Chickenpox

Medical specialist	Dermatology and genital specialist, children
Symptom	Vesicles such as teardrops, followed by symptoms of fever, muscle aches, weakness, loss of appetite
risk factor	Have never received chickenpox vaccination, low immune system
How to diagnose	Physical examination
Treatment	Get enough rest, drink enough, take symptomatic drugs
Drug	Paracetamol, antihistamines (loratadine, cetirizine, diphenhydramine), calamine lotion, antivirals (acyclovir, valacyclovir, famciclovir)
Complications	Pneumonia, secondary bacterial infection, sepsis, dehydration, problems with pregnancy
When to see a doctor?	Smallpox lesions in the eyes, high fever, decreased consciousness, shortness of breath

Understanding

Chickenpox ( chickenpox ) is an acute infectious disease caused by Varicella zoster. This infectious disease is also known as varicella.

Just like other diseases caused by viruses, chickenpox can heal by itself or is a self-limiting disease.

Reason

Chickenpox is caused by infection with the Varicella zoster virus.

This virus can be transmitted quickly through the air when the patient coughs or sneezes, as well as direct contact from mucus, saliva, or from blisters on the skin.

People with chickenpox can transmit this virus from 1-2 days before the rash appears until the blisters dry up.

Symptom

Symptoms of chickenpox generally appear 10-21 days after exposure to the varicella virus.

The initial symptoms that appear are red spots that itch and generally appear on the chest, back, face, then spread throughout the body.

In some cases, the chickenpox rash can spread to other areas, such as the eyes, throat, and genitals.

The chickenpox rash has three distinct stages, namely:

• stage 1: small red spots appear that stand out on the body
• stage 2: raised red spots filled with fluid (vesicles) like dewdrops and turn into blisters ( blisters ). At this stage, sufferers usually feel itching and discomfort
• stage 3: the blistering rash turns into crusts and scabs. These blisters can take several days to heal

Apart from the appearance of the chickenpox rash, other accompanying features are:

• high fever
• headache
• pain in the muscles
• mild stomach pain
• loss of appetite
• easily tired and weak

Risk Factors

Several risk factors can increase the occurrence of chickenpox, including:

• never had chickenpox
• have not received the chickenpox vaccine
• have a weak immune system (immunocompromised), such as people with cancer, undergoing chemotherapy or using high-dose corticosteroid drugs, people with HIV/AIDS
• people who work in public facilities, such as schools, daycare, and hospitals
• babies born to mothers diagnosed with chickenpox 2-5 days before delivery
• pregnant mother
• school-age child

Diagnosis

In making the diagnosis of chickenpox, doctors generally look at the clinical characteristics of the existing skin lesions.

Several diagnostic steps are carried out, including:

Medical Interview

Systematic medical interviews are still being carried out to confirm the diagnosis of chickenpox.

The doctor will ask questions, such as when complaints of spots or chickenpox rash appeared, accompanying symptoms, and whether there was contact with sufferers of chickenpox before.

Physical examination

Physical examination in people with chickenpox is very typical, namely the discovery of skin lesions in the form of vesicles that are shaped like dewdrops (teardrops).

In addition, various skin lesions can be found in various stages.

In some cases, patients can also experience a secondary bacterial infection which gives an appearance of swelling, redness, and pus coming out of the chickenpox lesions.

Tzanck’s test

An easy supporting examination to do at an affordable cost is the Tzanck test.

This test is carried out by taking a sample from the scraping base of the vesicle lesion on the skin.

This scraping sample will later be stained with Giemsa stain and viewed under a microscope.

A positive result will give an appearance of inclusion bodies and multinucleated data cells.

Polymerase Chain Reaction (PCR)

One of the sensitive supporting examinations in diagnosing chickenpox is a polymerase chain reaction, aka PCR.

PCR is performed by taking samples from skin lesions, either in the form of vesicles or crusts.

Serological Examination

The serological examination is carried out to detect the presence or absence of varicella-specific antibodies. However, this test is less sensitive than PCR.

Active IgM serology indicates active infection, but cannot distinguish whether this is primary infection, reinfection, or reactivation.

In addition, active IgG may indicate a recent infection or immunity resulting from vaccination.

Direct Fluorescent Antibody Assay (DFA) and Virus Culture

In addition to PCR, virus isolation techniques that can be used to diagnose varicella include direct fluorescent antibody assay (DFA) and viral culture.

However, these two techniques are not recommended considering their lower sensitivity level compared to PCR.

In addition, getting viral culture results also takes longer.

Treatment

Considering that chickenpox is caused by a viral infection and is a self-limiting disease, the treatment given is generally supportive.

Drug Therapy

In some cases, antiviral administration can be considered, especially for groups at risk of complications.

To relieve the symptoms that appear, the doctor can give certain chickenpox drugs.

To reduce itching, your doctor may suggest using topical calamine lotion.

Apart from that, it can also be suggested to use antihistamines such as diphenhydramine, loratadine, and cetirizine to help reduce itching.

