Child with varicella disease.
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Chickenpox

Chickenpox, also spelled chicken pox, is the commonly known name for varicella disease, frequently but not exclusively contracted in childhood. more...

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Medicines

Chickenpox is caused by the varicella-zoster virus (VZV), also known as human herpes virus 3 (HHV-3), one of the eight herpes viruses known to affect humans. It is characterized by a fever, followed by itchy raw pox or open sores which heal without scarring.

Effects

Chickenpox has a two-week incubation period and is highly contagious by air transmission two days before symptoms appear. Therefore, chickenpox spreads quickly through schools and other places of close contact. Once someone has been infected with the disease, they usually develop protective immunity for life, and cannot get it again. As the disease is more severe if contracted by an adult, parents have been known to ensure their children become infected before adulthood.

The disease is rarely fatal: if it is involved in a fatality, the actual death is usually from opportunistic varicella pneumonia, and occurs more frequently in pregnant women. In the US, 55 percent of chickenpox deaths were in the over-20 age group, which is indeed at risk from the virus. Doctors advise pregnant women who come into contact with chickenpox should contact their doctor immediately, as the virus can cause serious problems for the foetus.

Later in life, viruses remaining in the nerves can develop into the painful disease, shingles, particularly in people with compromised immune systems, such as the elderly, and perhaps even those suffering sunburn. Some of these will develop zoster-associated pain or post-herpetic neuralgia, described usually as horrible or "excruciating". A chickenpox vaccine has been available since 1995, and is now required in some countries for children to be admitted into elementary school. In addition, effective medications (e.g., acyclovir) are available to treat chickenpox in healthy and immunocompromised persons. Symptomatic treatment: calamine lotion to ease itching and paracetamol to reduce fever, is widely used. It is contraindicated to use aspirin in children with chickenpox, as it can lead to Reye's syndrome.

History

One history of medicine book claims Giovanni Filippo (1510–1580) of Palermo gave the first description of varicella (chickenpox). Subsequently in the 1600s, an English physician named Richard Morton described what he thought was a mild form of smallpox as "chicken pox." Later, in 1767, a physician named William Heberden, also from England, was the first physician to clearly demonstrate that chickenpox was different from smallpox. However, it is believed the name chickenpox was commonly used in earlier centuries before doctors identified the disease.

There are many explanations offered for the origin of the name chickenpox:

  • the specks that appear looked as though the skin was picked by chickens,
  • the disease was named after chick peas, from a supposed resemblance of the seed to the lesions
  • Samuel Johnson suggested that the disease was "no very great danger," thus a "chicken" version of the pox
  • the term reflects a corruption of the Old English word, "giccin", which meant "itching"

As "pox" also means curse, in medieval times some believed it was a plague brought on to curse children by the use of black magic.

Read more at Wikipedia.org


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Acyclovir Is Useful in Treating Chickenpox in Children
From American Family Physician, 3/1/02 by Richard Sadovsky

Acyclovir has been used to treat chickenpox in children even though the benefits have not been clearly established. Most experts feel that effective treatment is limited to episodes in which the medication is started after the first day of rash. Concerns about viral resistance have also influenced decisions about acyclovir risk-benefit. Balfour and associates used a randomized, double-blind trial to look at the risks and benefits of treating chickenpox (within 24 hours of rash onset in all age groups) with acyclovir, comparing five days of therapy with seven days of therapy. Viral in vitro resistance was tested after treatment. Participants were divided into two groups. Group A was enrolled within 24 hours of rash onset, and group B was enrolled 24 to 48 hours after rash onset. Patients in group A randomly received acyclovir for seven days or acyclovir for five days followed by two days of placebo. Patients in group B randomly received either five days of acyclovir and two days of placebo (active medication started 24 to 48 hours after rash onset) or placebo for the first day, acyclovir for five days, and placebo on the seventh day (active medication started 48 to 72 hours after onset of rash). The dosage of acyclovir used was 20 mg per kg, with a maximum dosage of 800 mg given orally four times daily. Patients were regularly evaluated for chickenpox for 90 days. Skin lesions from all patients were cultured repeatedly for varicella zoster virus, and the isolates were tested for susceptibility to acyclovir. Other symptoms were also routinely evaluated, as was the intensity of pruritus.

There was no difference in clinical end points between the two populations in group A, both of which received acyclovir for varying periods. A comparison of group A with group B clarified the point that earlier treatment shortened the duration of symptoms. Adverse events, including elevated liver function test results, were mild or moderate, and aspartate aminotransferase levels did not differ between the two groups.

The period of viral shedding was significantly shorter in patients in group A than in those in group B who received five days of acyclovir and two days of placebo, but not significantly so when compared with patients in group B who received placebo for the first day followed by five days of acyclovir, and one additional day of placebo. There was no benefit from the longer seven-day medication course. Earlier treatment also demonstrated quicker cessation of new lesion formation, reduction in fever duration, and more rapid healing. There was no evidence of short-term viral resistance with treatment.

The authors conclude that children, adolescents, and adults with chickenpox have a shorter clinical illness when given acyclovir earlier following onset of rash, preferably within 24 hours. There also appears to be benefit in initiating treatment during the second day of rash when compared with starting on the third day of rash. Five days of treatment are as effective as seven days of treatment. Treatment with acyclovir does not cause short-term viral resistance.

Balfour HH, et al. Controlled trial of acyclovir for chickenpox evaluating time of initiation and duration of therapy and viral resistance. Pediatric Infect Dis J October 2001; 20:919-26.

COPYRIGHT 2002 American Academy of Family Physicians
COPYRIGHT 2002 Gale Group

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