New Diet for Chickenpox

Chickenpox Cure Ebook

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Fast Chicken Pox Cure Summary

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Varicella Chickenpox Clinical Summary

Chickenpox results from primary infection with varicella zoster virus and is characterized by a generalized pruritic vesicular rash, fever, and mild systemic symptoms. The skin lesions have an abrupt onset, develop in crops, start on the trunk and spread outward, and evolve from erythematous, pruritic macules to papules and vesicles (rarely bullae) that finally crust over within 48 hours. The classic lesions are teardrop vesicles surrounded by an erythematous ring (dewdrop on a rose petal). The most common complication of varicella is occasional secondary bacterial infection, usually with Streptococcus pyogenes or Staphylococcus aureus. Other complications from varicella include encephalitis, glomerulonephritis, hepatitis, pneumonia, arthritis, and meningitis. Cerebellitis (manifested clinically as ataxia) may develop and is usually self-limited. Although several illnesses can present with vesiculobullous lesions, the typical case of varicella is seldom confused with other problems....

Chickenpox

Although chickenpox was confused with smallpox until very recent times, the history of the reign of King Myongjong (1545-67) refers to big and small eruptive diseases. The big eruptive disease probably corresponds to smallpox however, whether the small eruptive disease corresponds to chickenpox or measles is uncertain. In the Sukchong Sillok (Sukchong reigned from 1674 to 1720), a description of eruptive diseases with big and small efflorescences survives that suggests a slightly different meaning from previous records of these eruptive diseases. At this time, measles was generally distinguished from smallpox, so the small eruptive disease could have been chickenpox. In the records of the period 1724-76, references to episodes of illness and recovery of the Queen and the Prince included all the symptoms of chickenpox. Similar examples can be found following the middle period of the Yi Dynasty.

Allochthonous Parasites in the Americas Previous Syntheses

Chickenpox After reexamining the evidence for and against the introduction of diseases listed in Table V.9.1,1 have removed one disease. Chickenpox is omitted from Table V.9.2 because it is present in small nucleated populations that lack antibodies for acute, infectious microbes (Black 1980). In addition, Varicella zoster can follow a chronic course, expressing itself as chickenpox in children and as shingles in adults (Brunell 1976).

Diagnostic procedures in eczema herpeticum

The clinical diagnosis can be confirmed by polymerase chain reaction (PCR) for viral DNA, by electron microscopic detection of herpes group virus from blister fluid, or by commercial immunofluores-cence tests for cells affected by HSV. The diagnosis is supported by demonstration of large multinucleated cells in the blister fluid and conventional light microscopy (Tzanck test). A less sensitive method is viral culture, and less specific methods are serologic tests. The choice of the optimal test depends on the clinical manifestation of the disease.25

Herpes Zoster Clinical Summary

Herpes zoster is a dermatomal, unilateral reactivation of the varicella zoster virus. Pain, tenderness, and dysesthesias may present 4 to 5 days prior to an eruption composed of umbilicated, grouped vesicles on an erythematous, edematous base. The vesicles may become purulent or hemorrhagic. Nerve involvement may actually occur without cutaneous involvement. Ophthalmic zoster involves the nasociliary branch of the fifth cranial nerve and presents with vesicles on the nose and cornea (Hutchinson sign). Ramsay Hunt syndrome is a herpes zoster infection of the geniculate ganglion that

Effects on Academic Functioning

The treatment for most childhood cancers takes weeks or months. Children often miss extended periods of time at school, partly because of clinic or hospital visits for treatment but also because children may need to stay away from school due to the immunosuppression resulting from the treatment. Many cancer treatments reduce immune function, making children vulnerable to serious illness in response to ordinarily minor infections. School requirements for vaccinations now lessen the exposure to serious contagious childhood illnesses such as chickenpox. However, many children are advised to avoid school when respiratory illnesses are endemic. Even when the children do attend school during cancer treatment, they may have difficulty learning. Fatigue, a common response to both chemotherapy and radiation, can interfere with concentration and sustained attention.

