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Why is chickenpox dangerous in adults?
A clarification needs to be made right away: for the so-called “childhood” diseases, the concept of “adult” begins already from adolescence. If the disease overtook you after 12 years, the likelihood of moderate or even severe chickenpox with a bouquet side effects the higher the older you are. Chickenpox is most severe for people over 50 years of age, if they get it for the first time. However, fortunately, the chances that an adult will not have time to become infected with the varicella-zoster virus before such a respectable age are almost zero.
How to prevent the spread of chickenpox
Common primary varicella infection; This is associated with high morbidity. The complexities of the central nervous system such as Reye's syndrome, Guillain-Barré syndrome and encephalitis Thrombocytopenia and purpura. Exposure to the varicella-zoster virus during pregnancy can cause viral pneumonia, preterm labor and delivery, and rarely maternal death. Offspring may remain asymptomatic or develop shingles at young age without a previous history of primary varicella infection. The varicella-zoster virus remains dormant in the sensory ganglia after infection. Herpes zoster is a grouped vesicular lesions usually affecting a single dermatome. Other infections resulting from viral reactivation include postherpetic neuralgia, vasculopathy, myelopathy, retinal necrosis, cerebellitis, and sinus herpes.
- Approximately 25% of fetuses become infected.
- It can reactivate after many years like shingles.
Where and how can an adult get chickenpox
Paradox: an adult is many times more likely to meet the chickenpox virus than children. The same applies to teenagers who begin to move a lot outside the home. The varicella-zoster virus is extremely volatile, easily moves through the air, and is transmitted by airborne droplets. A sick person is contagious even before the first symptoms appear (about 48 hours before them). That is, no contact with the patient is necessary. You can just ride in the same elevator, in the same subway car, you can walk past the carrier of the virus, or sit in his place at a table in a cafe. The only thing that saves is the instability of the virus that got into the air. But, you don’t really have to count on this if you haven’t had chickenpox yet.
This may take 5 to 10 days. Children should stay away from school or childcare during this contagious period. Adults with chickenpox who work with children should also stay at home. This is how long it takes for the virus to replicate and show up in a characteristic rash on a new host.
Because chickenpox can cause complications in immunocompromised individuals and pregnant women, these people should avoid visiting friends or family when there is famous case chickenpox. In case of unintentional contact, consult a doctor who can prescribe special preventive treatment.
As it is not necessary to rely on nonspecific immunity. If someone tells you that good immunity can save you from chickenpox, do not believe it. The only way to gain immunity to the varicella-zoster virus is to contract the virus, either through disease or vaccination. And this immunity lasts as long as the virus is present in the body. Therefore, when an adult who claims not to have had chickenpox as a child does not get chickenpox, there are only two options. Either as a child he had an asymptomatic course of chickenpox, or for some reason this disease was not recorded in his children's medical record. Alas, there are still parents who manage not to remember what hurt their children in childhood.
Chickenpox vaccination
Vaccination is available for chickenpox, and is highly recommended. Chickenpox is strongly prevented by vaccination with live attenuated varicella vaccines. The vaccine is subsidized for non-immune individuals who are immunocompromised or in other ad hoc groups. Contact the Immunization Advice Center for the most up-to-date information.
Chickenpox is usually diagnosed clinically based on the characteristic rash and consistent cultures of the lesions. Lesions can be detected at all stages of development and healing in affected areas. Children's chickenpox is not usually declared a prodrome; it starts from the beginning of the exanthema. In adults and adolescents, chickenpox may be preceded by a prodrome of nausea, myalgia, anorexia, and headache. The triad of rash, malaise, and low-grade fever may signal the onset of the disease, although the typical patient is contagious for 1–2 days before the rash develops.
Be vigilant: you can also get chickenpox from a patient with shingles (herpes zoster), because this disease is also caused by the varicella-zoster virus, being in fact the “reincarnation” of the virus in the body of a person who once had chickenpox.
For chickenpox in adults, there is a seasonality - these are the winter and spring periods.
Vesicles may appear on the palms and soles and on mucous membranes along with painful, shallow, oropharyngeal or urogenital ulcers. Intense itching usually accompanies the vesicular stage of the rash. The typical patient remains infective for 4-5 days after the onset of the rash, by which time the last breakage of the vesicles has usually corroded.
