Chickenpox and shingles – symptoms, treatment, complications

Proven content

Shingles and chickenpox are closely related, because it is not possible to get shingles without getting chickenpox first. During the primary infection, i.e. chicken pox, the virus enters our nervous system, more precisely into the ganglia of the intervertebral nerves and cranial nerves, where it remains latent for many years. In the presence of favorable factors, the infection may reactivate and the herpes zoster may develop.

Chicken pox is a common acute childhood rash infectious disease, while shingles is also an infectious rash disease that occurs most often later in life. Both diseases are the result of infection with the same virus – varicella-zoster virus (VZV), belonging to the Herpes family.

Shingles – the routes of infection and risk factors

The infection with the varicella zoster virus occurs through droplets or through direct contact with a person suffering from chickenpox or shingles. The sick person is contagious to the environment 2-3 days before the appearance of the rash to about 7-8 days from the appearance of the rash, usually until the last vesicular eruptions have dried up.

The smallpox virus is very infectious towards susceptible persons, i.e. without protective antibodies. Thus, most often after contact with a person with chickenpox, a person who has not had chickenpox develops the disease. Chickenpox can also develop if a susceptible person comes into contact with someone with shingles, but is much less contagious than the primary infection. However, it is not possible for another person to develop shingles after contact with someone with shingles. A person suffering from shingles is not dangerous for people who have had chickenpox.

The greatest number of cases of chickenpox is observed between the ages of 1 and 15 and in the spring period. On the other hand, shingles is a disease of the mature period and can occur regardless of the season. The storage of chicken pox gives permanent immunity to repeated infection.

Factors contributing to the development of shingles

Age over 65, cancer, immunosuppressive therapy, treatment with corticosteroids, HIV infection, children born to mothers who have had chickenpox during pregnancy.

The occurrence of herpes zoster should always be a signal for a diagnosis of cancer or immunity disorders.

Chickenpox – symptoms

The disease usually develops 11-21 days after contact with the sick person and covers the following periods:

— the pre-rash period: 1-2 days before the rash, general malaise, headache, pain in muscles and joints, sore throat, diarrhea and mild fever; the teaser period does not always have to occur

– rash period: characteristic itchy blistering rash all over the body; initially, the lesions appear on the trunk, then on the face, scalp, and finally on the limbs (rarely on the hands and feet); the rash is very characteristic: initially erythematous macula, then a papule which transforms into a vesicle filled with liquid content, after 2-3 days transforms into a blot which dries up, after the scab falls off a small scar and discoloration, which disappears without a trace in the form of uncomplicated smallpox ; smallpox scars remain in the case of superinfection of vesicular lesions by bacteria; in smallpox rash, the presence of several stages of the rash at different times is characteristic – the image of the “starry sky”; the number of efflorescence may vary from a few to several hundred; a fever may appear in the first 4 days of the rash.

Atypical forms of chicken pox

– congenital chickenpox – the course depends on the period of pregnancy;

– smallpox in the period up to the 20th week of pregnancy – the fetus usually dies or is damaged in the form of: deformation of the limbs, cataracts, microcephaly or hydrocephalus, skin scars;

– after 20 weeks of pregnancy – symptoms of congenital chickenpox are most often not observed in a child, however, there is a risk of shingles in the early stages of a child’s life

– maternal chickenpox 5 days before delivery and within 48 hours after delivery – very severe course of chickenpox in the newborn, often complicated by pneumonia and hepatitis with high mortality in the absence of antiviral treatment

– chickenpox in vaccinated persons – mild course, with a small number of maculopapular eruptions (vesicles appear rarely); fever-free course.

Shingles – symptoms

– the harbinger period: general malaise, headache, fever, characteristic pain or burning of the skin in a specific area along the path of the affected nerve (the so-called dermatome – e.g. in the area of ​​a specific intercostal nerve on one side of the body)

– period of skin lesions: a rash similar to chickenpox, but located only in a limited area of ​​the affected nerve; most often lesions appear on one side of the body along the intercostal nerves from the spine to the chest or cover the skin of the half of the face (involvement of the trigeminal nerve) – the name of the disease is derived from the characteristic clinical picture; after 3-4 weeks the skin changes disappear – scars or discoloration may remain; the skin lesion is accompanied by severe pain in the affected area, which may persist even up to 6 months after the disease

Unusual forms of shingles

– eye shingles – if left untreated, it can lead to visual impairment

– ear shingles

– recurrent shingles – may be a sign of cancer.

Chickenpox – complications

Factors that increase the risk of complications include: pregnancy, age over 20; immunosuppressive treatment, diseases with immunodeficiency, children born to mothers with smallpox in the perinatal period

complications: bacterial superinfections of skin lesions, pneumonia, cerebellitis, encephalitis, paralysis of cranial nerves, Reye’s syndrome – in children treated with acetylsalicylic acid

shingles: chronic neuralgia, conjunctivitis, optic neuritis, meningitis and encephalitis, spinal cord inflammation, facial paralysis

Diagnosis of chicken pox and herpes zoster

The diagnosis of both diseases is not difficult due to the characteristic clinical picture of the disease.

Treatment of chickenpox and shingles

Symptomatic treatment is used in uncomplicated forms of chickenpox: antipyretic drugs (aspirin must not be used in children), antipruritic drugs, painkillers.

Antiviral treatment is used in severe cases of chickenpox and in people at risk and in people with herpes zoster – oral or intravenous acyclovir is the drug of choice.

Both in the course of chicken pox and herpes zoster, you should not use any topical powders or ointments, because the risk of bacterial infection of the eruptions increases. Daily showering is recommended in any case.

Prevention of chicken pox and herpes zoster

The primary method of prevention is isolation of patients until the skin lesions dry. Additionally, it is possible to get vaccinated against chickenpox. The vaccine is recommended to all people who have not suffered from chickenpox, in particular: a woman planning a pregnancy, patients before the planned transplant, patients with leukemia in remission, health care professionals and people caring for patients with immunodeficiency. Basic vaccination consists of 2 doses administered 6-8 weeks apart.

It is also possible to administer a specific immunoglobulin as post-exposure prophylaxis = after contact with a person suffering from chickenpox, patients with significant immunodeficiency and newborns born to mothers with chickenpox between the 5th day before delivery and the 2nd day after delivery.

Text: Mirosław Jawień, MD, PhD