Chickenpox in Children: Causes, Symptoms, and Treatment

Chickenpox (varicella) is an acute viral disease characterized by maculopapular-vesicular rash on the skin and mucous membranes accompanied by an intoxication syndrome. It is predominantly diagnosed in childhood: about 90% of the world's population experiences this disease before the age of 15.
The peak incidence occurs in preschool age — 3–4 years.
Chickenpox in children is considered one of the most common infectious diseases, as the susceptibility of the human body to the varicella virus is nearly 100%, and after the disease, immunity is generally retained for life (with exceptions for individuals with immunodeficiency conditions).

Causes of Chickenpox

The Herpes zoster virus is an anthropogenic DNA virus belonging to the Herpesviridae family, specifically the human herpes virus type 3.
This infectious agent is the primary cause of chickenpox and shingles. The herpes virus type 3 is characterized by high contagion and instability in the external environment. The virus can survive in saliva for up to 15 minutes, and it quickly degrades under ultraviolet light and high temperatures.
Infection with the varicella virus occurs through airborne droplets and vertical (transplacental) routes.
One can only contract the virus from an infected person: 2 days before the appearance of their rash and during the subsequent 5 days. On the 6th day after the first rash element appears, the patient is considered epidemiologically safe for others.

Symptoms of Chickenpox

The classic clinical picture of chickenpox is characterized by a certain stage of progression:
The incubation period (from the moment of infection to the appearance of the first clinical symptoms) lasts from 11 to 21 days.
The prodromal period (2 days before the characteristic rash appears) does not develop in all children. 48 hours before the first rash elements appear, the child may complain of fatigue, loss of appetite, nausea, and vomiting.
The peak period of the disease. The appearance of the first rash elements is accompanied by a rise in body temperature (37–38 °C) and other manifestations of intoxication syndrome (loss of appetite, malaise, headache, sweating).

Characteristics of the rash:

• localization: face, scalp, entire body surface (abdomen, thighs, shoulders, chest, except for palms and soles), mucous membranes of the mouth, throat, and external genitalia
• primary elements: macules (red or pink spots), papules, vesicles
• vesicle sizes reach 5 mm, surrounded by a ring of hyperemia
• the rash is polymorphic (elements at different stages of development are present simultaneously) and appears in waves ("new crops")

Atypical forms of chickenpox are characterized by the formation of pustules (elements filled with pus or blood) and pronounced intoxication syndrome.

Diagnosis of Chickenpox

The diagnosis of chickenpox is based on physical examination data of the child and epidemiological history. The identification of polymorphic maculopapular-vesicular rash and the presence of contact with a carrier of the viral infection are reliable signs of chickenpox. In some cases, laboratory methods are used: virological and serological tests, as well as PCR.

Treatment Methods for Chickenpox

Treatment of the disease aims to prevent secondary infections and support the immune system for faster recovery. Hospitalization is required for children with complicated and atypical forms of chickenpox.

Care

• regularly change bed linen and clothing (once a day)
• keep fingernails short to reduce the risk of skin damage
• for severe itching, children are recommended to wear soft cotton gloves

In post-Soviet countries, rash elements were traditionally treated with aniline alcohol or water solutions (such as brilliant green), however, modern skin care recommendations for chickenpox differ significantly. Due to the increasing resistance of infectious agents to medications, the use of local treatment is considered ineffective and is not recommended in most cases.

Medication treatment is used to alleviate the symptoms of the disease:

• antihistamines — prescribed for severe itching that causes significant discomfort to the child
• antipyretics — used for high body temperature

Often, parents independently prescribe antiviral medications for their children, but this is strictly prohibited: these medications are used in severe cases of the disease, complicated forms of chickenpox, and in high-risk patients only as prescribed by a doctor.
In some countries, vaccination is used — a method of active specific prevention of chickenpox by introducing a weakened virus into the child's body. The immune system recognizes the vaccine as a foreign antigen and produces antibodies. Memory immune cells retain information about the virus and provide long-term protection against infection.

Consequences of Chickenpox

All complications of chickenpox can be divided into local (skin) and systemic.
Local complications include abscesses, furuncles, and carbuncles that arise due to the addition of a secondary bacterial infection against the background of reduced immunity. The appearance of the rash is accompanied by intense itching, so the child constantly scratches and injures the papules and vesicles, which contributes to additional skin infection. Scars at the site of rashes usually occur in atypical forms of the disease.

Systemic Complications of Chickenpox

Carditis — inflammation of the heart or its membranes. To confirm the diagnosis, the doctor may prescribe an ECG, echocardiography (ultrasound of the heart), blood tests (including markers of myocardial damage), and other studies.

Arthritis — an inflammatory disease of one or more joints, accompanied by pain, swelling, limited mobility, and sometimes redness of the skin over the joint:

• joint pain (worsens with movement or persists at rest)
• joint swelling (edema)
• stiffness, especially after sleep or prolonged rest
• limited range of motion
• local increase in temperature and redness of the skin (not always)

Varicella encephalitis is one of the most common complications of the disease. Brain damage develops 1–2 weeks after the rash appears and manifests with general brain symptoms (headache, seizures, altered consciousness), focal neurological symptoms (paresis of limbs, sensory disturbances), as well as signs of intoxication (increased body temperature, sweating, loss of appetite, weakness).
Varicella pneumonia is more common in adults and manifests as respiratory failure (shortness of breath, cough with hemorrhagic sputum, acrocyanosis, chest pain) and pronounced general intoxication syndrome.

Consultation with a doctor during chickenpox is indicated to exclude infectious-inflammatory damage to the cardiovascular system, identify possible post-infectious immune-inflammatory complications after chickenpox, assess the functional state of the cardiovascular system, determine the volume of additional examinations, and plan further monitoring.