To relieve fever, headaches, and muscle aches, the doctor will prescribe paracetamol.

Avoid giving aspirin to people with smallpox because it can cause complications with Reye’s syndrome.

Make sure you consult first if you want to give medicines to people with smallpox, especially if you use over-the-counter drugs.

In groups of people at risk, the administration of antivirals can help relieve symptoms and reduce complications.

Some antiviruses that are commonly used include:

• acyclovir
• valacyclovir
• famciclovir

Varicella zoster immunoglobulin (VZIG) can be given to groups that are especially vulnerable, namely newborns of mothers who have had chickenpox before or after giving birth, premature babies, children aged less than 1 year, and pregnant women.

It is recommended to give VZIG immediately or up to 10 days after exposure to varicella.

Home Care

Apart from taking medicines recommended by doctors, there are several treatments that can be done at home to help relieve symptoms.

• Drink enough to avoid dehydration and consume nutritious food to help increase endurance.
• Get enough rest and avoid contact with other people to prevent transmission of chickenpox.
• Avoid scratching the smallpox blisters. Scratching the skin can increase the risk of secondary bacterial infection, leave scars, and slow healing.
• Make sure you trim your nails to avoid creating a wound from accidentally scratching.
• For children, you can wear gloves to prevent your little one from scratching at night.
• Wear loose, comfortable, and soft clothing.
• Keep bathing and maintaining personal hygiene to avoid secondary bacterial infections. When bathing, avoid scrubbing too hard and dry your body by patting it gently.
• Compress the itchy area with cold water or apply calamine lotion.

Related Drugs

The following is a summary of the list of drugs associated with chickenpox:

• Calamine lotion
• Antihistamines such as diphenhydramine, loratadine, cetirizine
• Paracetamol
• Acyclovir
• Valacyclovir
• Famciclovir

Prevention

An effective way to prevent chickenpox is to vaccinate against chickenpox.

This vaccination is highly recommended for children and adults who have not received the chickenpox vaccine.

Based on the immunization schedule recommended by the Indonesian Pediatrician Association (IDAI), the chickenpox vaccine is given to infants in 2 doses. Vaccination can be started from the age of 12-18 months with an interval of 6 weeks to 3 months.

If the child is 13 years old or older, chickenpox vaccination is still given but the interval between the first and second doses is 4-6 weeks.

In adults, the chickenpox vaccine can be given immediately regardless of age.

As with vaccinations in children, the chickenpox vaccine in adults is also given in 2 doses with an interval of 4-8 weeks from the first dose.

Despite being an effective preventive measure against chickenpox, chickenpox vaccination cannot be given to groups of pregnant women, people with weakened immune systems, and people who are allergic to gelatin and the antibiotic neomycin.

If you are one of this group, the prevention you can take is to avoid contact with people who are sick with chickenpox.

If a family member has chickenpox, there are several steps that can be taken as an effort to prevent transmission of infection at home, such as:

• Separate sufferers from healthy family members in another room
• as much as possible avoid contact with people with chickenpox considering this disease is easily transmitted through the air. If you really have to treat sufferers, make sure you wear a mask
• always wash your hands before and after contact with people with chickenpox
• try not to share personal utensils and cutlery with people with chickenpox
• be sure to regularly clean the surfaces of furniture or parts that are frequently touched together
• remind smallpox sufferers to stay at home until the rash is completely dry and healed

Complications

After recovering from chickenpox, the Varicella zoster virus actually resides in the nerve cells.

Later, this virus will be active and return in the form of shingles or shingles.

This disease can appear usually triggered because of low body resistance.

Although in general, this disease is not dangerous, chickenpox still has complications. Some of the complications of chickenpox that arise include:

• scar tissue formation
• a secondary bacterial infection that can occur in the skin, joints, soft tissue
• sepsis
• dehydration
• pneumonia
• encephalitis
• toxic shock syndrome
• death

Pregnant women who are infected with chickenpox can increase the risk of complications in the form of pneumonia.

Its effects on the fetus, chickenpox can cause complications of congenital varicella syndrome which is characterized by the formation of low birth weight, skin lesions, disorders of the brain, eyes and limbs, as well as problems with the digestive system.

If chickenpox occurs a week before the baby is born or a few days after the baby is born, it can increase the risk of developing neonatal varicella, which is a life-threatening infection.

When to See a Doctor?

As with other viral diseases, chickenpox can heal by itself without special treatment.

However, if you are not sure whether the symptoms that appear are chickenpox, you can confirm it with your doctor.

Immediately go to the doctor if the person with chickenpox is under 6 months old or belongs to the immunocompromised group.

In addition, don’t delay seeing a doctor if you find other accompanying characteristics of chickenpox, such as:

• chickenpox rash spreading to the eye area (one or both eyes)
• Chickenpox rash turns red, and warm, pus oozes, and even pain. This condition can indicate the involvement of other skin infections
• high fever
• loss of consciousness
• hard to breathe
• worsening cough
• stiff neck
• violent vomiting
• loss of muscle coordination