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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/29 11:13:21」(JST)

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Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV).^[1] The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab over.^[2] It usually starts on the face, chest, and back and then spreads to the rest of the body.^[2] Other symptoms may include fever, feeling tired, and headaches.^[2] Symptoms usually last five to ten days.^[2] Complications may occasionally include pneumonia, inflammation of the brain, or bacterial infections of the skin among others.^[3] The disease is often more severe in adults than children.^[4] Symptoms begin ten to twenty one days after exposure to the virus.^[5]

Chickenpox is an airborne disease which spreads easily through the coughs and sneezes of an infected person.^[5] It may be spread from one to two days before the rash appears until all lesions have crusted over.^[5] It may also spread through contact with the blisters.^[5] Those with shingles may spread chickenpox to those who are not immune through contact with the blisters.^[5] The disease can usually be diagnosed based on the presenting symptom;^[6] however, in unusual cases may be confirmed by polymerase chain reaction (PCR) testing of the blister fluid or scabs.^[4] Testing for antibodies may be done to determine if a person is or is not immune.^[4] People usually only get the disease once.^[5]

The varicella vaccine has resulted in a decrease in the number of cases and complications from the disease.^[7] It protects about 70 to 90 percent of people from disease with a greater benefit for severe disease.^[4] Routine immunization of children is recommended in many countries.^[8] Immunization within three days of exposure may improve outcomes in children.^[9] Treatment of those infected may include calamine lotion to help with itching, keeping the fingernails short to decrease injury from scratching, and the use of paracetamol (acetaminophen) to help with fevers.^[5] For those at increased risk of complications antiviral medication such as aciclovir are recommended.^[5]

Chickenpox occurs in all parts of the world.^[4] Before routine immunization the number of cases occurring each year was similar to the number of people born.^[4] Since immunization the number of infections in the United States has decreased nearly 90%.^[4] In 2013 chickenpox resulted in 7,000 deaths globally – down from 8,900 in 1990.^[10] Death occurs in about 1 per 60,000 cases.^[4] Chickenpox was not separated from smallpox until the late 19th century.^[4] In 1888 its connection to shingles was determined.^[4] The first documented use of the term chicken pox was in 1684.^[11] Why this term was used is not clear but it may be due to it being a relatively mild disease.^[11]

Signs and symptoms

A single blister, typical during the early stages of the rash

The early (prodromal) symptoms in adolescents and adults are nausea, loss of appetite, aching muscles, and headache. This is followed by the characteristic rash or oral sores, malaise, and a low-grade fever that signal the presence of the disease. Oral manifestations of the disease (enanthem) not uncommonly may precede the external rash (exanthem). In children the illness is not usually preceded by prodromal symptoms, and the first sign is the rash or the spots in the oral cavity. The rash begins as small red dots on the face, scalp, torso, upper arms and legs; progressing over 10–12 hours to small bumps, blisters and pustules; followed by umbilication and the formation of scabs.^[12]^[13]

At the blister stage, intense itching is usually present. Blisters may also occur on the palms, soles, and genital area. Commonly, visible evidence of the disease develops in the oral cavity and tonsil areas in the form of small ulcers which can be painful or itchy or both; this enanthem (internal rash) can precede the exanthem (external rash) by 1 to 3 days or can be concurrent. These symptoms of chickenpox appear 10 to 21 days after exposure to a contagious person. Adults may have a more widespread rash and longer fever, and they are more likely to experience complications, such as varicella pneumonia.^[12]

Because watery nasal discharge containing live virus usually precedes both exanthem (external rash) and enanthem (oral ulcers) by 1 to 2 days, the infected person actually becomes contagious one to two days before recognition of the disease. Contagiousness persists until all vesicular lesions have become dry crusts (scabs), which usually entails four or five days, by which time nasal shedding of live virus ceases.

The condition usually resolves by itself within a couple of weeks.^[14] The rash may, however, last for up to one month, although the infectious stage does not last longer than a week or two.^[15]

Chickenpox is rarely fatal, although it is generally more severe in adult men than in women or children. Non-immune pregnant women and those with a suppressed immune system are at highest risk of serious complications. Arterial ischemic stroke (AIS) associated with chickenpox in the previous year accounts for nearly one third of childhood AIS.^[16] The most common late complication of chickenpox is shingles (herpes zoster), caused by reactivation of the varicella zoster virus decades after the initial, often childhood, chickenpox infection.

