Most adults have had varicella zoster (VZ). The incubation period 10-21 days. Highly infectious (about 90%) 48 hours before the rash and last until the vesicles crust is over. Very contagious, the whole department infected (face to face 5 minutes or indoor contact more than one hour). Previous infection can be confirmed by measuring VZV antibodies. Zoster may occur months to years after primary varicella infection. Maternal:
Pneumonia occurs in up to 10%, with mortality up to 45% in the pre-antiviral era. The mortality today is less than 1%. Mechanical ventilations can be required with up to 6% mortality. Other complications include encephalitis, generalized spread to internal organs, hepatitis, arthritis, pericarditis, glomerulonephritis, Reye's Syndrome and hemorrhagic varicella.
Low birthweight, neurological abnormalities (microcephaly, cortical atrophy, mental retardation and dysfunctional bowel and bladder sphincters. Eye defects (microphthalmia, chorioretinitis, cataracts) Hypoplasia of the limbs Skin scarring in a dermatomoid distribution
Amniocentesis with PCR for viral DNA PCR, otherwise with detection of IgM antibodies in fetal blood. However, both these tests may give false negative results.VZV antibodies of limited valu In the first 28 weeks of pregnancy and within 3 weeks of delivery, mother should receive 1,000 mg VZIG immediately after exposure if known or found to be IgG negative. If the mother present with symptoms the value of VZIG is uncertain and the patient should receive antiviral treatment in the form of acyclovir or valcyclovir. Up to 50% infections are infected 1 to 4 weeks before delivery. Is fatal in 20-30% of infants if maternal infection occurs 5 days before the delivery and up to 2 days postpartum, but severe infection up to one month has been seen. The infant is protected by maternal antibodies at least one month after delivery. Newborns should not be exposed to VZ if mother have not had the disease. Management:
(1) Chickenpox in pregnancy. Green-top Guideline Nor. 13, September 2007
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