varicella tb

8/11/2019 Varicella TB

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VARICELLA


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Group Members

Agus Riansyah

Nofianty S.

Rini Dwi Astuti

Nurul Fadilah A. Polanunu

Rezki Argha NauliA. Nurul fadilah

Sanny Manuhutu

Muh. Khaerul Muqsith

Faris Azhar

Nur Syazni

Irsan Kurniawan

Windy Nurul AisyahMuh. Sangaji Ramadhan

Husni Harmansyah


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PATIENTS ID

Name : Ms. AT

Gender : Female

Age : 18 years old Marital Status: Not Marriedyet

Religion : Kristen Protestan

Occupation : Student Registered : November 25th, 2014


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PHYSICAL EXAMINATION

Blood Pressure : 110/70 mmHg

Heart Rate : 92 x/min

Respiratory Rate : 22 x/min Temperature : 390C


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DERMATOLOGY STATUS

Location : Generalized

Efflorescence : Erythema-based vesicles ,

crusts, pustule.


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Patients Photo

(a) (b)

(a) Vesicles on superior extremity (b) vesicles on face


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(a) Vesicles on region abdomen (b) vesicles on region

lumbalis and umbilicalis posterior

(a) (b)


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DIAGNOSE

VARICELLA


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TREATMENT

IVFD RL : Dextrose 5% = 1:1 20 drops/minutes

Acyclovir 5 x 400 mg

Neurodex 2 x 1 tab MBO talk


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Overview

The highly contagious primary infection caused

by varicella-zoster virus.

It is characterized by successive crops of pruritic

vesicles that evolve to pustules, crusts, and attimes, scars.

This infection is often accompanied by mild

constitutional symptoms Primary infection occurring in adulthood may be

complicated by pneumonia and encephalitis


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EPIDEMIOLOGY

Without immunizaton, 90% of cases occur in

children


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TRANSMISSION

Airborne droplets as well as direct contact

Indirect contact uncommon

Patients are contagious several days before

varicella exanthem appears and until last crop

of vesicles

Crusts are not infectious.

VZV can be aerosolized from skin of

individuals with herpes zoster


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PATHOGENESIS

VZV enter through mucosa of respiratory tract

Local replication (primary viraemia)

replicating in cells of RES and dissemination to

the skinLocalization of VZV in the basal celllayervirus replication, ballooning

degeneration of epithelial cells, and

accumulation of edema fluid


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CLINICAL MANIFESTATIONS

Prodrome 14 days (range, 10-23 days)

Characteristically absent or mild.

Rarely in children, more common in adults: headache,

general aches and pains, severe backache, malaise. Exanthema appears within 23 days.

History

Exposure at day care, school, to older sibling; relative

with zosterSkin Symptom

Exanthem usually quite pruritic


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SKIN LESIONS

Vesicular lesions

Scanty in number in children and much more indense in adults

Vesicles become umbilicated and rapidly evolvetopustules and crusts over an 8- to 12-h period

With subsequent crops, all stages of evolutionmay be noted simultaneously, i.e., papules,vesicles, pustules, crusts, i.e., polymorphic

Crusts fall off in 13 weeks, leaving a pink,somewhat depressed base


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DISTRIBUTIONS

First lesions begin on face and scalp

Mostly distributed in areas least exposed topressure, i.e., back between shoulder blades,flanks, axillae, popliteal and anticubital fossae

Density highest on trunk and face, less onextremities

Palms and soles usually spared

Can also occur on mucous membranes, mostcommon on palate followed nose, conjunctivae,pharynx, larynx, trachea, GI tract, urinary tract,vagina


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LABORATORY EXAMINATIONS

VZV Antigen Detection DFA

Viral Cultures

Tzanck Smear Serology

Dermatopathology


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DIAGNOSIS

Usually made on clinical findings alone

DD: Widespread vesicles/crusts


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TREATMENT

Symptomatic

Lotions

Oral antihistamines Antipyretic agents

Antiviral agents

Acyclovir 20 mg/kg (max 800 mg) 4 x 1 for 5days


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PREVENTION

Varicella Immunization (varivax)


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PROGNOSIS

Self-limited, however, mortality rate 1 : 50.000(cases in United States)

Complication in

varicella tb

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