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Varicella Zoster Virus: Symptoms & Treatment

Instructor: Rachel Torrens
Varicella-zoster virus is a unique virus because it can cause two different illnesses. In this lesson, learn the symptoms and treatments for each of these infections.

Varicella-Zoster Virus

Ryan, a 63-year-old male, is getting ready for work. As he slips on his shirt, he feels an ache over his left-side ribs, but dismisses this as the result of wrestling with his grandson yesterday. Once in the car, he reaches for his seatbelt and the ache becomes worse and the area begins tingling and burning. Ryan wonders if he's having a heart attack and debates driving to the hospital.

Across town, Kelly, a 6-year-old girl, is telling her mom she doesn't feel well. Her mom takes her temperature and finds that Kelly has a fever. While tucking her into bed, Kelly's mom notices several red spots on Kelly's abdomen.

Ryan and Kelly are victims of the same virus, varicella-zoster virus. Varicella-zoster virus can lead to two infections:

  1. Varicella, commonly known as chickenpox
  2. Herpes-zoster, commonly known as shingles

Let's explore each of these illnesses in greater detail.

Varicella: Symptoms and Treatments

Symptoms

The classic symptom of varicella is a red, bumpy rash on the body which evolves into clear-fluid filled blisters, known as vesicles. These vesicles are extremely itchy, and take about 7-10 days before scabbing and falling off. During the illness progression, the vesicles may spread from the trunk to the extremities and face. In severe cases, the vesicles may spread to the inside of the mouth and throat, the mucous membranes of the eyes or perineal region.

Varicella (chickenpox) is known for the itchy rash it causes.
child with chickenpox

Prior to the rash, a person may experience:

  • headache
  • fever
  • tiredness

Chickenpox is rarely life threatening for a healthy child; but if contracted in adulthood, it can lead to serious complications.

Treatments

Currently there is a vaccine which protects against varicella; thus the occurrence rate of this illness has diminished. However, children who have been vaccinated can still get the illness, but the symptoms are more mild and the duration shorter.

For a mild case of varicella, the treatments revolve around making the person more comfortable:

  • Oatmeal baths, baking soda baths, or calamine lotion may be applied directly to the skin to decrease itchiness.
  • Antihistamines, such as diphenhydramine, may be used to decrease itchiness.
  • Fever medications, such as acetaminophen or ibuprofen, may be used to decrease fever and help with pain.

For a severe case of varicella, the treatments include all the aforementioned with the addition of:

  • Antivirals, such as acyclovir
  • Intravenous immunoglobulins

Returning to Kelly, we find her at home with vesicles covering her face, arms, trunk, and legs. Her mom has given her daily oatmeal baths and the dosage of diphenhydramine recommended by Kelly's pediatrician. Several days later, Kelly's vesicles start to scab and fall off. Kelly returns to school - fever and spot free!

Herpes-Zoster: Symptoms, Complications and Treatments

The varicella-zoster virus is able to go dormant, lying silently in the spinal cord. When activated it travels along the spinal nerve causing a painful, blistering rash in the area of skin associated with that nerve, known as a dermatome. This illness is referred to as herpes-zoster or shingles.

Symptoms

Herpes-zoster causes the following symptoms:

  • blistering, painful rash
  • fever or chills
  • headache
  • nausea
  • malaise
  • sensitivity to light

The rash is usually preceded by skin sensitivity, such as aching, itching, numbness, or burning in the area where the rash will eventually emerge. Remember, the rash is confined to a dermatome, which means the rash does not cross the midline of the body.

Herpes-zoster most often causes a rash on dermatomes of the body's trunk. The second most common place is on one side of the face, at times involving the ear, eye, or tongue. The rash lasts for approximately 2 to 4 weeks.

The rash caused by herpes-zoster (shingles) only occurs on one side of the body.
shingles rash

Some people never develop the classic rash, but just experience increased pain and sensitivity in that area. Often healthcare providers are fooled and think an underlying organ, like the heart or lungs, is to blame for the pain.

Complications

Shingles can lead to two long-term complications. If the eye is involved in the rash, loss of vision is a serious possible complication.

Secondly, certain individuals continue to have pain in the affected dermatome even after the rash has cleared. This is referred to as post-herpetic neuralgia.

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