Chickenpox in adults
definition
Chickenpox (varicella) is a highly contagious disease that usually occurs in childhood and is therefore one of the typical childhood diseases.
Chickenpox is caused by the chickenpox virus (varicella zoster virus). In the normal course of the disease, there is a high fever and a characteristic, itchy rash (exanthem) all over the body.
Anyone who has had the disease once cannot get it a second time. Shingles is an illness caused by the same virus that stays in the body for life. Chickenpox - as the first manifestation - can also only appear in adulthood, although the course may change and often be severe.
causes
The cause of chickenpox is the same in children and adults. The chickenpox infection (varicella) is caused by the varicella zoster virus.
It belongs to the herpes virus group and is closely related to the herpes simplex virus (cold sores, genital herpes) and the Epstein-Barr virus (Pfeiffer's glandular fever). In addition to chickenpox, the chickenpox virus can also cause shingles.
The virus enters the body through skin contact or through inhalation of virus particles. From there it penetrates into immune cells, the so-called mononuclear cells, which are found everywhere in the body.
Through these it is transported to nearby lymph nodes where it multiplies. Above a certain amount of virus, the virus also reaches the spleen and liver via the blood, where it can multiply so strongly that it eventually spreads via other mononuclear cells and via the blood into cells of the skin and mucous membranes.
At the same time, the virus infects cells of the nervous system (nerve cell nodes in the lumbar spine) in which it lasts for a lifetime and from where it can lead to shingles in old age.
The virus kills cells in the skin and mucous membrane, which leads to the typical rash (cytopathogenic effect). A massive immune reaction when the virus is in the blood or in many lymph nodes leads to a fever.
diagnosis
As a rule, the diagnosis can be made by a doctor after a patient discussion and examination based on the typical symptoms. This applies to both adults and children.
In the case of atypical or very mild courses, such as after vaccination (breakthrough varicella), the diagnosis can be confirmed by detecting viral genetic material from the blood of the sick person. Using antibodies from the sick person's blood, a distinction can be made between an initial infection and a recurrence (shingles).
How high is the risk of infection?
Chickenpox is one of the most contagious diseases in the western world.
Most people get infected through a droplet infection. Even from a distance of several meters, microscopic drops of liquid with virus particles can be inhaled from the respiratory tract of a sick person and lead to the disease. A smear infection is also possible.
In particular, contact with the saliva of sick people, as well as the liquid content of the skin vesicles, is infectious. Even if these liquids get on objects, they are still contagious.
If chickenpox occurs in pregnant women, these lead to symptoms in the unborn child in 1-2% of cases (diaplacental transmission). The risk is highest between the 5th and 24th week of pregnancy.
Concomitant symptoms
The typical symptoms of chickenpox are rash (rash), feeling sick and fever.
The rash usually begins on the forehead at the hairline and from there spreads to the entire body, except for the palms of the hands and the soles of the feet. The face, the hairy scalp and the oral mucosa are usually also affected. The rash is very itchy and often flares up.
This means that a new vesicle forms every one or two days. At the beginning, the rash shows up as small pimples and blisters on reddened skin. One speaks of papules and vesicles.
Over time, the contents of the vesicles become cloudy and a crust forms. If the blisters start to bleed on their own instead of crusting without scratching, this is a sign of an immunodeficiency. A presentation to the doctor should take place.
Since blisters appear next to one another in different phases (new -> cloudy -> crusted) due to the progression in spurts, the rash is also referred to as a "starry sky" -like appearance. The rash usually heals after a week.
itching
The typical rash in chickenpox is accompanied by severe itching. Nevertheless, the blisters should not be scratched open.
On the one hand to prevent scarring, on the other hand because bacteria can settle in the scratched areas and trigger an additional infection (bacterial superinfection). This leads to inflammation and increased scarring.
In the case of severe itching, Dimetinden can e.g. help in the form of Fenistil® drops or dragees. Adults should take 1-2mg a maximum of three times a day (1mg usually corresponds to 20 drops, or 1 dragee).
