What is Chickenpox in Children?
Chickenpox is an acute viral infection that manifests itself as mild fever, as well as small vesicles with clear contents that appear on the skin and mucous membranes of a child.
- without complications;
- with pneumonia;
- with encephalitis;
- with meningitis;
- with other complications.
Chicken pox is a typical childhood illness. Almost all children on the planet suffer the disease before the age of 10-14 years. A sick person is the only source of infection (including those with herpes zoster). From the patient, you can catch an infection 24 hours before the first rash and within 3-4 days after the appearance of the last rashes, especially in the first hours and days after the onset of vesicles. The virus can be detected in the contents of the vesicles, but not in the crusts that form in their place.
The transmission route for chickenpox infection is airborne. Rarely, the disease can be transmitted by contact, and you can get infected even at a great distance from the source. The virus can “migrate” with air currents through the ventilation of buildings, up and down stairwells. Also, the virus is transmitted to the fetus from the mother.
Children under 3 months of age rarely get chickenpox. But, as with most other infectious diseases, if the mother has no antibodies, newborns are also at risk of infection. The highest incidence rate is highest in winter and autumn. The minimum incidence is in the summer. Epidemics happen in big cities, but outbreaks are localized mainly in children’s groups (kindergartens, schools, etc.).
After 6 transferred chickenpox in children, a strong immunity is formed. Thanks to him, repeated diseases are rare (up to 3% of cases).
Smallpox is typical and atypical.
With typical smallpox, rashes form in the form of bubbles filled with a clear liquid on the patient’s body. In terms of severity, one distinguishes such typical chickenpox: mild, moderate, severe.
With mild typical chickenpox, body temperature rises to the level of 37.5–38.5 ° С. There are practically no symptoms of intoxication, a rash in a small amount.
With a moderate form, the temperature of the patient’s subject is 39 ° C. Detect mild symptoms of intoxication. Rashes on the skin are plentiful, also found on the mucous membranes.
Severe forms differ in temperature, reaching 39 ° C, while the rashes are very plentiful and large (there is no growth dynamics of the rashes). At the peak of the disease, neurotoxicosis with convulsive syndrome and meningoencephalitic reactions can occur.
Atypical chickenpox is divided into: hemorrhagic, rudimentary, gangrenous and generalized (visceral).
A rudimentary form of atypical chickenpox is common among children with residual immunity or those who received immunoglobulin, plasma during the incubation period. This form is characterized by rose-papular eruptions with rare vesicles that are barely visible. Body temperature is not elevated, the general condition is normal.
Generalized (visceral) form occurs in newborns. Sometimes it also affects older children who are weakened by serious illnesses and are treated with immunosuppressive drugs. Manifestations of the disease: hyperthermia, severe intoxication and damage to internal organs: lungs, liver, kidneys, etc. The disease is severe, frequent deaths. An autopsy shows small necrotic foci in the affected organs and in the bone marrow.
The hemorrhagic form of smallpox is characteristic of children who have weakened body forces and who suffer from hemoblastoses or hemorrhagic diathesis, and treatment was carried out for a long time with corticosteroid hormones or cytostatics. With this form of the disease, the liquid filling the rashes-bubbles becomes hemorrhagic for 2-3 days. There is a possibility of hemorrhages in the mucous membranes and skin. Cases of nosebleeds and bloody vomiting are recorded. The prognosis in most cases is unfavorable.
There is also a gangrenous form in which inflammation appears surrounded by hemorrhagic vesicles, after which necrosis appears, which is covered with a bloody scab. After they fall away, deep ulcers remain, which increase and can merge. This form of smallpox can develop in an emaciated child if proper care is not taken for them, and the microbial flora joins the disease. The course of this form of smallpox is long.
But in typical cases of chickenpox in children, the disease is easy. The temperature returns to normal 3-5 days after the onset of the disease. If the form is severe, high body temperature can last up to a week or even 10 days. The crusts fall off after 1-2 weeks, in some cases (rarely) – on the third week of the disease. After crusts on the skin, slight pigmentation is noticeable, sometimes even scars.