The back of a 30-year-old male after five days of the rash
A 3-year-old girl with a chickenpox rash on her torso
An Indian child with chickenpox at an orphanage in Howrah.
Lower leg of a child with chickenpox

Pregnancy and neonates

During pregnancy the dangers to the fetus associated with a primary VZV infection are greater in the first six months. In the third trimester, the mother is more likely to have severe symptoms.^[17] For pregnant women, antibodies produced as a result of immunization or previous infection are transferred via the placenta to the fetus.^[18] Women who are immune to chickenpox cannot become infected and do not need to be concerned about it for themselves or their infant during pregnancy.^[19]

Varicella infection in pregnant women could lead to spread via the placenta and infection of the fetus. If infection occurs during the first 28 weeks of gestation, this can lead to fetal varicella syndrome (also known as congenital varicella syndrome).^[20] Effects on the fetus can range in severity from underdeveloped toes and fingers to severe anal and bladder malformation. Possible problems include:

Damage to brain: encephalitis,^[21] microcephaly, hydrocephaly,^[22] aplasia of brain
Damage to the eye: optic stalk, optic cup, and lens vesicles, microphthalmia, cataracts, chorioretinitis, optic atrophy
Other neurological disorder: damage to cervical and lumbosacral spinal cord, motor/sensory deficits, absent deep tendon reflexes, anisocoria/Horner's syndrome
Damage to body: hypoplasia of upper/lower extremities, anal and bladder sphincter dysfunction
Skin disorders: (cicatricial) skin lesions, hypopigmentation

Infection late in gestation or immediately following birth is referred to as "neonatal varicella".^[23] Maternal infection is associated with premature delivery. The risk of the baby developing the disease is greatest following exposure to infection in the period 7 days before delivery and up to 8 days following the birth. The baby may also be exposed to the virus via infectious siblings or other contacts, but this is of less concern if the mother is immune. Newborns who develop symptoms are at a high risk of pneumonia and other serious complications of the disease.^[24]

Diagnosis

The diagnosis of chickenpox is primarily based on the signs and symptom, with typical early symptoms followed by a characteristic rash. Confirmation of the diagnosis is by examination of the fluid within the vesicles of the rash, or by testing blood for evidence of an acute immunologic response.

Vesicular fluid can be examined with a Tzanck smear, or better by testing for direct fluorescent antibody. The fluid can also be "cultured", whereby attempts are made to grow the virus from a fluid sample. Blood tests can be used to identify a response to acute infection (IgM) or previous infection and subsequent immunity (IgG).^[25]

Prenatal diagnosis of fetal varicella infection can be performed using ultrasound, though a delay of 5 weeks following primary maternal infection is advised. A PCR (DNA) test of the mother's amniotic fluid can also be performed, though the risk of spontaneous abortion due to the amniocentesis procedure is higher than the risk of the baby's developing fetal varicella syndrome.^[24]

Pathophysiology

Exposure to VZV in a healthy child initiates the production of host immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA) antibodies; IgG antibodies persist for life and confer immunity. Cell-mediated immune responses are also important in limiting the scope and the duration of primary varicella infection. After primary infection, VZV is hypothesized to spread from mucosal and epidermal lesions to local sensory nerves. VZV then remains latent in the dorsal ganglion cells of the sensory nerves. Reactivation of VZV results in the clinically distinct syndrome of herpes zoster (i.e., shingles), postherpetic neuralgia,^[26] and sometimes Ramsay Hunt syndrome type II.^[27] Varicella zoster can affect the arteries in the neck and head, producing stroke, either during childhood, or after a latency period of many years.^[28]

Shingles

After a chickenpox infection, the virus remains dormant in the body's nerve tissues. The immune system keeps the virus at bay, but later in life, usually as an adult, it can be reactivated and cause a different form of the viral infection called shingles (also known as herpes zoster).^[29] The United States Advisory Committee on Immunization Practices (ACIP) suggests that every adult over the age of 60 years get the herpes zoster vaccine.^[30]