Secondary bacterial infection of skin lesions, manifesting as and is the most common complication in healthy children. Staphylococci and streptococci are the most commonly encountered bacterial pathogens. Bacterial superinfection may predispose to scarring. Localized bacterial superinfection rarely presents as septicemia, culminating in secondary bacterial pneumonia, otitis media, or necrotizing fasciitis. The latter represents a significant, potentially life-threatening morbidity.
How does chickenpox in adults
In adolescents and adults, chickenpox almost always occurs in a complicated form.
From the moment of infection to the first symptoms of chickenpox in an adult, a minimum, 7, maximum, 23 days pass. The disease begins with a sharp rise in temperature to 39-40 degrees, which can last for several days, hardly giving in to control. This is due to the peculiarities of the immune response to the virus in adults.
Common primary varicella infection
A common primary varicella infection, usually seen in the immunocompromised or adult population, can have a high incidence. Ninety percent of varicella pneumonia cases occur in the adult population. Rarer complications of disseminated chickenpox include myocarditis, gangrene, hepatitis, and glomerulonephritis.
Hemorrhagic complications are more common in immunocompromised or immunosuppressed populations, although healthy children and adults have been affected. Five major clinical syndromes have been described. These syndromes have variable courses, with febrile purpura being the mildest and having an uncomplicated outcome. In contrast, malignant varicella purpura is a severe clinical condition with a mortality rate of over 70%.
At this stage, an adult with chickenpox feels weakness, aching joints and muscle pain, headaches, nausea - all these are signs of a general intoxication of the body. On the background high temperature and intoxication, an adult with chickenpox may experience loss of consciousness. In this case, you should immediately call an ambulance, since with a similar course of chickenpox, the patient should be observed in the hospital.
The etiology of these hemorrhagic varicella syndromes is unknown, although an autoimmune pathophysiological mechanism has been implicated. These children may remain asymptomatic, or they may develop zoster at a young age with no prior history of primary varicella infection.
Peripartum infection of the fetus before sufficient maternal antibody has crossed the placenta to confer temporary passive immunity to the fetus often results in severe disseminated varicella in the newborn, which has significant mortality.
Important: in no case do not use aspirin (acetylsalicylic acid) or analgin (baralgin, metamizole sodium) as an antipyretic and analgesic for chickenpox. According to numerous scientific data, the use of these drugs in chickenpox (it is with this disease, and not in general) often leads to complications from the liver.
The characteristic varicella vesicle surrounded by an erythematous halo is described as a rose on a rose petal. A drop of pink petaled vesicles of chickenpox. Vesicular eruption on the trunk showing papules, vesicles and crusts. Chickenpox is clinically characterized by the presence of active and healing lesions at all stages of development in the affected areas. Lesions characteristically heal without scarring, although excoriation or secondary bacterial superinfection predisposes to scarring.
Adults with windy autumn have a more difficult course than children. Adults may experience a more widespread rash; prolonged fever; And an increased chance of complications, the most common of which is chickenpox pneumonia. There are also clinical variants of varicella infection. Hemorrhagic lesions are rare and are most often associated with immunocompromised or immunocompromised patients.
Following the temperature, a chickenpox rash appears. In this case, the temperature can remain high. Classic bubbles usually appear first on the body, then cover the neck and face. The rash can spread to the mucous membranes of the mouth, pharynx, tongue, and even to the mucous membranes of the genital organs. In addition, the rash can affect the inner surfaces of the eyelids and move to the cornea, which is fraught with loss of vision.
Bullous chickenpox can affect both children and adults and must be differentiated from other bullous disorders. The course of the disease is believed to remain unchanged, although a delay in diagnosis and treatment of elderly and immunocompromised patients may lead to serious morbidity.
Chickenpox and other viral exanthems may be concentrated in areas where intense sun exposure occurred during the incubation period. Centers for Disease Control and Prevention. Guidelines revised for chickenpox during pregnancy.
- Hirota T, Hirota I, Ishimiya M, etc.
- Immunohistochemistry in the diagnosis of skin viral infections.
