Congenital varicella syndrome
Overview
The infection of a mother with the varicella virus whilst she is pregnant.
Symptoms
* Mental deficiency * Seizures * Cortical atrophy * Prenatal growth deficiency * Small head * Chorioretinitis * Hypoplasia of limb * Rudimentary fingers * Rudimentary toes * Atrophy of limb * Limb paralysis * Clubfoot * Cutaneous scars * Vesicular eruptions * Rash * Malaise * Anorexia * Headache * Pruritic * Fever * Crop lesions
Causes
Congenital varicella may affect infants whose mothers had acute infections in their first or early second trimester. Neonatal infection is rare, probably due to transient maternal immunity. Second attacks are also rare. Varicella is transmitted by direct contact (primarily with respiratory secretions; less often with skin lesions) and respiratory droplets. The incubation period lasts from 13 to 17 days. It’s probably communicable from 1 day before lesions erupt to 6 days after vesicles form (it’s most contagious in the early stages of eruption of skin lesions). Most children recover completely, but potentially fatal complications may affect children receiving corticosteroids, antimetabolites, or other immunosuppressant agents, and those with leukemia, other neoplasms, or immunodeficiency disorders. Congenital and adult varicella may also have severe effects. Varicella occurs worldwide and is endemic in large cities. Outbreaks occur sporadically, usually in areas with large groups of susceptible children. It affects all races and both sexes equally. Seasonal distribution varies; in temperate areas, incidence is higher during late autumn, winter, and spring.
Treatment
Chickenpox calls for droplet and contact isolation until all vesicles and most of the scabs are dry (no new lesions; usually 1 week after the onset of the rash). Children with only a few remaining scabs are no longer contagious and can return to school. Congenital chickenpox requires no isolation. In most cases, treatment consists of local or systemic antipruritics: lukewarm oatmeal baths, calamine lotion, or diphenhydramine (or another antihistamine). Antibiotics are unnecessary unless bacterial infection develops. Salicylates are contraindicated because of their link with Reye's syndrome. Susceptible patients may need special treatment. When given up to 72 hours after exposure to varicella, varicella-zoster immunoglobulin may provide passive immunity. Acyclovir and famciclovir, antiviral agents, may slow vesicle formation, speed skin healing, and control the systemic spread of infection.
Resources
Main name of condition: Varicella virus antenatal infection