Herpes Zoster Shingles

Zoster is caused by the reactivation of the varicella-zoster virus (VZV, human herpesvirus 3, HHV-3, chickenpox). After the primary infection, VZV lies dormant in the dorsal root ganglia. The time between the onset of primary chickenpox and reactivation can be any time but usually decades later. Approximately 10 to 20 of the U.S. population eventually develop one or more cases of zoster in their lifetime. The incidence is much higher in immunocompromised patients and older adults. These rates are likely to decrease over time now that a VZV vaccine is given as part of the routine immunization schedule in children.

Other Diseases of the Spotted Fever Group

A final member of the spotted-fever group, rickettsialpox, is unique in not being transmitted by ticks. In 1946, a disease resembling chickenpox and exhibiting an eschar was reported in a New York apartment building. New York investigators collaborated with the U.S. Public Health Service, and within 8 months the entire picture of the disease had been elucidated. The agent was a hitherto unknown rick-ettsia that inhabited the mite Allodermanyssus sanguineus (a parasite of the house mouse) and was named Rickettsia akari. In 1949-50, the illness was also identified in the Soviet Union and there called vesicular rickettsiosis.

Infectious diseases causing vasculitis

Varicella zoster virus vasculopathy Varicella zoster virus (VZV) can lead to stroke due to viral infection of the cerebral artery walls (for review see Nagel et al. 25 ). Two different types of infection can be differentiated depending on the immune status of the patient. Immunocompromised individuals, e.g. organ transplant or AIDS patients, show a diffuse inflammation of cerebral blood vessels of all sizes. Immunocompetent patients may develop herpes zoster associated cerebral angiitis, a granulomatous angiitis that usually affects larger arteries. In both cases, histopathological features include multinu-cleated giant cells, Cowdry A inclusion bodies, and VZV particles. Vasculitis from infectious diseases, e.g. varicella zoster virus and HIV, can result in ischemic stroke.

Epidemiology and Incidence

Chickenpox is endemic worldwide, is highly communicable, and commonly appears as epidemics among children who are usually attacked between 2 and 8 years of age. (Infants are protected by transplacental maternal antibodies.) Few escape infection until adult life, and these usually live in isolated rural communities. Probably most of those who have seemed to escape the disease had subclinical infections. (The annual Report of Morbidity and Mortality in the United States shows, for 1984, 221,983 cases of varicella reported from 33 states, an incidence of 138 cases per 100,000 population. The age was known in 28 percent 56 percent of these cases appeared in the 5- to 9-year age group, less than 6 percent were 15 years of age or older.) The sporadic reactivation of the virus as shingles is unrelated to exposure to exogenous infection and, in general, is uncommon even in populations in which practically all have had chickenpox. Its peak incidence is after age 50. Of those who develop...

History and Geography

Garrison (1960) credit Giovanni Filippo Ingrassia, an Italian physician, with differentiating chickenpox from scarlet fever in 1553, and state that the English physician William Heberden (1785) gave the earliest clear description of varicella and distinguished it from smallpox in 1768. Jean Alibert (1832) included varicella in his group II category of exanthematous dermatoses -acute febrile contagous diseases. E. E. Tyzzer (1905), an American pathologist, described cellular inclusion bodies, and T. M. Rivers and W. S. Tillett (1924) reported isolation of the virus.

Varicella Zoster Virus

Varicella-zoster virus (VZV) is the etiological agent of chickenpox. Von Bokay was the first to observe that susceptible children might develop varicella after exposure to the herpes zoster virus. Joseph Garland, a long-term editor of the New England Journal of Medicine, was the first to suggest that zoster reflected activation of a latent varicella virus. '118 In 1954, Thomas Weller confirmed von Bokay's observation that children develop varicella following exposure to patients with herpes zoster by demonstrating, with tissue culture and antibody studies, that the two diseases were caused by the same virus. '119 The likelihood of developing zoster increases with advancing age, a phenomenon attributed to immune senescence and a decline in the VZV-specific T-lymphocyte population.' 1 Varicella, or chickenpox, results from the initial exposure to VZV, and approximately 1 in 1000 to 4000 patients with varicella develop neurological complications of...