The main problem with rashes in adults is that not only is it more profuse than in children, but it is almost always complicated by a bacterial infection. Bubbles tend to turn into pustules - acne with purulent contents that does not heal for a long time, after which the so-called pockmarks can remain on the skin "for memory" - visible to the eye small notches. The chickenpox rash itself in adults lasts longer than in children - up to 9 days. And its consequences often have to be cleaned in the beautician's office.
The illness begins with cold symptoms such as mild fever, headache, runny nose and cough. After a day or two, a rash begins, starting as small pink patches but rapidly progressing to itchy blisters that usually last three to four days before drying up and turning into scabs.
No specific treatment is recommended or required for healthy children and adults with chickenpox. It is important to try to prevent little child scratch the rash, as this can lead to permanent scarring or secondary infection. Use paracetamol to reduce fever or relieve discomfort. Aspirin should not be given to young children and adolescents due to the risk of developing serious condition called Reyes syndrome. This is especially important for children who have or may develop chickenpox.
In addition to a secondary bacterial infection, chickenpox in adults can lead to the following serious complications:
- viral pneumonia (especially often this complication occurs in adolescents and pregnant women).
- partial or complete loss of vision (when the rash spreads to the cornea of the eye, scars remain in place of the bubbles)
- vulvitis in women and inflammation of the foreskin in men
- optic neuritis (can also lead to loss of vision).
- viral tracheitis, laryngitis (with a rash of the mucous membranes of the pharynx).
- acute stomatitis
- kidney failure
- liver toxicity
- encephalitis and meningitis (these complications occur when the chickenpox virus affects the nerve cells and meninges.
As you can see, chickenpox in adults is no longer a harmless childhood disease. And it requires immediate treatment.
Chickenpox is spread through coughing, sneezing, and direct contact with fluid in the blistering rash. Dry scabs are not contagious. Since shingles also contain the virus, a person who has never had chickenpox can get chickenpox from a person who has shingles.
Forms and stages of the disease
A person with chickenpox is contagious for about one to two days before the onset of the rash and until the blisters are clipped, usually four to five days. The usual time between exposure to the virus and the development of the disease is about 14-16 days, although sometimes it can take longer.
How is chickenpox treated in adults?
Children after 12 years of age and adults with chickenpox are prescribed specific antiviral treatment, and a special regimen is also prescribed. Most often, without waiting for the onset of pustules, the doctor may recommend antibiotics.
Preventive measures for chickenpox for adults
Immunization - The best way protect against chickenpox. However, it is also important to maintain good hygiene practices, such as routine handwashing, especially after contact with a sick person. In Australia, there is a safe and effective vaccine to prevent chickenpox. If a person already has chickenpox, they are immune to the disease and do not need to be vaccinated. If there is uncertainty about whether a person has had chickenpox, it is still perfectly safe to have the vaccine.
To suppress viral activity, the following can be prescribed:
1. Virocidal drugs directed specifically against herpes viruses:
- acyclovir = zovirax = virolex (from 2 years old); also use acyclovir ointment for rashes and conjunctivitis (eye damage);
- valciclovir (from 12 years old),
- famciclovir (from 17 years old), isoprinosine.
2. Immunomodulators: interferon, viferon. In severe cases of chickenpox, patients are given stronger immunomodulators (thymolin, thymogen, IRS-19) and cytokine preparations (ronkeilikin).
How many days does windmill last?
Vaccination is also recommended for non-immune people in the following groups. Non-immune adolescents over 14 years of age and adults with high risk when susceptibility to chickenpox is likely, women planning to become pregnant immediately after childbirth of parents of young children, associate with people with reduced immunity. The varicella vaccine has been shown to be effective in preventing varicella if given within three days and possibly up to five days of contact with an infected person, with earlier administration being preferred.
3. Immunostimulants: cycloferon, anaferon
AT severe cases chickenpox use intravenous immunoglobulins. All of the above drugs should be used in age dosages.
To alleviate the symptoms of the course of the disease, the following are prescribed:
Bed rest 3-5 days (longer in complicated cases)
Careful care of the skin and mucous membranes:
Chickenpox: incubation period, contagiousness in adults
Zoster immune globulin injection given within 96 hours of chickenpox exposure provides immediate but temporary protection against chickenpox, and may be recommended if exposure has been in people at high risk of developing severe disease or pregnant women who are immune to chickenpox.
