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Acute varicella-zoster

Last reviewed: 5 Oct 2024
Last updated: 31 May 2024

Summary

Definition

History and exam

Key diagnostic factors

  • history of exposure
  • fever
  • vesicular rash
  • vesicles on mucous membranes
Full details

Other diagnostic factors

  • pruritus
  • headache
  • fatigue/malaise
  • sore throat
  • tachycardia
Full details

Risk factors

  • exposure to varicella
  • age 1 to 9 years
  • unvaccinated status
  • occupational exposure
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests 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)
Full details

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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