Clinicopathologic Correlations

White Papule Tonsil

Chickenpox, or varicella, is caused by the varicella-zoster DNA virus belonging to the Herpesviridae family. The illness is extremely contagious over several days preceding the development of the rash. Before the introduction of the vaccine in 1995, it was estimated that more than 3 to 4 million cases occurred each year. The vesicular eruption begins on the trunk, and the vesicular lesions are described as ''a dewdrop on a rose,'' progressing to pustular lesions that then crust over in 3 to 5 days. New lesions appear as older ones are crusting. Mild fever, malaise, pruritus, anorexia, and listlessness accompany the rash. The vesicular rash of chick-enpox is pictured in Figure 24-51. The distribution is shown on another child in Figure 24-52, and a close-up photograph of the vesicular lesions is shown in Figure 24-53. Although it is usually a mild, self-limited illness in healthy children, varicella can be fatal in someone who is immunocompromised. Like rubella, varicella is...

Intracranial vasculopathies caused by virus and bacterial infection

Intracranial Infection

Varicella zoster virus vasculopathy Varicella zoster virus (VZV) vasculopathy may often be clinically silent but may present with stroke and can be diagnosed because of the following symptoms, signs and findings (for review Nagel et al. 28 ). (1) About two-thirds of patients have a history of zoster rash, particularly ophthalmic-distribution zoster or a history of chicken pox. There is a delay between the onset of zoster chicken pox and the onset of stroke averaging 4.1 months (range between same day and 2.5 years). But about one-third of patients with a pathologically and virologically verified disease have no history of zoster rash or chicken pox. (2) Angiographic evidence of narrowing in cerebral arteries may be found in MR angiography. In vascular studies 70 had vasculopathies. Different patterns of vascular lesions have been found. There was pure large artery disease in 13 , pure small artery disease in 37 and a mixed vascular pathology in most patients (50 ). (3) Varicella...

Special Clinical Situations

Children who are immunocompromised or infected with HIV usually should not be given live-virus vaccines. However, measles can cause severe disease and death in symptomatic HIV-infected patients. MMR (but not MMRV) is recommended at age 12 months for HIV-infected children with CD4+ T-lymphocyte counts of 15 or greater. The second dose can be given 28 days later to improve the immune response. Children with age-specific low CD4+ counts should not be given measles virus-containing vaccine (AAP Red Book, 2009, 447-455) All HIV-infected children or children of unknown status born to HIV-infected women should receive immune globulin at 0.5 mL kg to a maximum dose of 15 mL, regardless of vaccination status, if exposed to wild-type measles. HIV-infected children are also at increased risk from complications of chickenpox and zoster, and those children with CD4+ counts of at least 15 should receive two doses of varicella vaccine 3 months apart. The MMRV vaccine is not used in this situation...

Varicella and Herpes Zoster

Varicella is one of the classic viral exanthems of childhood. Before routine vaccination, having chickenpox was one of childhood's rites of passage. The virus, a herpesvirus (human herpesvirus 3), is effectively transmitted, causing outbreaks in schools and households. Patients with primary varicella present with fever, headache, and sore throat. Generally within 1 to 2 days of onset of symptoms, a papulovesicular rash erupts diffusely. The classic description of the chickenpox lesion is a dewdrop on a rose petal, suggesting a central vesicle on an erythematous base. Lesions continue to appear for 5 to 7 days. All lesions going from papule to vesicle to crusted lesion takes about Herpes zoster is a reactivation of the neurotropic varicella virus, typically in a dermatomal distribution. This is more common in elderly or immunocompromised patients but can occur in healthy people as well. Patients with zoster may note generalized malaise, hyperesthesia, numbness, tingling, and pain in...

