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Varicella [Herpes] zoster virus (VZV); human herpesvirus 3 (HHV3)
Pathology:
1) VZV causes 2 distinct clinical entities in humans:
a) chicken pox (primary infection)
b) Herpes zoster or shingles (reactivation)
2) transmission:
a) inhalation of aerosolized respiratory droplets
- airborne precautions & contact precautions to prevent transmission of Herpes zoster [2]
b) direct contact with open shingles lesion
c) maternal-fetal transmission through placenta
3) reactivation:
a) VZV becomes latent in dorsal root ganglion after primary infection
b) VZV reactivates presumptively with a decline in immunity
Laboratory:
1) Varicella zoster virus identified by culture
- viral cultures take 2-3 weeks
- shell culture vial demonstrates cytopathic effect in 24-48 hours
2) Varicella zoster virus serology
3) Varicella zoster virus Ag in tissue
- direct fluorescent antibody
4) Varicella-zoster virus DNA
5) Varicella zoster strain type in isolate
6) see ARUP consult [3]
Management:
- acyclovir is the only agent recommended for treatment of varicella
- prophylaxis
- varicella virus vaccine
- varicella immune globulin in immunocompromised or pregnant patients within 96 hours of exposure
- airborne precautions & contact precautions to prevent transmission of Herpes zoster [2]
Related
chickenpox
Herpes zoster (shingles)
varicella virus vaccine (Varivax)
varicella-zoster immune globulin (VZIG)
Varicella-zoster virus DNA
General
herpesviridae
Properties
KINGDOM: virus
GENOME-TYPE: deoxyribonucleic acid (DNA)
DOUBLE-STRANDED
GENOME-SIZE: 120-200 kB
ENVELOPE: PRESENT
CAPSID-SYMMETRY: ICOSAHEDRAL
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 864-67
- Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18.
American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ARUP Consult: Varicella-Zoster Virus - VZV
The Physician's Guide to Laboratory Test Selection & Interpretation
https://www.arupconsult.com/content/varicella-zoster-virus
- Fisher JP, Bate J, Hambleton S.
Preventing varicella in children with malignancies: what is
the evidence?
Curr Opin Infect Dis. 2011 Jun;24(3):203-11
PMID: 21455062
- Gershon AA, Gershon MD.
Pathogenesis and current approaches to control of varicella-
zoster virus infections.
Clin Microbiol Rev. 2013 Oct;26(4):728-43. Review.
PMID: 24092852 Free PMC Article