For more detailed information, please refer to the package insert and ask your doctor.
fever
Fever occurs in around a third of all illnesses in children, and much more frequently in adults. Chickenpox can sometimes cause high temperatures of up to 40 ° C.
At high temperatures, fever can be reduced with ibuprofen 400, for example.
Aspirin should be avoided as it can lead to serious side effects when given in combination with the chickenpox infection (Reye's syndrome: acute encephalopathy and liver dysfunction); these are less common in adults than in children. Adults may experience even higher temperatures.
If you have a fever, you should definitely consult a doctor or go to a hospital.
treatment
Usually chickenpox infection does not require therapy. As more pronounced courses are more likely in adults than in children, an assessment should be made by a doctor.
Therapy against the actual chickenpox virus is advisable in adults (over 16 years of age) if the symptoms are pronounced, as more severe courses can occur in adults than in children. Depending on how severe the symptoms are, an antiviral agent (usually acyclovir) is administered as a tablet or directly into the vein.
Therapy with antibiotics is usually not appropriate because it cannot treat viruses, only bacteria. They are only used when chickenpox vesicles that have been scratched become inflamed (superinfection). A typical example of antibiotics for bacterial superinfection with scratched chickenpox is cefuroxime, which has to be taken as tablets for 5-10 days.
If the itching is severe, so-called antihistamines can be used as drops or coated tablets. The best known example of this is Fenistil (active ingredient: Dimetinden). Adults should take 1-2mg a maximum of three times a day (1mg usually corresponds to 20 drops, or 1 dragee). You will receive detailed information from the attending physician.
To lower the fever, aspirin should be avoided at all costs, as it can lead to serious side effects when given in combination with the chickenpox infection (Reye's syndrome: acute encephalopathy and liver dysfunction); these are less common in adults than in children.
For more detailed information, please contact your doctor.
Avoid scars
Scars usually only appear when the blisters are scratched open. Increased scarring occurs when bacteria settle in the scratched blisters and cause inflammation. Scars can be avoided by not scratching the blisters. Appropriate medication can be taken to alleviate the itching. For more information on medication, see the previous topic or contact your doctor.
Possible complications
In pregnant women, chickenpox can cause symptoms in the unborn child in approximately 1-2% of cases, including skin lesions and various malformations, and in 30% of cases can be fatal for the child (fetal varicella syndrome).
If a newborn is infected (from 5 days before, up to 2 days after birth), the disease is fatal in 30% of cases. If the virus spreads to the lungs, it can lead to pneumonia.
Bacteria can also trigger pneumonia if the immune system is weakened by the windbuck. Pneumonia caused by chickenpox virus is particularly common in adults. Furthermore, diseases of the nervous system (encephalitis, meningitis, coma), the liver, the heart, the joints, the kidneys and blood formation can occur.
Overall, complications are significantly more common in adults than in children.
Duration of illness
After infection, the infection usually lasts for two weeks without symptoms (incubation period). After this time there is often a general feeling of illness with a slight fever, tiredness, headache and aching limbs.
A typical chickenpox rash occurs one to two days after these symptoms first appeared. After one to two weeks at most, the rash will heal and all symptoms will be gone.
If complications arise, or if the sick person's immune system is weakened, the process will drag on even longer. In this case, a doctor should be consulted. Two to three days after the last symptoms have disappeared, there is no longer any risk of infection.
Vaccination against chickenpox in adults
A chickenpox vaccination is only useful for certain groups of people. In general, this only includes people who have never had a chickenpox infection.
Within this group, women who want to have children should be vaccinated, medical staff and all people with a suppressed immune system, for example with certain therapies or organ transplants.
People with severe atopic dermatitis and a lack of immunity and people who have close contact with immunosuppressed people should also be vaccinated. The vaccination consists of weakened viruses and is therefore considered a live vaccine. For some people (e.g. pregnant women) it is therefore not possible. Passive vaccination with chickenpox virus antibodies can be carried out here if there has been contact with an infected person.