Shingles affects one in five adults infected with chickenpox as children, especially those who are immune suppressed, particularly from cancer, HIV, or other conditions. Stress can bring on shingles as well, although scientists are still researching the connection.^[31] Shingles are most commonly found in adults over the age of 60 who were diagnosed with chickenpox when they were under the age of 1.^[32]

Prevention

Hygiene measures

The spread of chickenpox can be prevented by isolating affected individuals. Contagion is by exposure to respiratory droplets, or direct contact with lesions, within a period lasting from three days before the onset of the rash, to four days after the onset of the rash.^[33] The chickenpox virus is susceptible to disinfectants, notably chlorine bleach (i.e., sodium hypochlorite). Like all enveloped viruses, it is sensitive to desiccation, heat and detergents.

Vaccine

The varicella vaccine is recommended in many countries.^[8] Some countries require the varicella vaccination or an exemption before entering elementary school. A second dose is recommended five years after the initial immunization.^[34] A vaccinated person is likely to have a milder case of chickenpox if they become infected.^[35] Immunization within three days of exposure may improve outcomes in children.^[9]

It is part of the routine immunization schedule in the US.^[36] In the UK, the vaccine is currently only recommended in people who are particularly vulnerable to chickenpox.^[35] Other European countries include it as part of universal vaccinations in children.^[37] Not all countries provide the vaccine due to its cost.^[8]

Treatment

Treatment mainly consists of easing the symptoms. As a protective measure, people are usually required to stay at home while they are infectious to avoid spreading the disease to others. Cutting the nails short or wearing gloves may prevent scratching and minimize the risk of secondary infections.

Although there have been no formal clinical studies evaluating the effectiveness of topical application of calamine lotion, a topical barrier preparation containing zinc oxide and one of the most commonly used interventions, it has an excellent safety profile.^[38] It is important to maintain good hygiene and daily cleaning of skin with warm water to avoid secondary bacterial infection.^[39] Scratching may also increase the risk of secondary infection.^[40]

Paracetamol (acetaminophen) but not aspirin may be used to reduce fever. Aspirin use by someone with chickenpox may cause the serious, sometimes fatal disease of the liver and brain, Reye syndrome. People at risk of developing severe complications who have had significant exposure to the virus may be given intra-muscular varicella zoster immune globulin (VZIG), a preparation containing high titres of antibodies to varicella zoster virus, to ward off the disease.^[41]^[42]

Antivirals are sometimes used.^[43]^[44]

Children

If oral acyclovir is started within 24 hours of rash onset, it decreases symptoms by one day but has no effect on complication rates.^[45]^[46] Use of acyclovir therefore is not currently recommended for individuals with normal immune function. Children younger than 12 years old and older than one month are not meant to receive antiviral medication unless they have another medical condition which puts them at risk of developing complications.^[47]

Treatment of chickenpox in children is aimed at symptoms while the immune system deals with the virus. With children younger than 12 years, cutting nails and keeping them clean is an important part of treatment as they are more likely to scratch their blisters more deeply than adults.^[48]

Aspirin is highly contraindicated in children younger than 16 years, as it has been related to Reye's syndrome.^[49]

Adults

Infection in otherwise healthy adults tends to be more severe.^[50] Treatment with antiviral drugs (e.g. acyclovir or valacyclovir) is generally advised, as long as it is started within 24–48 hours from rash onset.^[47] Remedies to ease the symptoms of chickenpox in adults are basically the same as those used for children. Adults are more often prescribed antiviral medication, as it is effective in reducing the severity of the condition and the likelihood of developing complications. Antiviral medicines do not kill the virus but stop it from multiplying. Adults are advised to increase water intake to reduce dehydration and to relieve headaches. Painkillers such as paracetamol (acetaminophen) are recommended, as they are effective in relieving itching and other symptoms such as fever or pains. Antihistamines relieve itching and may be used in cases where the itching prevents sleep, because they are also sedative. As with children, antiviral medication is considered more useful for those adults who are more prone to develop complications. These include pregnant women or people who have a weakened immune system.^[51]

Sorivudine, a nucleoside analogue, has been reported to be effective in the treatment of primary varicella in healthy adults (case reports only), but large-scale clinical trials are still needed to demonstrate its efficacy.^[52]

