3.Differentiate the following: Neonatal Varicella, Congenital Varicella Syndrome and Herpes Zoster?

Neonatal Varicella Infants whose mothers develop varicella in the period from 5 days prior to delivery to 2 days afterward. High mortality Transplacental, which may occur 48 hrs. prior to the maternal rash. Infant rashes may occur during 1st wk or early 2nd wk of life Since the mother does not develop the antibody, the infant receives a large dose of virus without maternal anti –VZV antibody

Neonatal Varicella If 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

Congenital Varicella Infants whose mothers develop varicella early in pregnancy. Gestational period. Major development and innervation of the limb buds and maturation of the eyes Time of infection Organ system involved 6-12wk of gestation Maximal interruption of Limb development 16-20 wk of gestation Eye and Brain development

Stigmata of Varicella-Zoster Infection Congenital Varicella Stigmata of Varicella-Zoster Infection Damage to Sensory Nerves Cicatricial skin lesions Hypopigmentation Damage to Optic Stalk and Lens Vesicle Microphthalmia Cataracts Chorioretinitis Optic Atropy Damage to Brain/encephalitis Microcephaly Hydrocephaly Calcifications Aplasia of the Brain Damage to the Cervical or Lumbosacral cord Hypolasia of an extremity Motor and sensory deficits Absent DTR Hormer syndrome Anal/urinary sphincter dysfuction Cicatrix- zigzag scarring of the dermatomal distribution, associated with atropy of the affected limb.

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.

Congenital Varicella Prevention Vaccination of the mother of the varicella Vaccine 3 months prior to pregnancy

Herpes Zoster Vesicular lesions clustered within 1 or less commonly 2 adjacent dermatomes Elderly Children Burning pain Clusters of skin lesions in a dermatomal pattern Post herpetic neuralgia (complication) Mild rash Infrequently assoc. with localized pain, hyperesthesia, pruritus and low grade fever Symptoms of acute Neuritis are minimal Complete resolution within 1-2 wks

Herpes Zoster

Herpes Zoster Inc. risk Acquired varicella infection in the 1st yr of life Mothers have varicella infection in the 3rd trimester of pregnancy Immunocompromised Can have disseminated cutaneous disease that mimics varicella, visceral dissemination with pnueumonia, hepatitis, encephalitis and DIC

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 children Supportive therapy Or with oral acyclovir (20mg/kg/dose, max 800 mg/dose) Immunocompromised children Acyclovir (500mg/m2 or 10mg/kg q8hr IV)