With chickenpox, complications are specific – they arise under the influence of a virus or due to the attachment of bacterial flora. The most common specific complications are chickenpox encephalitis and meningoencephalitis. In rare cases, against the background of smallpox, nephritis, myelitis, myocarditis and other diseases occur.
In the early days of the disease, CNS damage is likely (when rashes are most pronounced). In this case, the patient’s condition is severe, hyperthermia is recorded. In the first 1-3 days, there are cramps and loss of consciousness with damage to the central nervous system. After improvement, focal symptoms and hemiparesis appear, which quickly passes. The course of the disease is favorable in most cases. Damage to the central nervous system with chickenpox is very rare.
More often, chickenpox encephalitis appears at the stage of crust formation; it is not associated with the severity of the acute phase of chickenpox. For several days the patient has normal temperature and normal general health, and then cerebral symptoms begin to appear, for example, lethargy, headache, and vomiting. The temperature rises. The most common in this case are cerebellar disorders: tremor, nystagmus, ataxia. Parents may note that the child walks staggering, may fall. Sometimes a sick child is not able to sit, stand, and cannot hold his head. Older children complain of dizziness (they can formulate it as if surrounding objects are staggering, including a crib).
The child speaks words more slowly and quietly. You may notice irregularities in the coordination of movements, meningeal symptoms are absent or mild.
Cerebrospinal fluid of a transparent shade, rarely fix cytosis as a result of an increase in the level of lymphocytes. Stable amount of sugar and protein. The disease proceeds favorably. Ataxia becomes smaller after a few days. But gait can be shaky for several months.
Complications in the central nervous system can manifest as paralysis of the facial or optic nerve, transverse myelitis, hypothalamic syndrome. In the specialized literature, Reye’s syndrome, fulminant purpura, myo-, meri- and endocarditis, hepatitis, glomerulonephritis, keratitis, etc. are described as complications of chickenpox in children in specialized literature.
Among bacterial complications, it is more often noted: phlegmon, abscess, impetigo, bullous streptoderma, erysipelas and lymphadenitis (it happens in malnourished children with poor skin and mucous membranes care).
Rashes on the oral mucosa can be complicated by stomatitis, and purulent conjunctivitis and keratitis on the mucous membrane of the eye. Croup syndrome and pneumonia are rare.
Causes of Chickenpox in Children
The causative agent of the disease is the herpes virus type 3. It contains DNA, similar in properties to HSV and is identical to the causative agent of herpes zoster, which is why it is designated as chicken pox virus – zoster.
Sometimes parents ask themselves why one virus can lead to different symptoms and manifestations. It all depends on the characteristics of specific immunity. Chicken pox is a manifestation of a primary infection in the body that is susceptible to the virus. And herpes zoster is a reactivation of a pathogenic infection in the immune system.
The virus quickly dies in the environment and is non-pathogenic to animals.
Pathogenesis during Chickenpox in Children
The virus enters the child’s body through the upper respiratory tract, in contact with the mucous membrane, where it multiplies initially. It enters the bloodstream through the lymphatic tract. With blood, it reaches the epithelial cells and mucous membranes, where it remains. Vesicles with serous contents appear. It contains a large amount of virus. Chickenpox virus can affect nerve tissue.
Changes in tissue structure occur in the skin and on the mucous membranes. Before the formation of the bubble, the virus infects the styloid epidermal cells, which are hyperplastic, and intranuclear and intititoplasmic oxyphilic inclusions are formed in them. Then in the cells begins balloon dystrophy, which leads to necrosis. The fluid that fills the bubbles is interstitial fluid. Swelling of the dermis is noted. When the reverse development of the bubbles begins, a brownish crust appears. If the form of the disease is generalized, vesicles can appear on the mucous membranes of the trachea, gastrointestinal tract, bladder, etc. Small foci of necrosis with peripheral hemorrhages can be found in the internal organs, mostly in the kidneys, liver, lungs and CNS Generalized forms of chickenpox are very rare, mainly in children with altered immune status.