After recovering from chickenpox, it is recommended by doctors that adults take one injection of VZV immune globulin and one injection of varicella vaccine or herpes zoster vaccine.^{[citation needed]}

Prognosis

The duration of the visible blistering caused by varicella zoster virus varies in children usually from 4 to 7 days, and the appearance of new blisters begins to subside after the fifth day. Chickenpox infection is milder in young children, and symptomatic treatment, with sodium bicarbonate baths or antihistamine medication may ease itching. it is recommended to keep new infants from birth up to age 6 months away from an infected person for 10 to 21 days because their immune systems are not developed enough to handle the stress it can bring on.^[53] Paracetamol (acetaminophen) is widely used to reduce fever. Aspirin, or products containing aspirin, should not be given to children with chickenpox, as it can cause Reye's Syndrome.^[54]

In adults, the disease is more severe,^[55] though the incidence is much less common. Infection in adults is associated with greater morbidity and mortality due to pneumonia (either direct viral pneumonia or secondary bacterial pneumonia),^[56] bronchitis (either viral bronchitis or secondary bacterial bronchitis),^[56] hepatitis,^[57] and encephalitis.^[58] In particular, up to 10% of pregnant women with chickenpox develop pneumonia, the severity of which increases with onset later in gestation. In England and Wales, 75% of deaths due to chickenpox are in adults.^[24] Inflammation of the brain, or encephalitis, can occur in immunocompromised individuals, although the risk is higher with herpes zoster.^[59] Necrotizing fasciitis is also a rare complication.^[60]

Varicella can be lethal to adults with impaired immunity. The number of people in this high-risk group has increased, due to the HIV epidemic and the increased use of immunosuppressive therapies.^[61] Varicella is a particular problem in hospitals, when there are patients with immune systems weakened by drugs (e.g., high-dose steroids) or HIV.^[62]

Secondary bacterial infection of skin lesions, manifesting as impetigo, cellulitis, and erysipelas, is the most common complication in healthy children. Disseminated primary varicella infection usually seen in the immunocompromised may have high morbidity. Ninety percent of cases of varicella pneumonia occur in the adult population. Rarer complications of disseminated chickenpox include myocarditis, hepatitis, and glomerulonephritis.^[63]

Hemorrhagic complications are more common in the immunocompromised or immunosuppressed populations, although healthy children and adults have been affected. Five major clinical syndromes have been described: febrile purpura, malignant chickenpox with purpura, postinfectious purpura, purpura fulminans, and anaphylactoid purpura. These syndromes have variable courses, with febrile purpura being the most benign of the syndromes and having an uncomplicated outcome. In contrast, malignant chickenpox with purpura is a grave clinical condition that has a mortality rate of greater than 70%. The cause of these hemorrhagic chickenpox syndromes is not known.^[63]

Epidemiology

Primary varicella occurs in all countries worldwide. In 2013 the disease resulted in 7,000 deaths – down from 8,900 in 1990.^[10]

In temperate countries, chickenpox is primarily a disease of children, with most cases occurring during the winter and spring, most likely due to school contact. It is one of the classic diseases of childhood, with the highest prevalence in the 4– 10-year-old age group. Like rubella, it is uncommon in preschool children. Varicella is highly communicable, with an infection rate of 90% in close contacts. In temperate countries, most people become infected before adulthood, and 10% of young adults remain susceptible.

In the tropics, chickenpox often occurs in older people and may cause more serious disease.^[64] In adults, the pock marks are darker and the scars more prominent than in children.^[65]

In the United States, the Centers for Disease Control and Prevention (CDC) does not require state health departments to report infections of chicken pox, and only 31 states currently volunteer this information.^[66] However, in a 2013 study conducted by the social media disease surveillance tool called Sickweather, anecdotal reports of chickenpox infections on Facebook and Twitter were used to measure and rank states with the most infections per capita, with Maryland, Tennessee and Illinois in the top three.^[67]

Etymology

Why the term was used is not clear but it may be due to it being a relatively mild disease.^[11] It has been said to be derived from chickpeas, based on resemblance of the vesicles to chickpeas,^[11]^[68]^[69] or to come from the rash resembling chicken pecks.^[69] Other suggestions include the designation chicken for a child (i.e., literally 'child pox'), a corruption of itching-pox,^[68]^[70] or the idea that the disease may have originated in chickens.^[71] Samuel Johnson explained the designation as "from its being of no very great danger."^[72]

