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

Congenital VaricellaStigmata of Varicella-Zoster Infection

Damage to Sensory Nerves Cicatricial skin lesionsHypopigmentation

Damage to Optic Stalk and Lens Vesicle MicrophthalmiaCataractsChorioretinitisOptic Atropy

Damage to Brain/encephalitis MicrocephalyHydrocephalyCalcificationsAplasia of the Brain

Damage to the Cervical or Lumbosacral cord

Hypolasia of an extremityMotor and sensory deficitsAbsent DTRHormer syndromeAnal/urinary sphincter dysfuction

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 ChildrenBurning 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

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 therapyOr with oral acyclovir (20mg/kg/dose, max 800 mg/dose)

Immunocompromised children

Acyclovir (500mg/m2 or 10mg/kg q8hr IV)