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

2. 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

4. 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

5. 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

7. 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.

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 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

12. Herpes Zoster

13. 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

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