Society and culture

Some parents believe that it is better for children to contract chickenpox than to get the vaccine, and they deliberately expose their children to the virus, sometimes by taking them to "chickenpox parties." Some doctors counter that children are safer getting the vaccine, which is a weakened form of the virus, than getting the disease, which can be fatal.^[73]

Other animals

Humans are the only known animal that the disease affects naturally.^[4] However, chickenpox has been caused in other primates, including chimpanzees^[74] and gorillas.^[75]

References

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^ "Epidemiology of Varicella Zoster Virus Infection, Epidemiology of VZV Infection, Epidemiology of Chicken Pox, Epidemiology of Shingles". Retrieved 22 April 2008.
^ "Georgia ranks 10th for social media admissions of chickenpox". Retrieved 13 June 2013.
^ "Chickenpox in the USA". Retrieved 12 June 2013.
^ ^a ^b Belshe, Robert B. (1984). Textbook of human virology (2nd ed.). Littleton MA: PSG. p. 829. ISBN 0-88416-458-6.
^ ^a ^b Teri Shors (2011). "Herpesviruses: Varicella Zoster Virus (VZV)". Understanding Viruses (2nd ed.). Jones & Bartlett. p. 459. ISBN 978-0-7637-8553-6.
^ Pattison, John; Zuckerman, Arie J.; Banatvala, J.E. (1994). Principles and practice of clinical virology (3rd ed.). Wiley. p. 37. ISBN 0-471-93106-3.
^ Chicken-pox is recorded in Oxford English Dictionary 2nd ed. since 1684; the OED records several suggested etymologies
^ Johnson, Samuel (1839). Dictionary of the English language. London: Williamson. p. 195.
^ "Chicken Pox parties do more harm than good, says doctor". KSLA News 12 Shreveport, Louisiana News Weather & Sports.
^ Cohen JI, Moskal T, Shapiro M, Purcell RH (December 1996). "Varicella in Chimpanzees". Journal of Medical Virology 50 (4): 289–92. doi:10.1002/(SICI)1096-9071(199612)50:4<289::AID-JMV2>3.0.CO;2-4. PMID 8950684.
^ Myers MG, Kramer LW, Stanberry LR (December 1987). "Varicella in a gorilla". Journal of Medical Virology 23 (4): 317–22. doi:10.1002/jmv.1890230403. PMID 2826674.

External links

	Medicine portal
	Viruses portal

Chickenpox at DMOZ
"Prevention of Varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP)". Centers for Disease Control and Prevention (CDC). 12 July 1996. Retrieved 18 May 2013.
"Management of Varicella Zoster Virus (VZV) Infections" (PDF). Federal Bureau of Prisons: Clinical Practice Guideline. December 2011. Retrieved 18 May 2013.
John W. Gnann Jr. (2007). "Chapter 65 Antiviral therapy of varicella-zoster virus infections". PMID 21348091.
Sarah McSweeney-Ryan; Megan Sandel. "The Health Care of Homeless Persons - Part I - Varicella (Chickenpox" (PDF). Boston Health Care for the Homeless Program. Retrieved 18 May 2013.

UpToDate Contents

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1. 水痘帯状疱疹ウイルス感染の臨床的特徴：水痘 clinical features of varicella zoster virus infection chickenpox
2. 水痘帯状疱疹ウイルス感染の治療：水痘 treatment of varicella zoster virus infection chickenpox
3. 水痘帯状疱疹ウイルス感染の予防：水痘 prevention of varicella zoster virus infection chickenpox
4. 妊娠中の水痘帯状疱疹ウイルス感染 varicella zoster virus infection in pregnancy
5. 病院における水痘の予防および管理 prevention and control of varicella in hospitals

English Journal

Successful antiviral treatment after 6years of chronic progressive neurological disease attributed to VZV brain infection.