Shingles Not Just on Your Roof

Most of us have had chicken pox in our lives. Shingles are caused from the same virus, Varicella zoster also known as herpes zoster. Once you've had chicken pox, this virus may lie dormant in your body until a serious illness, emotional trauma, or prolonged stress weakens your immune system. Each year, 850,000 Americans are diagnosed with shingles.

Infectious Diseases Smallpox

Other well-known airborne infections that cause skin rashes or eruptions are also described in Toku-gawa sources. Chickenpox, for example, seems to have been common. In fact, in the shogun's palace, special ceremonies were held to celebrate a child's recovery from smallpox, measles, and chickenpox, indicating that all of these diseases were considered a threat to life in Tokugawa Japan.

Smallpox and the Modern Rise of Population

Smallpox was long recognized as a contagious disease with a pustular rash. Distinctive clinical features, such as the simultaneous maturation of pustules (this distinguishes it from chickenpox) and the centripetal distribution of pustules over the body, were not noted. Oddly, the residual facial scarring among recovered variola major victims, was rarely mentioned. Nevertheless, by the early seventeenth century, smallpox was recognized by both lay and medical observers as a distinctive disease.

Preoperative Preparation

Children who are systemically unwell should not have elective surgery. It is not unusual for a child to present with coryzal symptoms alone. There is an increased incidence of airway problems during anaesthesia these children are more at risk of laryngeal spasm, breath-holding and bronchospasm, and in the postoperative period the chance of post-intubation croup is increased. The decision to proceed should be made only by a senior anaesthetist. Occasionally these symptoms precede a more serious upper or lower respiratory tract infection. In very rare cases, the viraemic phase of the illness may be associated with a myocarditis. Each case should be dealt with on its merits. Children who have active viral illnesses such as chickenpox should not have elective surgery, nor should children who have recently been immunized using live vaccines, for two reasons first, there is an associated myocarditis or pneumonitis and, second, to protect others on the ward who may be immunocompromised.

The Pre Columbian Period

There is little question, however, that the New World Indians were virgin soil peoples for the host of diseases about to descend on them from Eurasian and African Old Worlds. In the words of Alfred Crosby (1986), They seem to have been without any experience with such Old World maladies as smallpox, measles, diphtheria, tracoma, whooping cough, chicken pox, bubonic plague, malaria, typhoid fever, cholera, yellow fever, dengue fever, scarlet fever, amebic dysentery, influenza and a number of helminthic infestations.

Prehistoric Incidence of Disease

n ot only did very few people of any origin cross the great oceans, but those who did must have been healthy or they would have died on the way, taking their pathogens with them. The indigenes were not without their own infections, of course. The Amerindians had at least pinta, yaws, venereal syphilis, hepatitis, encephalitis, polio, some varieties of tuberculosis (not those usually associated with pulmonary disease), and intestinal parasites, but they seem to have been without any experience with such Old World maladies as smallpox, measles, diphtheria, trachoma, whooping cough, chicken pox, bubonic plague, malaria, typhoid fever, cholera, yellow fever, dengue fever, scarlet fever, amebic dysentery, influenza, and a number of helminthic infestations. (Crosby 1986)

Diseases of Sub Saharan Africa to 1860

With the Europeans, and with more contact with the outer world, also came increased exposure to contagious diseases. The earliest European report of smallpox in sub-Saharan Africa dates from Angola in the 1620s, but the strong probability exists that it had been present there for several preceding centuries. In fact, August Hirsch pinpointed regions of central Africa along with India as the native foci of the disease, and others have also reported that smallpox was a very old disease on the African continent. This was very likely true of measles, chickenpox, and most other Eurasian diseases as well. Evidence for this assumption derives from the fact that, unlike the American Indians or the Pacific Islanders, sub-Saharan Africans did not die in wholesale fashion after contact with the Europeans. The Europeans, however, were extremely susceptible to African illnesses, especially to the African fevers - yellow fever and malaria. Indeed, white sailors on slaving vessels, and especially...

