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
EPIDEMIOLOGY
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
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
DIFFERENTIAL DIAGNOSIS
11
COMPLICATION
Children < 5 years secondary
bacterial infection
Children 5-11 years Varicella
encephalitis Reye syndrome
Fetal varicella syndrome
Immunocompromized : hepatitis,
encephalitis, pneumonia
LABORATORY FINDING
THERAPY
Antiviral therapy
Symptomatic therapy
Treatment of bacterial superinfection
13
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
Complication :
Children < 5 y.o : bacterial superinfection
5-11 y.o : varicella encephalitis and Rey syndrome
15
PREVENTION
Vaccination
Varicella-zoster immune globulin
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VARICELLA VACCINE
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TERIMA KASIH