Acute varicella-zoster

Last reviewed: 28 Aug 2022
Last updated: 05 Apr 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fever
  • vesicular rash
  • vesicles on mucous membranes
More key diagnostic factors

Other diagnostic factors

  • pruritus
  • headache
  • fatigue/malaise
  • sore throat
  • tachycardia
Other diagnostic factors

Risk factors

  • exposure to varicella
  • age 1 to 9 years
  • unimmunised status
  • occupational exposure
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • polymerase chain reaction
  • viral culture
  • direct fluorescent antibody testing (DFA)
  • Tzanck smear
  • latex agglutination (LA)
  • enzyme-linked immunosorbent assay (ELISA)
  • complement fixation
  • ultrasound (pregnant women)
More investigations to consider

Treatment algorithm

ACUTE

otherwise healthy children at low risk of severe disease

increased risk of moderate to severe disease

high risk of severe disease

severe disease

Contributors

Authors

Andrew Riordan, MD, FRCPCH, MRCP, DTM&H

Consultant in Paediatric Infectious Diseases and Immunology

Royal Liverpool Children's Hospital (Alder Hey)

Liverpool

UK

Disclosures

AR declares that he has no competing interests.

Acknowledgements

Dr Andrew Riordan would like to gratefully acknowledge Dr Steven Pergam, Dr Rupali Jain, and Dr Anna Wald, previous contributors to this topic.

Disclosures

SP has served as a consultant for Merck & Co., Inc, Optimer/Cubist, and Chimerix, and has participated in clinical trials with these three organizations. He is also an author of a paper cited in this topic. RJ declares that she has no competing interests. AW is a member of the Data and Safety Monitoring Board (DSMB) for a Merck study of a candidate VZV vaccine.

Peer reviewers

Chad M. Hivnor, Major, USAF, MC, FS

Chief

Outpatient & Pediatric Dermatology

59th Medical Wing/ SGOMD

Lackland Air Force Base

San Antonio

TX

Disclosures

CMH declares that he has no competing interests.

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