Disease Source Material

Smaller nucleated populations that are sedentary or consist of those who practice a mobile settlement strategy are likely to be infected by other types of parasites. The list of potential parasites varies, depending on the degree of mobility, the presence or absence of herd animals or pets, and the size of the population. Both F. Fenner (1980) and F. L. Black (1980) think chronic or latent infections, including chickenpox (Varicella zoster) and Herpes simplex, are probable candidates for persistence in small populations. Zoonotic infections, including yellow fever (arbovirus) and tetanus (Clostridium tetani), that are transferred from animal reservoirs to humans by accidents of proximity are also likely.

Disease Patterns of 15001900

Measles and chickenpox were probably also introduced by traders from time to time, but there is little documentation. Tuberculosis probably reached coastal West Africa in the early days of contact, but it did not become widespread until after 1900. Venereal diseases were a different story syphilis and gonorrhea were common among coastal groups by the eighteenth century, and these diseases must have spread inland as well. Gonorrhea may well have been an indigenous disease whose diffusion was facilitated by new conditions syphilis almost certainly arrived from the outside world.

Disease Patterns from AD 1000 to 1500

These long, complex processes must have had important implications for health conditions. Hunting-gathering populations were too sparse to support many acute diseases, especially smallpox, measles, poliomyelitis, chickenpox, and other viral infections that produce long-lasting immunities. They were mobile enough to avoid living for long in close proximity to accumulations of their own wastes.

AD 2001000 The West Reaches Its Nadir

The recovery of classical and Islamic medical writings permits, along with contemporary Western works, the identification of at least a few diseases. Smallpox and chickenpox were separated, and smallpox can occasionally be identified. Like most endemic diseases of humans that require direct contact, smallpox was a major killer of children (Hopkins 1983). Plague made its reappearance only to mark the end of the High Middle Ages, but leprosy was a near obsession in western Europe.

Varicella

Varicella is now much less common with universal varicella vaccination of children. Occasionally the family physician sees a case of breakthrough chickenpox in a vaccinated child. Unvaccinated adults may also present with varicella. Patients with varicella have fever and general malaise as a mild prodrome lasting 1 to 2 days before the rash appears. The rash typically begins on the face, scalp, or trunk and then spreads to the extremities. The lesions appear as erythema-tous macules and progress to papules with an edematous base. The papules quickly evolve into vesicles, appearing as dewdrop on a rose petal (Fig. 33-15). The vesicles evolve into pustules, which become umbilicated and subsequently crust over in the ensuing 8 to 12 hours. A defining characteristic of varicella is that lesions may be present in all stages simultaneously. Figure 33-15 Chickenpox. (e Richard P. Usatine.) Figure 33-15 Chickenpox. (e Richard P. Usatine.)

Zoster Vaccine

Later in life, approximately 15 of the population will develop herpes zoster (shingles). Zoster is the reactivation of latent varicella zoster virus in the sensory ganglia. It produces a classic rash along a single nerve track. Approximately 20 of persons with herpes zoster will develop postherpetic neuralgia, which is a painful debilitating condition that can persist for months after resolution of the herpes zoster rash. Adults get a boost in immunity with repeated exposure to children with the chickenpox. Zoster most frequently occurs in the elderly and immunocompromised individuals who have decreased circulating antibodies to varicella zoster virus.19 The varicella vaccine is relatively new and has only been recommended for use since 1996, therefore its true impact on chickenpox and zoster is not yet known. Continued use of the varicella vaccine will undoubtedly change the epidemiology of both of these diseases. As the prevalence of chickenpox declines, the rate of zoster will...

Neuromyelitis Optica

Devic's syndrome occurs in patients of varied ages (range, 1 to 73). The mean age at onset of monophasic Devic's syndrome is 27, whereas relapsing NMO (see later) tends to occur in an older age group (mean age at onset of 43). Monophasic Devic's syndrome affects males and females equally, whereas relapsing NMO affects females predominantly (F M, 3.8 1). One third of patients have a preceding infection within a few weeks of neurological symptom onset. Most commonly this is a nonspecific upper respiratory tract infection, flu, or gastroenteritis. The most common specific infections preceding the development of Devic's syndrome are chickenpox and pulmonary tuberculosis. Devic's syndrome has also followed vaccination for swine flu and mumps. Only a few instances of the familial occurrence of Devic's syndrome have been reported, and in one of these families a unique mitochondrial mutation was found. Devic's syndrome is said to be more common in Japan and East...