Like all medicines, vaccines can have side effects. Most side effects are minor and last a short time and do not lead to any long-term problems. There may be swelling, redness and soreness when the injection was given and fever. A mild rash similar to chickenpox may develop at the injection site or on the body. If this occurs, the rash usually appears about eight days after vaccination. People with this rash should avoid contact with people with weakened immune systems.
- treatment of rash sites with antiseptic drugs to prevent secondary infection, which often accompanies the course of chickenpox in adults (up to the formation of abscesses, followed by scarring, leaving scars on the skin).
- treatment of the oral mucosa - rinsing with furacillin and / or sodium sulfacyl
- for conjunctivitis, acyclovir ointment is used, and to prevent bacterial complications, albucid 20%, chloramphenicol ointment or tetracycline ointment.
- antihistamines (suprastin, tavegil, etc.);
- antipyretics (ibuprofen, nurofen, or physical methods of cooling - wrapping).
In addition, a plentiful alkaline drink is shown.
If a secondary bacterial infection cannot be avoided, antibiotics are used strictly as prescribed by the doctor., while 3rd generation cephalosporins are the drug of choice.
Important: if you have chickenpox or are recovering from it, beware of sunbathing during this period, as the chickenpox rash can cause pigmentation disorders in the affected areas of the skin. It is best to hide chickenpox-affected areas of the body until complete healing, as even fresh chickenpox scars can become hyperpigmented.
Adults with a pustular form of chickenpox are advised to refrain from water treatments until the pimples begin to dry out.
Chickenpox during pregnancy
If a woman who has not been vaccinated or has had chickenpox becomes ill during pregnancy, the unborn child may develop congenital smallpox, which is manifested by scars (scars) on the skin, low birth weight, even mental and mental retardation. physical development. But the risk that chickenpox during pregnancy will cause certain consequences depends on the gestational age at which the infection occurred. Chickenpox in late pregnancy is much more dangerous than chickenpox in early dates.
- Chickenpox in the early stages can lead to missed pregnancy and miscarriage, however, if the fetus survives, the risk of chickenpox complications will be very small (less than 1%).
- Chickenpox in the 2nd trimester has consequences for the unborn child in about 2% of cases.
- The greatest risk is infection of a pregnant woman in the 3rd trimester. If a pregnant woman has contracted chickenpox a few days before giving birth, then the risk of congenital chickenpox in an unborn child is 20-25%.
Chickenpox is viral disease which is found only in humans.
The virus is transmitted by airborne droplets and occurs most often in children, but it can also affect adults, leading to a more severe course.
Reasons for development
The disease is caused by the varicella-zoster virus, which belongs to the herpesvirus family (third type). This pathogen shows tropism for the skin epithelium. This is accompanied by the development of necrosis. In addition, the virus is able to penetrate into the nervous tissue, remaining there for a long time.A person can become infected not only from a sick person, but also from a sick person. This is due to the same pathogen, but a different reaction of the immune system to this virus. So, re-infection is accompanied by the development of not chicken pox, but herpes zoster. However, with sufficient immunity tension, repeated cases of the disease are casuistry.
An adult can become infected with the varicella-zoster virus through the air, which is realized through the following factors:
- particles of saliva;
- exhaled air.
Initially, the virus enters the epithelial cells of the respiratory tract, and from there it penetrates into the regional lymph nodes. Through the lymphatic vessels, the virus enters the bloodstream, which is accompanied by the development of an intoxication syndrome. The final place of “deployment” of the virus is the mucous membranes and skin, where certain rashes appear.
Symptoms of chickenpox in adults
The incubation period is 7-14 days. Chickenpox in adults has its own clinical features, they consist in the manifestation of the following symptoms: - later appearance of a rash (see photo);
- pronounced intoxication syndrome, which is several times higher than that in children;
- prolonged and high fever as the main manifestation of intoxication and the negative effect of the virus on the human body;
- the rash is more profuse than in children;
- rash persists for a long time, undergoes reverse development later;
- crusts are rejected much later than in children;
- vesicles (vesicles with transparent contents) almost always turn into pustules (skin elements filled with pus).
