Chicken pox

Senthamil Selvi.S1*, Dhariniya S2, Ruby Ravichandran3

1Infection Control Nurse, Maa Kauvery , Trichy, Tamil Nadu

2Nursing Educator, Maa Kauvery , Trichy, Tamil Nadu

3Senior Deputy Nursing Superintendent, Maa Kauvery , Trichy, Tamil Nadu

*Correspondence

Abstract

Chicken pox is an infectious childhood disease. It is rare in infants and newborns due to passive immunity received from the mother. The characteristic skin eruptions in chicken pox are vesicular with erythematous base and accompanied with pruritus. The skin of the palms and soles is typically spared. We report a case of neonatal varicella where the mother was having skin eruptions at the time of delivery and the neonate contracted it during the perinatal period and developed clinical disease on the day five of life. Specific anti-viral therapy was given to the mother and the baby and the recovery was uneventful.

Keywords: Neonatal varicella; Chicken pox; Varicella-zoster virus (VZV)

Introduction

Varicella-zoster virus (VZV) is a double stranded encapsulated DNA virus belonging to the Herpes virus family (human Herpes virus type 3, HHV-3).It is known to cause chicken pox in children and shingles and post-herpetic neuralgia in adults.Chicken pox is an extremely contagious rash seen in childhood and  unimmunized adults where the virus spreads by airborne transmission or via fomites. The incubation period from exposure to appearance of rash varies from 10 to 23 days with an average of 14 days. The clinical course of the disease is usually mild and self-remitting except in infants and persons over 15 years of age who tend to have severe disease.

Case Presentation

There was history of 18 days old female neonate, born by LSCS with the baby Birth Weight 3.2 kg,Admission weight 3.690 kg,38 weeks ofGestation was brought with complaints of skin lesion over the last 5 days fever 1 day and passage of loose stools 5days Varicella infection in mother 6 days after delivery and varicella infection in sibling 4 weeks earlier.

Clinical Findings

On examination neonate had polymorphic pustular lesions all over the body. Blood sugar was serially monitored and values were normal. Initial blood investigations showed Hb: 14.7, TC: 11170, platelet: 222000 with negative CRP. Neonate was treated with IV Inj.Acyclovir, IV paracetamol and other supportive measures. Neonate was on DBF and tolerated well. Pustular lesions improved and no new lesions appeared.

Fig (1): Polymorphic pustular lesions all over the body

Investigations and results

Initial blood investigations showed Hb: 14.7, TC: 11170, platelet: 2,22,000 with negative CRP. Blood sugar was serially monitored and values were normal,

Management

  • Neonate was treated with,Inj.Acyllovir, Inj.Paracetamol, Coriminic drops, Acyclovir ointment topical cream, Nasoclear nasal drops. Calamine lotion to itchy spots.
  • Dressed the baby in loose-fitting clothes that do not irritate blisters. Some babies may be more comfortable in just a diaper.
  • Preventing babies from scratching the blisters with the Newborn mittens.
  • Kept the Baby warm and exclusive Exclusive Breast feeding given.
    Kept the baby’s nails clean and short to reduce the risk of infection from scratching the blisters.

Outcome

The neonate showed gradual clinical improvement following initiation of antiviral therapy and supportive management. The vesicular and pustular skin lesions began to crust and heal, with no appearance of new lesions during hospitalization. The baby tolerated oral feeds well and remained hemodynamically stable throughout the treatment period. Serial monitoring of blood glucose and vital signs remained within normal limits. No complications such as pneumonia, encephalitis, secondary bacterial infection, or sepsis were observed. The neonate was discharged in stable condition with advice regarding skin care, exclusive breastfeeding, immunization follow-up, and regular pediatric review. The recovery was uneventful, indicating a favorable response to early diagnosis and timely treatment.

Discussion

Neonatal varicella is an uncommon but potentially serious infection caused by the varicella-zoster virus (VZV). The risk of severe disease is greatest when maternal varicella develops within a few days before or after delivery, as insufficient maternal antibodies are transferred to the infant. In the present case, the mother developed varicella shortly after delivery, and the neonate manifested symptoms within the first week of life, suggesting perinatal transmission.

The diagnosis was primarily based on the characteristic clinical presentation of widespread polymorphic vesicular and pustular lesions, together with a history of recent maternal and sibling varicella infection. Early recognition of the disease and prompt initiation of antiviral therapy were essential in preventing serious complications. Acyclovir remains the treatment of choice for neonatal varicella and has been shown to reduce disease severity and mortality when administered early.Supportive measures such as maintenance of hydration, fever control, skin care, and prevention of secondary bacterial infection played an important role in recovery. Close monitoring is necessary because neonatal varicella can progress rapidly to severe systemic involvement including pneumonia, hepatitis, meningitis, or encephalitis. In this case, no evidence of systemic complications was observed, and the infant responded well to treatment.This case highlights the importance of maternal history, early diagnosis, appropriate antiviral therapy, and vigilant nursing care in achieving successful outcomes in neonatal varicella infection.

The American Academy of Pediatrics recommends vaccinating babies at both 12 to 15 months and 4 to 6 years of age. A parent or caregiver who misses this vaccine schedule can still catch up and vaccinate their child. Vaccinations can stop the spread of chickenpox and virtually eliminate the child’s risk of developing the disease. If a vaccinated child does get chickenpox, which is very uncommon, the infection is often less severe. Some other strategies to prevent chickenpox in babies include washing children’s hands before they eat and after they play, especially if they have been playing with other children, and avoiding people with recent exposure to chickenpox. People who wish to try getting pregnant can ask a doctor about getting their vaccines beforehand. Healthcare professionals cannot give the chickenpox vaccine during pregnancy.

Conclusion

Neonatal chickenpox (varicella) is a rare but potentially life-threatening condition that requires prompt recognition and management. A detailed maternal history and careful clinical assessment are crucial for early diagnosis. Timely administration of antiviral therapy along with supportive nursing care can significantly reduce complications and improve prognosis. The present case demonstrates that early intervention, continuous monitoring, and parental education contribute to successful recovery and favorable clinical outcomes. Preventive strategies, including varicella vaccination and infection control measures, remain important in reducing the burden of neonatal varicella.

References

  1. Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, et al. Varicella zoster virus infection. Nat Rev Dis Primers. 2015;1:15016. doi: 10.1038/nrdp.2015.16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Petrakis V, Panagopoulos P, Terzi I, Papazoglou D. Cutaneous Manifestations in Patients with SARS-CoV-2 Infections. ActaDermatovenerol Croat. 2022 Dec;30:216–219. [PubMed] [Google Scholar]

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