Chickenpox

Question 1

What causes chickenpox?

Answer 1

Chickenpox is caused by primary infection with varicella zoster virus (VZV), a human herpesvirus.

Question 2

What is shingles and how is it related to chickenpox?

Answer 2

Shingles is reactivation of dormant varicella zoster virus in the dorsal root ganglia after primary chickenpox infection.

Question 3

How is chickenpox transmitted?

Answer 3

Via respiratory droplets, airborne spread, and direct contact with vesicular fluid; it can also be caught from someone with shingles.

Question 4

How infectious is chickenpox?

Answer 4

Chickenpox is highly infectious, with up to 90% secondary infection rates in susceptible household contacts.

Question 5

What is the incubation period of chickenpox?

Answer 5

Approximately 10–21 days.

Question 6

When is a person with chickenpox infectious?

Answer 6

From 1–4 days before the rash appears until all lesions have crusted, usually about 5 days after rash onset.

Question 7

How does chickenpox typically present clinically?

Answer 7

With fever followed by an intensely itchy rash that starts on the head or trunk and spreads peripherally.

Question 8

How does the chickenpox rash evolve?

Answer 8

Macules progress to papules, then vesicles, which crust over in crops.

Question 9

In which age group is chickenpox more severe?

Answer 9

Older children and adults tend to have more severe disease than younger children.

Question 10

What systemic symptoms are usually seen in chickenpox?

Answer 10

Mild fever, malaise, fatigue, and loss of appetite.

Question 11

How is chickenpox diagnosed?

Answer 11

Clinically, based on the characteristic rash and exposure history.

Question 12

What is the mainstay of chickenpox management?

Answer 12

Supportive care.

Question 13

What supportive measures help reduce symptoms in chickenpox?

Answer 13

Keeping cool, trimming fingernails, calamine lotion, loose clothing, and antihistamines for itch.

Question 14

Which analgesic is recommended in chickenpox?

Answer 14

Paracetamol.

Question 15

Which medications should be avoided in chickenpox and why?

Answer 15

NSAIDs should be avoided as they increase the risk of severe secondary bacterial skin infection and invasive Group A streptococcal disease.

Question 16

What is the most common complication of chickenpox?

Answer 16

Secondary bacterial infection of skin lesions.

Question 17

What serious bacterial complication can rarely occur following chickenpox?

Answer 17

Invasive Group A streptococcal infection, including necrotising fasciitis.

Question 18

What rare neurological complication can occur in chickenpox?

Answer 18

Encephalitis, including cerebellar involvement.

Question 19

What rare respiratory complication can occur in chickenpox?

Answer 19

Pneumonia, particularly in adults and immunocompromised patients.

Question 20

Which groups are at highest risk of severe chickenpox?

Answer 20

Immunocompromised patients, newborns, pregnant women, and adults.

Question 21

Who should receive varicella zoster immunoglobulin (VZIG)?

Answer 21

Immunocompromised individuals and newborns with peripartum exposure.

Question 22

When should aciclovir be used in chickenpox?

Answer 22

IV aciclovir should be considered if chickenpox develops in immunocompromised patients or severe cases.

Question 23

What is the school exclusion advice for chickenpox according to NICE?

Answer 23

Exclude until all lesions are dry and crusted, usually 5 days after rash onset.

Question 24

Does chickenpox vaccination form part of the routine UK immunisation schedule?

Answer 24

No, it is not routinely offered but may be given to high-risk contacts or privately.

Question 25

What long-term consequence can follow chickenpox infection?

Answer 25

Reactivation later in life as shingles.