Varicella-Zoster Virus (VZV)


Epidemiology


Etiology


Physiology


Pathology


Diagnosis

Sputum GS/Cult+Sens:
ABG: hypoxemia
CXR/ Chest CT patterns:
1) Alveolar infiltrates (most common pattern):
-Nodular/ miliary densities may occur (miliary areas may remain as areas of “buckshot” calcification after resolution)
-Hilar adenopathy/small pleural effusions are sometimes seen
-Radiologic findings correlate with and follow the severity of skin rash
2) Nodular Interstitial infiltrates (less common pattern):
3) Miliary calcific pattern (on CXR): resembles old Histo


Clinical

Pulmonary Manifestations

Dermatologic Manifestations

Other Manifestations

Shingles


Treatment

PO Acyclovir (800 mg/day PO x 5 days): effective, if given within 24 hours of onset of rash, to decrease fever/ tachypnea/ hypoxemia/duration of illness
-Effect on complications is unknown
-Risk/benefit ratio favors use in pregnant patients

IV Acyclovir (10 mg/kg IV q8 hrs x 7 days): for VZV pneumonia or VZV in an immunocompromised host
IV Foscarnet (40 mg/kg IV q8 hrs x 10 days): indicated for Acyclovir-resistant VZV
Post-Exposure Prophylaxis (indicated for Varicella-seronegative hosts with close and prolonged exposure): VZV immune globulin
Infection control: airborne precautions


Treatment


References