Varicella Vaccine

Varicella zoster virus is a herpes virus that infects nearly all humans. Primary infection with Varicella zoster causes chickenpox (varicella), which is one of the most common childhood diseases. Chickenpox has always been thought to be a benign disease causing few serious complications in children. The rate of chickenpox prior to the vaccine becoming available was thought to approximate the birth rate with 3 to 4 million cases annually resulting in 11,000 hospitalizations and 100 deaths. Adults who develop chickenpox have a 25 greater risk for developing serious complications from varicella compared to children. Chickenpox is highly contagious and has a secondary household transmission rate of 87 . Following resolution of the primary infection, varicella becomes latent in cranial nerve, dorsal routs, and autonomic ganglia. The varicella vaccine is made up of an attenuated Oka strain of varicella zoster virus. This is a live attenuated vaccine. Attenuation was achieved by performing...

Maternal circulation

The placenta modifies the immune systems of both mother and fetus so that the fetus is not rejected. The mechanism by which this occurs is poorly understood. In pregnancy there is a reduction in cell-mediated immunity. There is a reduction in the activity of T-cytotoxic cells and a reduction in numbers of T-helper cells. The trophoblast acts as an immunologically inert barrier between mother and fetus. However, there is an increase in numbers and activity of neutrophils. IgG is transferred to the fetus in utero and confers some passive immunity. It may produce fetal disease. Modification of the maternal immune system may be the cause of the rapid spread of some cancers during pregnancy and the rapidity with which some viral disorders become life-threatening, e.g. chickenpox with pneumonitis.

Recapitulation

Clear that smallpox and measles were attacking primarily children by the mid-thirteenth century, and probably even earlier. Influenza, however, may have grown in virulence, especially after 1150, when the climate turned colder and wetter. Other serious maladies included leprosy and chickenpox. The period from 1050 to 1260 may have seen some demographic expansion, notably in the east, but disastrous weather patterns and ensuing famine and pestilence began to close this window of opportunity around 1150.

European Diseases

Clearly then, with maladies capable of producing these high levels of mortality, conceivably the pre-Columbian populations of the Caribbean could have been much larger than heretofore believed. This also ignores mortality generated by other illness such as chickenpox, diphtheria, scarlet fever, typhoid, whooping cough, and bubonic plague, all of which were also introduced from Spain. No wonder then, that by 1570 most of the Indians of the region had vanished. Only the Caribs still survived in the eastern Caribbean - an area not yet much frequented by the Europeans.

Subject Index

See also anthrax Cheyne-Stokes respiration, 32 chickenpox, 162, 285, 359-60 childbed fever, 265-67, 304 China. See East Asia, China chincough, 360-62 Chinese liver fluke, 81 chirimacha, 71 in varicella-zoster virus disease, 359 viral, 231 Conn's syndrome, 170 consumption, 339. See also tuberculosis contagious abortion, 59 continued fever, 350 convulsions, 120, 185, 215, 329-30, 360 convulsive ergotism, 120 coolie itch, 165 corneal herpes, 161 coronary artery disease, 101, 157 coronary disease, 159 coronary heart disease, 157, 159-60 cor pulmonale, 101 dwarf tapeworm, 320 dysentery, 105. See also diarrhea amebic, 19-21 bacillary, 21, 43-44 characteristics, 105 diarrheal diseases, 92-94 enteric diarrhea and, 340 dysmimia, 226 dyspepsia, 105-7, 166 dysphagia, 108, 226-27 dysphonia, 226 dyspnea in brown lung, 53 in croup, 82 dropsy and, 101-2 in histoplasmosis, 163 in myasthenia gravis, 226 in pneumonia, 256 in varicella-zoster virus disease, 359 dysuria, 161, 291...

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