more itchy.
The above special types are rare, but once they occur, care should be strengthened to prevent secondary infections. Otherwise, it is not just a matter of scarring, but also serious complications such as pneumonia, encephalitis, myocarditis, nephritis, and even life-threatening.
How does Chinese medicine treat chickenpox?
Modern medicine has no specific drugs for viral diseases, so the treatment of chickenpox is mainly to prevent secondary infections and strengthen care. Fever should be bed rest, eat easily digestible food, to ensure the supply of nutrients and water; higher body temperature can be given antipyretic, skin itching can be oral antihistamines, can also be used externally to stop itching glycerine lotion, blisters after the breakthrough of the application of 2% gentian violet, and so on, are symptomatic treatment.
Chinese medicine believes that this disease is exogenous evil, injury to the lungs and spleen, dampness and heat, hair on the skin. The treatment is based on wind-dispersing and heat-clearing, detoxification and elimination of dampness, and can be divided into the following two types according to the severity of the disease:
(1) wind-heat and dampness evidence of the light type, the evidence shows that the fever, coughing, sniffling, chicken pox is red, sparsely distributed, and contains clear and bright water, accompanied by itching, poor nutrition, and the bowel movements, the tongue coating is thin and white, and the pulse is floating. The treatment should be to relieve wind, clear away heat and dampness. The formula is Yin Qiao San plus subtraction.
(2) Damp-heat blazing evidence is a serious evidence, mostly seen in children with weak physique. Heavy fever, manifested as strong heat and thirst, red lips and face, mental depression, dense acne rash purple dark color, acne pulp turbid and opaque, and even oral herpes, accompanied by a dry mouth and want to drink, dry stools, short and red urination, yellow and thick and dry tongue coating, and the pulse is torrential or slippery. This is a case of evil prevailed in the body, dampness, heat and toxicity of the internal offense. Treatment should increase the power of clearing heat, cooling blood and detoxification. The formula selected plus flavor disinfectant drink plus subtraction.
According to the patient's specific situation, the appropriate choice of Western medicine symptomatic treatment, such as antipyretic, antipruritic and so on. The rest of the requirements of Chinese and Western medicine in nursing, diet, disinfection, isolation, etc. are the same.
Chickenpox (varicella) is an infection caused by varicella-zoster virus, which is highly contagious. It is highly contagious and generally provides lifelong immunity after infection.
〖Clinical features〗
I. Etiology
Varicella zoster virus causes.
Second, the prevalence of age, mainly in children
Third, the incubation period
2 weeks,
Fourth, the prodromal symptoms of fever and other discomforts, 1 to 2 days out of the rash, from the trunk to the limbs of the spread of the rash,
Fifth, the characteristics of the lesions pimples, blisters, scabs at the same time, the size of mung beans, surrounded by a red halo, the mucous membranes may be a rash (Fig1), the skin, the skin and the skin, the skin and the skin, the skin and the skin, and the skin.
Sixth, self-conscious symptoms, slightly itchy,
seventh, the course of the disease
2 to 3 weeks,
eighth, prognosis
self-limiting, generally do not leave scars, can cause neurocutaneous reinfection, manifested as herpes zoster.
〖Differential Diagnosis〗 Impetigo
〖Preventive Treatment〗
Symptomatic, strengthen care, prevent secondary infection. Actively isolate the patient to prevent infection.
(a) Early isolation until the rash is completely crusted and dry.
(ii) local treatment to stop itching and prevent infection, can be externally applied gentian violet liquid, secondary infection can be externally used antibacterial ointment.
(c) secondary infection systemic symptoms are serious, available antibiotics.
For those with low resistance, intramuscular injection of gammaglobulin 3ml/day for 3 days.
Varicella
Varicella (Varicella,Chicken-pox) is an acute respiratory infectious disease caused by varicella-herpes zoster virus (Varicella-herpds,zoster virus,VZV). Chickenpox is a primary infection, mostly seen in children, clinically characterized by mild and systemic symptoms and rapidly developing macules, papules, herpes and crusts on the skin and mucous membranes in batches.
