CASE HISTORY 1
The patient was an 8 year-old female who presented to her pediatrician with fever and a diffuse rash (onset 3 days ago). On examination she was irritable but alert. She had fever for the first two days of the rash but since then has not had fever. She had diffuse vesiculopustular lesions over her entire body, with some areas showing older, crusted lesions. The liver and spleen were not enlarged. Her pediatrician examined her and confirmed a diagnosis of chickenpox. The patient's mother expressed concern about her other child, a 3 year old boy currently undergoing chemotherapy.
STUDY QUESTIONS
1. If the patient developed a complication requiring hospital admission, what type of isolation would be required? Answer
2. What is known about the pathogenesis of the infection? Answer
3. The pediatrician made a clinical diagnosis. Should laboratory tests be run to confirm the diagnosis? Answer
4. Are there any effective anti-viral agents that act against this virus? Answer
5. Are there any long term consequences associated with this viral infection? What bacterial superinfections may occur with varicella? What are other complications of varicella? Answer
6. A new vaccine against VZV is available. Describe it. Should the 3 year-old boy receive the vaccine or any other therapy? What are the current recommendations for the use of the vaccine? Answer
7. Two weeks later, the patient=s mother who did not have a history of chickenpox and is 39 weeks pregnant, develops varicella. She develops respiratory distress and is admitted. The next day she delivers the infant. What should be done for the baby and mother? Answer
8. Two weeks after that, a nurse who cared for the mother develops chickenpox. She thought that she had the illness, but questioned her mother who reported that she had not. The nurse had been at work for the past 2 days and had been on the Pediatric ward, caring for children with hematologic malignancies. What action should be taken? What could have been done to prevent this problem? Answer