Presentation on theme: "Neonatal Varicella Infants whose mothers develop varicella in the period from 5 days prior to delivery to 2 days afterward. High mortality Transplacental,"— Presentation transcript:
1 3.Differentiate the following: Neonatal Varicella, Congenital Varicella Syndrome and Herpes Zoster?
2 Neonatal VaricellaInfants whose mothers develop varicella in the period from 5 days prior to delivery to 2 days afterward.High mortalityTransplacental, which may occur 48 hrs. prior to the maternal rash.Infant rashes may occur during 1st wk or early 2nd wk of lifeSince the mother does not develop the antibody, the infant receives a large dose of virus without maternal anti –VZV antibody
4 Neonatal VaricellaIf the mother was more than infected 5 days, she can still pass the virus to her child, but in a milder form due to her anti-VZV.Treatment:1 vial of human varicella-zoster immune globulin (VariZIG)Acyclovir (10mg/kg q8hrs IV) when lesions develop
5 Congenital VaricellaInfants whose mothers develop varicella early in pregnancy.Gestational period. Major development and innervation of the limb buds and maturation of the eyesTime of infectionOrgan system involved6-12wk of gestationMaximal interruption of Limb development16-20 wk of gestationEye and Brain development
7 Stigmata of Varicella-Zoster Infection Congenital VaricellaStigmata of Varicella-Zoster InfectionDamage to Sensory NervesCicatricial skin lesionsHypopigmentationDamage to Optic Stalk and Lens VesicleMicrophthalmiaCataractsChorioretinitisOptic AtropyDamage to Brain/encephalitisMicrocephalyHydrocephalyCalcificationsAplasia of the BrainDamage to the Cervical or Lumbosacral cordHypolasia of an extremityMotor and sensory deficitsAbsent DTRHormer syndromeAnal/urinary sphincter dysfuctionCicatrix- zigzag scarring of the dermatomal distribution, associated with atropy of the affected limb.
9 Congenital Varicella Diagnosis Maternal history PCR Fetal cord sampling and Chorionic villus sampling (detection of viral DNA, virus or antibody)Persistent positive VZV IgG antibody titer after 12-18months of age is indicator of prenatal infection in an asymptomatic child.
10 Congenital Varicella Prevention Vaccination of the mother of the varicella Vaccine 3 months prior to pregnancy
11 Herpes ZosterVesicular lesions clustered within 1 or less commonly 2 adjacent dermatomesElderlyChildrenBurning painClusters of skin lesions in a dermatomal patternPost herpetic neuralgia (complication)Mild rashInfrequently assoc. with localized pain, hyperesthesia, pruritus and low grade feverSymptoms of acute Neuritis are minimalComplete resolution within 1-2 wks
13 Herpes ZosterInc. riskAcquired varicella infection in the 1st yr of lifeMothers have varicella infection in the 3rd trimester of pregnancyImmunocompromisedCan have disseminated cutaneous disease that mimics varicella, visceral dissemination with pnueumonia, hepatitis, encephalitis and DIC
14 Herpes Zoster treatment Healthy Adult Acyclovir (800mg 5x a day PO for 5 days) Famciclovir (500mg tid PO for 7 days) Valacyclovir(1000mg tid PO for 7 days)Healthy childrenSupportive therapyOr with oral acyclovir (20mg/kg/dose, max 800 mg/dose)Immunocompromised childrenAcyclovir (500mg/m2 or 10mg/kg q8hr IV)