[Clinical manifestations]
Incubation period of 14 to 16 days (10 to 24 days)
(a) Prodromal period Infants and young children often have no prodromal symptoms. Elderly children or adults may have fever and headache, general malaise, nausea and upper respiratory symptoms, 1 to 2 days before the rash. Occasionally, a prodromal rash may appear.
(2) Rash period Rash appears at the same time of fever or 1-2 days later, and the rash has the following characteristics:
1. It is first seen on the trunk and head, and then extends to the whole body. Rash development is rapid, the beginning of the red blotchy rash, within a few hours into papules, and then the formation of herpes, herpes when the feeling of skin scratching, and then dry scabs, this process sometimes only 6 to 8 hours, such as the absence of infection, 1 to 2 weeks after the scabs fall off, generally do not leave a scar.
2. The rash is often oval, 3 to 5 mm, surrounded by a red halo, herpes superficial easy to break. The blister fluid is transparent at the beginning, and then turbid, secondary infection can be purulent, the scab time is prolonged and can leave a scar.
3. The rash is centripetal distribution, the trunk is the most, followed by the head and face and proximal extremities. The number varies from a few to thousands.
4. The rash appears in batches, and spots, papules, herpes, and crusts can be seen in the same area at the same time.
5. Superficial herpes can occur in the mucous membranes of the oral cavity, vulva, eye conjunctiva, etc., and is easily broken to form superficial ulcers with pain.
Atypical chickenpox is often formed when there is an immune deficiency, coagulation mechanism disorders and secondary infections. Rash fusion for herpes type, diameter up to 2 ~ 7cm, easy to secondary aureus infection and septicemia and death; herpes is hemorrhagic, subcutaneous, mucous membrane petechiae for hemorrhagic type, can be accompanied by other parts of the body hemorrhage; a large swath of necrosis of the skin, the systemic toxicity of the severe symptoms is called necrotic type; lesions spread to involve the viscera is called the dissemination of the type, most often seen in immunocompromised patients. Chickenpox infection in the first trimester of pregnancy can lead to fetal congenital malformations, known as congenital varicella syndrome.
[Complications]
(a) Secondary infection of cutaneous herpes can cause herpes pustularis, cellulitis, sepsis, and so on.
(b) Pneumonia Adults are mostly primary varicella pneumonia, which occurs 1 to 5 days after the rash, and children are often secondary pneumonia, which occurs 2 to 3 weeks later in the course of the disease.
(C) varicella encephalitis incidence of less than 1 per thousand, more children than adults, often one week after the onset of rash. Clinical manifestations and cerebrospinal fluid seen with the general viral encephalitis similar to the mortality rate of about 5%, a few have central nervous system sequelae.
(D) Other varicella hepatitis, myocarditis, nephritis, etc. are rare.
[Diagnosis]
(I) Epidemiology For preschool children with mild fever and respiratory symptoms in winter and spring, attention should be paid to careful physical examination, and ask whether there is a history of contact with chickenpox patients.
(2) Clinical manifestations According to the characteristics of the rash, centripetal distribution, appeared in batches, a variety of rashes at the same time, mucous membrane rash, systemic symptoms are mild or absent, most can establish the diagnosis.
(C) Laboratory tests
1. The total number of blood leukocytes is normal or slightly elevated.
2. Herpes scrapings or tissue biopsy, scrapings of fresh herpes substrate with Rachel's or Giemsa's staining to check the multinucleated giant cells, with acid staining to check the nuclear inclusion bodies.
3. Virus isolation In the onset of the disease within 3 days of herpes fluid to do cell culture, the virus isolation of the positive rate is high, and then use immunofluorescence, enzyme-linked immunosorbent assay and radioimmunoassay and other methods of identification. You can also take fresh herpes fluid directly to do electron microscopy.
4. Serum antibody detection can be measured by complement binding test and other methods.
[Differential diagnosis]
This disease should be differentiated from the following diseases:
(a) pustulosis occurs around the nose and lips and exposed parts of the limbs. Easy to form pustules and thick yellow scabs, spread by scratching. It does not appear in batches and has no systemic symptoms.
