Chickenpox scabs

Introduction The lesion is mainly in the spinous cell layer of the skin, with degenerative degeneration and intracellular edema, forming cystic cells, and eosinophilic inclusion bodies in the nucleus. Cystic cells or multinucleated giant cell lysis and tissue fluid infiltration are a period of treatment for chickenpox.

Cause

Cause: Varicella-Zoster virus and herpes simplex virus belong to the herpesvirus subfamily. The virus is latent in the host for a long time, and the disease manifests as herpetic damage of the whole body or local skin mucosa, and it is easy to relapse as a common feature. Varicella-zoster virus is a spherical virus particle with a diameter of about 150-200 nm and a bilayer lipoprotein envelope. The varicella-zoster virus has only one serotype, and humans are the only natural host. The varicella-zoster virus VZV is weak against the in vitro environment and quickly loses its activity in the dry herpes sac; however, it can be stored at -65 °C for a long time in the herpes liquid. The virus can be cultured in vitro using human embryonic fibroblasts, but cannot be grown in general animal tissues such as chicken embryos.

an examination

Related inspection

Skin lesion

diagnosis:

1. Clinical course of chickenpox: The incubation period is about 12 to 21 days, with an average of 14 days. The onset is more acute, and there are symptoms such as hypothermia or moderate fever, headache, myalgia, joint pain, general malaise, loss of appetite, and cough in the prodromal period; rash occurs within a few hours after onset, or within 1-2 days. The whole course of disease is as short as one week and as long as several weeks.

2. Characteristics of chickenpox rash: The number of chickenpox rashes is large, ranging from hundreds to thousands. It usually appears on the face, scalp and torso first. Its distribution is centripetal, with more hairline, chest and back, less facial parts, and occasional palm soles. Mucosa in the nose, throat, mouth, vulva and other parts can also cause rash. The rash is still accompanied by varying degrees of systemic symptoms, but tends to be less than before the rash. The fever generally decreases to normal as the rash stops. The rash has a tingling sensation, sometimes causing irritability to the patient due to itching. The rash on the mucosa is easily broken into ulcers, often accompanied by pain. The number of rashes is more severe. Chickenpox eruption undergoes four stages of rash, papules, herpes and scarring. It was a red spot rash at first, turned into a deep red papule after a few hours, and became herpes after a few hours. Typical herpes is oval in shape, thin and fragile, surrounded by redness, and normal skin between herpes. The blister fluid gradually becomes cloudy after being transparent, and even has a pustular appearance; it can also form a typical pustule due to secondary purulent infection caused by the patient's scratching, and thus causes systemic symptoms to worsen. If no purulent infection occurs, 1 to 2 days after the formation of herpes, it begins to dry up from the center of herpes. After a few days, the clam shells fall off and are removed in about 2 weeks. Because the herpes is superficial, it will not leave any scars after the healing. Even if there is temporary pigmentation in the local area, it can gradually disappear. The varicella rash occurs in batches. In the process of the gradual evolution of the previous rash damage, a new batch of herpes appears again, causing damage in all stages of erythema, papules, herpes and scars to coexist in the same patient at the same time. . Especially on the 2nd to 3rd day of rash, the rash is often seen in the same part, which is another important feature of varicella rash. As the patient's immunity gradually increases, the rash gradually decreases. The last batch of rashes that occurred in the rash period stopped developing and subsided, and the patient recovered.

Differential diagnosis

Clinical classification of chickenpox: According to the clinical characteristics of patients, chickenpox can be divided into the following types:

(1) Ordinary type: The majority of patients with chickenpox have a good prognosis. In general, the systemic symptoms of chickenpox patients are relatively mild. The course of the disease lasts about 1 week and you can heal itself. Adult and infant patients tend to have more rashes and more severe illnesses, and the course of disease can be delayed for several weeks.

(2) Progressive disseminated varicella: can be seen in a variety of reasons leading to weakened resistance, for example, suffering from leukemia, lymphoma and other malignant tumors, or long-term application of various immunosuppressive agents, adrenocortical hormone patients. Such patients are prone to develop progressive disseminated varicella after infection, and the condition is severe; the viremia lasts for a long time, there are symptoms of high fever and systemic poisoning, the body rash is dense and dense, and new rashes appear continuously. Herpes is large, can be fused together to form a bullous, or hemorrhagic herpes is not easy to scar, and even a large piece of necrosis occurs in the skin and subcutaneous tissue of the rash. Defects and ecchymoses are sometimes seen on normal skin. The mortality rate of patients with progressive disseminated varicella is about 7%.

(3) Primary varicella pneumonia: Most patients with sputum are adults, and primary varicella pneumonia occurs on the first to sixth sick days, but the severity of the disease varies. Mild people have no obvious symptoms; severe cases can have high fever, cough, chest pain, hemoptysis, difficulty breathing and cyanosis. Chest signs were not obvious, or a small amount of dry, wet snoring and wheezing; X-ray chest radiographs showed diffuse nodular shadows in both lungs, and the lungs and lungs were more prominent. The pathological process of varicella pneumonia is generally synchronized with the rash, often with the rash subsided and improved; but after a few patients with severe varicella pneumonia disappeared, the X-ray shadow can still exist for 2 to 3 months before dissipating.

(4) Varicella encephalopathy (varicella encephalopathy): It is rare to see the clinical manifestations of encephalitis 3 to 8 days after the rash, and a few are seen from 2 weeks before the rash to 3 weeks after the rash. Usually 5 to 7 years old children, more men than women. Clinical features and cerebrospinal fluid examination characteristics are similar to other viral encephalitis. The onset is tempered, there may be no fever and meningeal irritation in the early stage, common headache, vomiting and paresthesia, or cerebellar symptoms such as ataxia, nystagmus, dizziness and language disorder; severe cases may have convulsions, paralysis, lethargy Or coma. After the illness, there may be sequelae such as mental disorders, mental retardation and seizures. The course of varicella encephalitis is 1 to 3 weeks, and the mortality rate is 5% to 25%. Those who suffer from coma and convulsions have a serious prognosis.

(5) Others: Severe varicella infection can lead to focal necrosis of liver tissue, typical intranuclear inclusions in hepatocytes and biliary epithelial cells, clinical manifestations of varicella hepatitis, patients with hepatomegaly, abnormal liver function, may be accompanied There are jaundice. Varicella complicated with nephritis, interstitial myocarditis, etc. have also been reported, severe arrhythmia can cause patients to die. In addition, infection of chickenpox in early pregnancy may cause fetal malformations; infection of chickenpox in the second trimester may cause fetal congenital varicella syndrome.

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