Gilden D1, Grose C2, White T3, Nagae L4, Hendricks RL5, Cohrs RJ6, Nagel MA3.
Journal of the neurological sciences.J Neurol Sci.2016 Sep 15;368:240-2. doi: 10.1016/j.jns.2016.07.035. Epub 2016 Jul 15.
We describe an extraordinary case of an immunocompetent patient who developed sacral-distribution zoster, followed 3months later by neurological disease that progressed for 6years and was attributed to varicella zoster virus (VZV) infection of the brain. Despite the prolonged infection, neurologic s
PMID 27538641

LONG-COURSE ORAL CORTICOSTEROID TOXICITY IN CHILDREN.

Aljebab F1, Choonara I1, Conroy S1.
Archives of disease in childhood.Arch Dis Child.2016 Sep;101(9):e2. doi: 10.1136/archdischild-2016-311535.57.
BACKGROUND: Long courses of oral corticosteroids are commonly used in children in the management of conditions such as nephrotic syndrome, leukaemia, asthma and others. Various adverse drug reactions (ADRs) are known to occur with their use. This systematic review aimed to identify the most common a
PMID 27540239

Clinical and corneal microbial profile of infectious keratitis in a high HIV prevalence setting in rural South Africa.

Schaftenaar E1,2,3, Peters RP2,3,4, Baarsma GS5, Meenken C6, Khosa NS2,3, Getu S1, McIntyre JA2,3,7, Osterhaus AD8, Verjans GM9,10.
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology.Eur J Clin Microbiol Infect Dis.2016 Sep;35(9):1403-9. doi: 10.1007/s10096-016-2677-x. Epub 2016 May 28.
The purpose of this investigation was to determine the clinical and corneal microbial profile of infectious keratitis in a high human immunodeficiency virus (HIV) prevalence setting in rural South Africa. Data in this cross-sectional study were collected from patients presenting with symptoms of inf
PMID 27236644

Japanese Journal

臨床報告水痘・帯状疱疹ウイルス感染を契機とした眼窩先端部症候群の1例

満川忠宏,柳沼重晴,今野公士 [他]
眼科 55(13), 1635-1640, 2013-12
NAID 40019922024

Laboratory and Epidemiology Communications : A Case of Atypical Hand-Foot-and-Mouth Disease Caused by Coxsackievirus A6 : Differential Diagnosis from Varicella in a Pediatric Intensive Care Unit

Yasui Yoshinori,Makino Tomohiko,Hanaoka Nozomu [他]
Japanese Journal of Infectious Diseases 66(6), 564-566, 2013-11
NAID 40019890627

Influence of Vaccination Dose and Clinico-Demographical Factors on Antibody Titers against Measles, Rubella, Mumps, and Varicella-Zoster Viruses among University Students in Japan

Takeuchi Jiro,Goto Masashi,Kawamura Takashi [他]
Japanese Journal of Infectious Diseases 66(6), 497-502, 2013-11
NAID 40019890464

Related Pictures

★リンクテーブル★

国試過去問	「104F003」
リンク元	「水痘」「chicken pox」「水疱瘡」
拡張検索	「varicella-zoster virus」

「104F003」

Chickenpox
	Male with varicella disease
Classification and external resources
Specialty	Infectious disease
ICD-10	B01
ICD-9	052
DiseasesDB	29118
MedlinePlus	001592
eMedicine	ped/2385 derm/74, emerg/367
Patient UK	Chickenpox

　　[★]

一般用語と専門用語の組合せで誤っているのはどれか。

[正答]

※国試ナビ4※　［104F002］←［国試_104］→［104F004］

「水痘」

　　[★]

日: すいとう
英: varicella, chickenpox
同: 水疱瘡(みずぼうそう)
関: 水痘・帯状疱疹ウイルス、帯状疱疹、水痘生ワクチン

五類感染症(小児科定点)(週)

特徴

100%顕性感染

病原体

水痘・帯状疱疹ウイルス（VZV）

潜伏期間

潜伏期：11-21(平均15日)

感染経路

空気感染？
接触感染・飛沫感染→結膜・気道粘膜 (SMB.528)

疫学

年齢：5-9歳。(熱帯、亜熱帯では成人が感染する)。ほとんどが10歳以前に感染

免疫不全患者や新生児では重症化

季節性：12-1月ピーク。8-10月谷。
感染率：家族内感染70-90%
新生児の死亡率は30%
白血病児では死亡率が高い。

米：130-200人死亡/年。白血病児の死亡率：7-28%
日：白血病児の死亡数、死亡率：水痘 36/118(30.5%)、帯状疱疹 1/48(2.1%)、麻疹 7/48(12.1%)

