Detailed diagnosis formulation algorithm
To correctly determine the treatment strategy, a physician must formulate a detailed clinical diagnosis. This process consists of several mandatory steps:
- Determining the clinical form. It is necessary to establish whether the infection is proceeding in a typical or atypical form.
- Assessing the severity of the course. Severity is determined in accordance with the current clinical classification (e.g., moderate or severe course).
- Identifying complications. Any concurrent pathological conditions caused by the infection are indicated.
Examples of correct formulation include the following options: «Chickenpox, moderate course (ELISA negative test from 02.12.2018, positive from 11.12.2018)» or «Chickenpox, severe course. Complication: meningoencephalitis».
Planning patient management tactics
After establishing the diagnosis, a plan of further actions is outlined. First, the place of treatment is decided: whether hospitalization in an infectious diseases hospital is required or home treatment is possible.
The prescription of evidence-based treatment is always carried out taking into account the severity of the disease, the presence of specific complications, and the patient's background comorbid conditions. It is extremely critical to immediately determine the criteria for clinical recovery. If the disease proceeds without complications, discharge of the convalescent is allowed exclusively upon complete clinical recovery and no earlier than the 5th day from the moment the last skin vesicle appeared.
Clinical manifestations and false polymorphism
Diagnosis relies on the characteristic clinical picture. Usually, the rise in body temperature coincides with the appearance of the exanthema. However, in some cases (which may cause diagnostic errors), a prodromal period lasting about two days with mild intoxication (weakness, headache, decreased appetite) is observed.
Typical rash in chickenpox is localized on the face, scalp, trunk, and extremities. The main feature of the exanthema is false polymorphism. This means that elements at different stages of development can be simultaneously found on the patient's skin: macules, papules, and dense unilocular vesicles. Involvement of the oropharyngeal mucous membranes (enanthema) is also characteristic, where single aphthae, erosions, or vesicles appear against the background of moderate hyperemia (e.g., on the soft palate or palatine arches).
Diagnostic errors and epidemiological history
In the early stages, chickenpox is sometimes mistaken for rubella. The initial diagnostic error is usually associated with the following factors:
- Presence of an atypical prodromal period (which is rare for this infection).
- Late appearance of the rash (e.g., only on the third day of illness).
- Absence of typical vesicular elements at the time of the first medical examination.
Taking an epidemiological history is critical to confirm the diagnosis. The physician needs to find out whether the patient has had this infection before and whether specific vaccination was administered. Contacts with infected individuals within the maximum incubation period, which is up to 23 days before the onset of the disease, are also clarified. At the same time, it should be remembered that the pathogen has high contagiousness and volatility, so infection is possible even in the absence of direct close contact, through the spread of the virus with air currents.
Briefly: answers to topical questions
What drugs are used for etiotropic treatment of chickenpox?
For etiotropic treatment of chickenpox in severe cases or in immunocompromised individuals, antiviral drugs and specific antibodies are used.
- Acyclovir — a DNA synthesis blocker. Prescribed orally 800 mg 5 times a day or intravenously by drip 5–10 mg/kg every 8 hours for 5–10 days.
- Vidarabine — used as an intravenous infusion at a dose of 10–15 mg/kg daily for 5–10 days.
- Specific immunoglobulin — administered strictly in severe cases of infection.
What drugs are used for local treatment of vesicles in chickenpox?
Antiseptic solutions are used for local treatment of vesicles in chickenpox.
- Brilliant green solution — a 1% solution is used for dabbing rash elements.
- Potassium permanganate — used as solutions for dabbing the rash (especially on the genitals) or hygienic baths at a concentration of 0.05%.
- Fucorcin — is also used for local treatment of vesicular rashes.
In addition, an aqueous solution of nitrofurazone (1:5000 ratio) or potassium permanganate solution is used to care for the oral mucosa.
What are the main clinical differences between chickenpox and shingles?
The main clinical differences between chickenpox and shingles lie in the nature of the infection, localization, and features of the rash, as well as the presence of pain syndrome in shingles.
| Sign | Chickenpox (Varicella) | Shingles (Herpes zoster) |
|---|---|---|
| Nature of infection | Primary infection, predominantly in children | Reactivation of the virus in individuals who have previously had chickenpox; endogenous infection in adults |
| Rash localization | Generalized vesicular rash; can be located on any part of the body, including the scalp | Vesicular rash along nerve trunks or within dermatomes |
| Rash features | False polymorphism: simultaneous presence of macules, papules, vesicles, and crusts; no staged spread | The rash appears in the pain area; grouped vesicles are formed |
| Pain syndrome | Sources indicate skin pruritus for chickenpox | Pronounced pain syndrome along the affected nerve is characteristic, preceding the rash |
What complications are most typical for chickenpox?
Chickenpox complications are divided into specific ones, caused directly by the virus, and non-specific ones, associated with secondary bacterial flora superinfection.
- CNS involvement: encephalitis and meningoencephalitis. They occur during the crusting period; encephalitis accounts for 90% of neurological complications.
- «Varicella» viral pneumonia: develops on days 3–5 from the onset of the disease.
- Other specific complications: nephritis, myocarditis.
- Purulent complications: suppuration of chickenpox rash elements; pathogens are Streptococcus pyogenes and Staphylococcus aureus.
To recognize the rash, remember the term «False polymorphism»: macules, papules, and vesicles are simultaneously present in one skin area.
Class and exam questions
When is a patient with an uncomplicated form cleared for discharge?
The patient can be discharged upon clinical recovery, but strictly no earlier than the 5th day from the moment the last skin vesicle was formed.
Why might chickenpox be mistaken for rubella in the early days?
This occurs if the disease begins with a prodromal period, the rash appears late (e.g., on the 3rd day), and typical vesicles are still absent upon initial examination.
What timeframe does gathering the epidemiological history cover?
It is necessary to identify all possible contacts with infected individuals for a period of up to 23 days before the onset of symptoms, taking into account the maximum incubation period of the infection.
What else to study on this topic
- Prognosis for the fetus in case of maternal infection at various stages of gestation.
- Determination of management tactics for contact children (e.g., attending kindergarten).
- Specific antiviral therapy depending on the severity of the condition.
- Assessment of neurological status to rule out meningoencephalitis.
- Clinical features of atypical forms of chickenpox.
Master the complete topic in the «Infectious Diseases» course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Treatment of Chickenpox and Shingles" plus 3,312 more subject pages
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 41 video lessons on the subject
Other topics in the "Respiratory Infections" section
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.