(2) papular urticaria is a skin allergic disease in infants and children. The rash is a red papule with small blisters at the tip, no red halo, appearing in batches, centrifugal distribution, not involving the head and mouth.
(C) Herpes zoster Herpes are arranged in clusters, distributed along the peripheral nerves of the skin on one side of the body, asymmetric, with localized pain.
[Treatment]
(I) general treatment and symptomatic treatment
Respiratory isolation, bed rest, strengthen care to prevent the herpes rupture infection. Rash has broken out can be coated with gentian violet or neomycin ointment. Secondary infection should be early selection of sensitive antibiotics. Itchy people can be given glycerine lotion and antihistamine drugs. Pneumonia and encephalitis are treated as pneumonia and encephalitis. Hormone is generally prohibited, when combined with serious complications, under the premise of applying effective antibiotics, discretionary use. Those who have used hormones before the disease should reduce or stop using them as soon as possible.
(B) antiviral therapy
Interferon, 100 to 200,000 μ / day, for 3 to 5 days; other such as adenosine, acyclic guanosine can also be used. Varicella (varicella, chicken pox) ...... Pathogen: virus multiplies in the nucleus of infected cells, forming eosinophilic inclusion bodies, the virus exists in the herpes blister plasma, blood and pharyngeal secretions, through contact or droplet infection, highly contagious, susceptible to about 90% of the disease after contact. Virus in vitro viability is very weak, can be inactivated by ethanol, 1 time the disease can be lifelong immunity. Modern medical pathology: the virus enters the human body through the mouth and nose, first multiply in the respiratory mucosal cells, and then enter the blood to produce viremia. The herpes of varicella is limited to the epidermal layer of echinocytes, with degenerative lesions and intracellular edema, formation of vesicular cells, and the formation of unicompartmental herpes of water due to cell lysis, liquefaction, and influx of tissue fluids (smallpox forms a multicompartmental herpes), with capillary dilatation and tonic nucleated cell infiltration in the dermis. Mucosal rash lesions are similar to the rash. Chinese medicine etiology and pathogenesis analysis: Chinese medicine believes that this disease is exogenous when the evil venom, mostly from the mouth and nose into the lungs and spleen. Lungs and fur, the main purging and descending, the external evil attack lungs, declaring and descending disorder, the initial stage of the lungs and symptoms, such as fever, cough, runny nose, and so on. If there is dampness and heat in the stomach and intestines, or if the virus penetrates deeper, symptoms of qi may appear. Spleen is the master of muscle, the evil poison and internal dampness fight, external muscle surface, help the cause of chickenpox Bulu. This disease mostly belongs to the wind-heat light evidence, the time line of the evil venom clearing that is solved. Because of this disease, the evil venom is generally only hurt Wei, gas, and very little into the camp blood, so the condition is lighter than smallpox, measles, prognosis is good, and the change of the evidence of risk is also less. A small number of children due to poisonous heat blazing, internal offense gas camp, or even camp blood involved, heavy can be accompanied by high fever, irritability, face red, pox points thick, color red, purple and other serious conditions. Clinical manifestations: incubation period: 7-17 days. Prodromal period: the onset of acute, young children prodromal period symptoms are often not obvious, the beginning of the rash. Older children often have fever, up to 39-40 ℃, often accompanied by general malaise, loss of appetite, can be seen in the antecedent rash, such as scarlet fever or measles-like rash, disappear in 24 hours. Rash period: on the day of onset of disease or the second day of the appearance of the initial red maculopapular rash, a few hours later quickly become herpes blisters, the diameter of 0.3-0.8mm droplet-shaped blisters, which is surrounded by a red halo. 24 hours of blisters, the liquid becomes cloudy, easy to break, herpes lasts for 3-4 days and then scabs, scabs cover the shedding in 5-10 days, short-term ellipse-shaped shallow scars remain. Chickenpox rash usually appears in batches within 3-5 days of the onset of the disease, the development of each batch of rash has the above