Symptoms of Chickenpox in Children
From 11 to 21 days the incubation period lasts (on average – 2 weeks). The disease has an acute onset, the temperature of the child reaches 37.5-38.5 ° C. A mandatory symptom is the appearance of a rash described above. At first, the rashes look like small spots-papules, which after 2-3 hours turn into a vesicle with a diameter of 0.2 to 0.5 cm. The vesicles are usually round or oval, their base is uninfiltrated. Have transparent content. Individual vesicular elements have umbilical fusion in the center. Bubbles “deflate” when punctured. At the end of the first day (or on the second, which happens less often), the bubbles “deflate” and become crusty. Crusts disappear at 1-3 weeks from the onset of the disease.
Doctors recommend that you do not separate the crust from the skin, otherwise scars may form. After the crusts themselves have disappeared, dim pigment spots are visible in their place, if the process went well, the spots will go away, there will be no scarring. Rashes are visible on the face, under the hair, on the torso, arms and legs. The rash is usually not on the palms and soles of the child.
Sometimes rashes can appear on the oral mucosa, conjunctiva, and in more rare cases, on the mucous membrane of the throat and even the genitals of the patient. On the mucous membrane, the rash is tender, after opening it turns into superficial erosion, which leads to pain in the affected areas. Erosions heal on 3-5 days.
When infected with chickenpox, a rash does not occur simultaneously in all areas. Between the rashes there may be a gap of 1-2 days. Therefore, both fresh vesicles and crusts are observed on the skin. This is called a “false polymorphism” of the rash, characteristic of a disease like chickenpox.
When a rash appears on a new area of the skin or mucous membranes, a rise in temperature begins. At the height of the disease, rashes are most pronounced, general malaise begins, appetite is disturbed, the daily routine is also (due to sleep disturbances). Younger children become irritable, capricious, they are concerned about itchy skin, intoxication Symptoms are more pronounced with a profuse rash and in young children.
A blood test shows the immutability of peripheral blood. In some cases, a small leukopenia and relative lymphocytosis are recorded.
Diagnosis of Chickenpox in Children
Chickenpox is recognized in children by a vesicular rash based on the entire body, including under the hair on the head. The rash undergoes a peculiar evolution and is characterized by polymorphism.
Laboratory diagnosis involves the use of PCR. This method allows you to detect viral DNA in the blood and in the fluid that fills the rashes. For serological diagnosis using RSK and ELISA. CSC – complement fixation reaction. ELISA – enzyme immunoassay. Using the immunofluorescence method, one can detect the chickenpox gene in smears from the contents of the vesicles covering the skin and mucous membranes.
Differentiation of chickenpox is carried out in children with strofulus, impetigo, generalized forms of herpes, etc.
Forecast. Usually the disease ends in recovery. With malignant forms (gangrenous, generalized, hemorrhagic), deaths occur. A poor prognosis is also in cases of severe complications caused by the bacterial flora in young children, especially newborns, and with congenital chickenpox.
Treatment for Chickenpox in Children
For recovery, the hygienic content of the child, the cleanliness of the bed, linen, any clothes and hands are important. Vesicles (rashes) must be treated with a brilliant green solution, 5% cycloferon liniment, or 1-2% potassium permangalate solution.
The doctor may recommend general baths with a weak solution of potassium permanganate, rinsing the mouth with disinfectant solutions after eating. In cases of purulent complications, antibiotics are required at the doses prescribed by the attending physician. Treatment of smallpox with corticosteroid hormones is not indicated. But with the occurrence of chickenpox encephalitis or meningoencephalitis, steroid hormones have a positive effect.
Severe chickenpox in children is treated with antiviral drugs from the acyclovir group at a rate of 15 mg / (kg-day). It is administered orally or intravenously. Such therapy interrupts the course of chickenpox. The use of antiviral drugs has a positive effect, especially in cases of complication of the disease, for example, encephalitis, specific pneumonia, etc. In some cases, taking anaferon helps.
Prevention of Chickenpox in Children
In order to prevent congenital chickenpox in case of contact with patients with chickenpox in the last months of pregnancy, and if the woman has not previously suffered this disease, she is recommended to introduce 20 ml of immunoglobulin.
Sick children are isolated so that outbreaks do not occur in an organized team.