症状

全身倦怠感、小紅斑(掻痒感。頭皮にも出現。口腔粘膜、眼瞼粘膜。紅斑→丘疹→水疱→膿疱→痂皮→瘢痕無し)

合併症

細菌感染
ライ症候群
神経合併症

脳炎

小脳失調症

(1000例中1例以下)

肺炎

成人での合併例が多い 20%

母子感染

母胎は水痘に感染しやすい。発症したらアシクロビルによる治療を行う。

先天性水痘症候群

妊娠初期に罹患した例の5%(61例中3例)で起こる

眼症状、大脳萎縮、皮膚瘢痕、四肢欠損、萎縮

周産期及び新生児期水痘

母胎の発症　　新生児の発症
-----------------------------
出産5日以前　生後0-4日　　→正常
前4日-後2日　生後5-10日　→重症　播種性・出血性水痘　死亡率30%
-----------------------------

水痘の既往やワクチン投与のない妊婦が分娩5日前-分娩2日後に水痘を発症した場合、胎児の水痘が重症化する(死亡率30%)

→抗体が母体から新生児に移行しないため

分娩間近や分娩前の発症：母胎に免疫グロブリンを投与。

産後2日以内の発症　　：新生児に免疫グロブリンの投与

経過

7-10日で治癒

治療

アシクロビル、ビダラビン
感染から72時間以内：水痘ワクチン接種→60-80%の発症阻止 (NDE.428)
感染から一週間以内：抗ウイルス薬の服用→軽症化 (NDE.428)

検査

水痘皮内反応。8hrで判定できる。陰性ならワクチン接種。

予防

水痘生ワクチン。

免疫の獲得率が90%程度。水痘の感染防除、帯状疱疹の発症予防にも効果有り
免疫不全症患者も接種可能。ただし全く免疫が0の患者にはいけない。

ZIG

日本にはない
免疫グロブリン製剤

出席停止の解除(学校保険法)

発疹が全て痂皮化するまで (NDE.428)

「chicken pox」

　　[★] 水疱

関: blister、bulla、bullae、bullous、chickenpox、varicella

「水疱瘡」

　　[★]

英: varicella、chickenpox
関: 水痘

「varicella-zoster virus」

　　[★] 水痘・帯状疱疹ウイルス VZV

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[CDC2011SS-2] "Chickenpox (Varicella) Signs & Symptoms". http://www.cdc.gov/. November 16, 2011. Retrieved 4 February 2015.

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[Sickweather-67] "Chickenpox in the USA". Retrieved 12 June 2013.

[Belse-68] Belshe, Robert B. (1984). Textbook of human virology (2nd ed.). Littleton MA: PSG. p. 829. ISBN 0-88416-458-6.

[Shors-69] Teri Shors (2011). "Herpesviruses: Varicella Zoster Virus (VZV)". Understanding Viruses (2nd ed.). Jones & Bartlett. p. 459. ISBN 978-0-7637-8553-6.

[70] Pattison, John; Zuckerman, Arie J.; Banatvala, J.E. (1994). Principles and practice of clinical virology (3rd ed.). Wiley. p. 37. ISBN 0-471-93106-3.

[oed-71] Chicken-pox is recorded in Oxford English Dictionary 2nd ed. since 1684; the OED records several suggested etymologies

[72] Johnson, Samuel (1839). Dictionary of the English language. London: Williamson. p. 195.

[73] "Chicken Pox parties do more harm than good, says doctor". KSLA News 12 Shreveport, Louisiana News Weather & Sports.

[74] Cohen JI, Moskal T, Shapiro M, Purcell RH (December 1996). "Varicella in Chimpanzees". Journal of Medical Virology 50 (4): 289–92. doi:10.1002/(SICI)1096-9071(199612)50:4<289::AID-JMV2>3.0.CO;2-4. PMID 8950684.

[75] Myers MG, Kramer LW, Stanberry LR (December 1987). "Varicella in a gorilla". Journal of Medical Virology 23 (4): 317–22. doi:10.1002/jmv.1890230403. PMID 2826674.

匿名

検索

案内

varicella