In some cases, it can be the direct cause lethal outcome. Therefore, if suspicious signs appear, you should immediately consult a doctor.
These clinical signs are:
- an increase in temperature simultaneously with the appearance of skin rashes;
- polymorphism of the rash, that is, the presence of various skin elements on the same part of the body;
- no rash on palms and soles;
- repeated rashes are accompanied by an additional increase in body temperature;
- the appearance of a rash on the mucous membrane of the oral cavity and genital organs.
- 1) chickenpox incubation period– time from infection to the appearance of the first clinical symptoms chickenpox in adults, the average duration of which is 7-14 days.
- 2) prodromal period, which is almost always noted in adults, unlike children. It is characterized by an increase in body temperature, malaise, headache, nausea and vomiting, that is, all signs of intoxication that develops in response to viremia.
- 3) The period of skin rashes, which appear either simultaneously with fever, or a few hours after it. The rash can be different - spots, papules (pimples), vesicles (filled with transparent contents). There is no pattern in the spread of the rash. Drying of the vesicles is accompanied by the formation of crusts, but in adults, their suppuration is most often noted (pustules are formed).
- 4)convalescence period, which is characterized by a gradual normalization of body temperature, health is restored. Skin itching may persist at the site of skin rashes.
Diagnostics
The diagnosis of this disease has two goals:- 1) Confirm this infection.
- 2) Determine the degree of its severity.
However, in some cases, it is necessary to conduct additional research methods, namely:
- general clinical blood test, which reveals inflammatory changes;
- general clinical analysis of urine (normal);
- microscopic examination to detect viruses (a few hours are enough to get the result);
- virological examination, which involves the sowing of pathological discharge on special media;
- serological testing to detect antibodies to the varicella-zoster virus;
- polymerase chain reaction, which has the highest reliability in relation to the establishment of the final diagnosis.
Possible Complications
Late diagnosis and late initiation of treatment can lead to the development of complications. Among them the most common and dangerous are the following:- bacterial skin infections;
- due to the activation of conditionally pathogenic microflora against the background of a decrease in immunity;
- and meningoencephalitis;
- arthritis;
- hepatitis and others.
Treatment of chickenpox in adults
Treatment of chickenpox in adults is carried out only conservatively. It aims to achieve the following goals:
- 1) Relief of clinical manifestations.
- 2) Prevention of secondary bacterial complications.
Therefore, they are used medications that eliminate certain symptoms of chickenpox disease, that is, symptomatic therapy is carried out. AT recent times Vidarabine was created for intravenous administration.
It is used to suppress viral activity in those patients who have a sharply reduced immunity (persons taking corticosteroids, patients with leukemia, etc.). In most cases, treatment is carried out on an outpatient basis. However, sometimes the patient needs to be hospitalized. The indications for this are:
- the presence of complications of the disease;
- severe course, which is often recorded in adult patients;
- the inability to isolate the patient to prevent the disease of new patients.
- 1) Bed rest;
- 2) Compliance with dietary nutrition;
- 3) Antihistamines that suppress the severity of developing allergic reactions;
- 4) Antipyretic drugs, which are indicated when the body temperature rises above 37.5 degrees Celsius;
- 5) Multivitamins;
- 6) To combat intoxication, it is recommended to increase the amount of fluid you drink, but if this is not possible due to the patient's condition, then it is administered intravenously using colloid and crystalloid solutions.
Prevention of chickenpox in an adult
Prevention of chicken pox can be both specific and non-specific. In the first case, the introduction of a special vaccine is indicated. It forms immunity against the varicella-zoster virus. Adults are shown the introduction of two doses, the interval between which should be 1.5-2.5 months. This vaccine is not included in the schedule of routine vaccinations.Holding nonspecific prophylaxis shown in the following situations:
- 1) Persons in contact with a sick person;
- 2) Medical workers;
- 3) Persons with reduced immunity.
- early detection of sick persons;
- their isolation from healthy patients (it continues for another 5 days after the last skin rash appears);
- carrying out anti-epidemic measures;
- introduction of specific immunoglobulin to weakened children and pregnant women at full term.