process, therefore, at the same time, maculopapular rash, herpes blisters and scabs can be seen. The rash is pruritic. The rash is mainly found on the trunk and head and face, less on the distal extremities, and even less on the palms and soles of the feet, with a centripetal distribution, which is one of the characteristics of chickenpox rash. The number of rashes varies from tens to hundreds. Mucosal chickenpox rash can occur in the oral cavity, eye conjunctiva, vulva, etc., rupture can become shallow ulcers, rapid healing. If herpes occurs in the cornea, it is potentially dangerous to vision. A small number of heavy, seen in frail young infants, immunodeficient children, or children being treated with hormones and other immunosuppressive drugs (such as rheumatic fever or renal disease children) with chickenpox can often exacerbate the condition, and occasionally fatal, the clinical manifestations of the herpes number of herpes, densely covered the whole body, and often fused to form a large pustular type of herpes, or hemorrhagic rash, or accompanied by a severe thrombocytopenia. A small number of children develop malignant purpura, most often occurring around 7 days after the onset of the disease, and the purpura may be accompanied by necrotic lesions. Congenital chickenpox, occurring within 5-10 days after birth, is due to the mother's chickenpox at the end of pregnancy, the condition is often more severe, and the morbidity and mortality rate can be up to 20%. Diagnosis: 1. According to the epidemiological data, the diagnosis can be made on the basis of mild systemic symptoms, typical droplet-shaped herpes, together with maculopapular rash, blisters and crusts, and centripetal distribution of the rash. 2. Laboratory examination: most of the white blood cells are normal. Within 3 days of the onset of chickenpox, blister fluid inoculated with human fetal amniotic membrane cell culture, often can be isolated virus, pharyngeal secretions and blood can also be isolated virus, but the positive rate is low. From the fresh chickenpox bottom material, scraping, Ricci staining, can find multinucleated giant cells and nuclear inclusion bodies, can be used as one of the rapid diagnostic methods. Serum complement binding test, in the recovery period, antibody titer increased more than 4 times, has diagnostic significance. 3. Complications The more common is the rash secondary bacterial infection. Varicella encephalitis, the incidence rate is less than 2%. The clinical presentation is generalized viral encephalitis, occurring 3-20 days after onset of illness. Fifteen percent of survivors have permanent sequelae such as seizures, mental retardation, or behavioral abnormalities. Primary varicella pneumonia, most often occurring 2-6 days after rash onset, is clinically severe with interstitial pneumonia-like lesions on X-ray and may last 6-12 weeks. Differential diagnosis: 1. herpes pustulosis: mostly occurring in summer and fall, with the face, limbs, herpes fluid is pus-like, smear signs and culture can be seen staphylococcus, etc.. 2. herpetic eczema (Kaposi chickenpox-like rash): when eczema with herpes simplex infection. Clinical manifestations of more acute onset, high fever, collapse and chickenpox-like rash, often violent course, high mortality rate, extensive skin involvement, large loss of body fluids, resulting in hydroelectrolyte disorders, shock or secondary infection and death. 3. Hand, Foot and Mouth Disease (HFMD): Mostly seen in children under 4 years old. Distal extremities such as palms, soles or fingers, toes between the appearance of herpes, rarely formed ulcers, not scab. The pathogens are coxsackie A16, 10, 17 enteroviruses and so on. 4. Mossy urticaria: most common in infants and young children. The tip of the rash is slightly similar to herpes, but smaller and firmer than chickenpox, mostly distributed in the limbs, trunk, red papules appear in batches, scratching. Most have a history of allergy and insect bites or intestinal roundworm infection. Treatment: general care: the disease is highly contagious, found that the child should be immediately isolated, at least until the pox rash all scabs. Children with fever should be put on bed rest and given easily digestible food and sufficient water. Children's skin should be clean, due to itchy skin, to prevent scratching, should cut nails, with gloves. Drug treatment: Symptomatic treatment: for those with skin breakage, 10% gentian violet can be applied externally; itchy skin