Histology: A skin biopsy of a vesicle shows an intraepidermal blister that forms via ballooning degeneration of the keratinocytes. There is a perivascular lymphocytic infiltrate in the dermis. Multinucleated giant cells can be seen at the base of the blister.
Pathogenesis: Varicella (chickenpox) is caused by VZV. This is a double-stranded DNA virus with a lipid capsule. It is spread from human to human via the respiratory route. Once inhaled, the highly infectious virus invades endothelial cells in the respiratory tract. The virus quickly disseminates to the lymphatic tissue and then to other organ systems. This virus is neurotrophic and can lie dormant in the dorsal root ganglion, with the potential to reactivate much later in the form of shingles.
Treatment: Most childhood infections require no specific therapy other than supportive care and treatment of secondary bacterial infection. Immunocompromised individuals, including pregnant women, should be treated with an antiviral medication such as acyclovir. Neonates are also at high risk for serious disease and need to be treated. The vaccine provides long-term effectiveness that has been shown to last for decades. More time is needed to firmly establish the need for and timing of any booster vaccinations.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
