Chickenpox

Chickenpox is a common childhood viral illness that is characteized by the formation of itchy, red blisters all over the body.


Signs and Symptoms of the Chickenpox

The most recognizable sign of Chickenpox is its characteristic rash. However, other symptoms prior to the development of the rash include:

• Fever
• Headache
• Loss of appetite

The rash itself undergoes three different phases:

• Formation of red or pink bumps all over your body.
• Rupture and/or leakage of infectious fluid from the Bumps.
• Scab formation and healing.

Patients will be contagious until all the bumps have scabbed over.

Causes of Chickenpox

Chickenpox is caused by a virus from the Herpes family called Varicella-Zoster. Most cases are transmitted via direct contact with an infected person’s body fluid. These include:

• Saliva
• Coughing
• Sneezing
• Contact with blisters

At Risk Population

Previous infection, vaccination, or vertical immunity passed from mother to newborn (immunity lasts about three months from birth) reduces risk. Anyone who has not been exposed may contract the virus. Risk of infection also increases under any of these conditions:

• Recent contact with an infected individual.
• Under 12 years of age.
• Adults residing with infected children.
• Spending time in a school or childcare facility with infected individuals.
• Immunocompromised individuals.

Diagnosis

Diagnosis is often clinical. See your doctor for confirmation. If the attending physician is unsure, farther lab investigations are also available to ascertain diagnosis.

Complications

Seek medical attention if the following conditions develop::

• Eyes become affected by the Rash.
• Rash becomes infected.
• Systemic symptoms like shortness of breath or dizziness develop.

Populations most at risk include:

• Infants
• Elderly patients
• Immunocompromised individuals
• Pregnant women

Affected pregnant women may bear children with birth defects, including:

• Poor growth
• Small head size
• Eye problems
• Intellectual disabilities

Treatment

Most forms of treatment for Chickenpox concentrates on symptomatic and supportive care and infection control. Because it is caused by a virus, the body’s immune system needs time to heal. Infection control measures should also be instituted to prevent spread of the disease.

In the event of an unbearable itch, antihistamines can be used.  Itching can also be soothed by:

• Bathing in lukewarm water
• Moisturizing lotions
• Comfortable clothing

High-Risk Patients

Antiviral drugs may be prescribed to those who experience complications from the virus, or who are at risk for adverse effects. Note though that these antiviral drugs do not cure chickenpox. Instead, they make the symptoms less severe, and make your body more likely to heal faster.

Duration of Disease

Most cases of chicken pox resolve within 10 days or so.

Chickenpox Immunity

Once exposed, most people become immune to the virus for their lifetime. However, in later stages of life, the varicella virus may re-emerge as Shingles during adulthood if the patient’s immune system is compromised.

Prevention

A chickenpox vaccine is available and should be given to the child between 12 and 15 months of age. A booster is given between age 4 and 6. 

Adults can opt to take the vaccination though efficacy is reduced.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

Bronchiolitis

Bronchiolitis is a common childhood disease found in children less than 2 years of age, often affecting infants aged between 3-6 months. It can affect up to one in three children within their first year of life.

It is a condition that results in inflammation of the bronchioles, the smallest airways in the lungs and presents with coughing, wheezing, shortness of breath with secondary difficulty in feeding.

It is caused by the Respiratory Syncytial Virus in 70% of cases and is much more common in the winter months in Temperate countries.

Treatment for Bronchiolitis is often supportive and symptomatic.


Signs and Symptoms

Coughing, Wheezing, Shortness of breath over one to two days, followed by crackles and/or wheezing are typical presentations of Bronchiolitis.

After the episode, it is common for the airways to remain sensitive for several weeks, leading to recurrent cough and wheezing.

Severe signs of the disease include:

• Poor feeding (less than half of usual fluid intake in preceding 24 hours)
• Lethargy
• History of apnea
• Respiratory rate >70/min
• Presence of nasal flaring and/or grunting
• Severe chest wall recession
• Cyanosis

Causes

The Respiratory Syncytial Virus is responsible for up to 70% of cases. Other viruses include the common influenza virus, coronavirus, adenovirus, rhinovirus, and other respiratory viruses.

Some studies have suggested a connection between voluntary caesarean births and bronchiolitis. This link becomes more prominent in studies done amongst premature babies, those with low birth weights and/or congenital heart defects.

On a lighter note, studies also show evidence that breastfeeding provides some protection against bronchiolitis.

Diagnosis

Diagnosis of Bronchiolitis is clinical. A chest X-ray is useful to exclude bacterial pneumonia but it is not indicated in routine cases. Testing for specific viral strains can be done but has a low risk -  benefit ratio as identifying the virus has little effect on management.

As bronchiolitis is often caused by a virus, antibiotics are not indicated unless a superseding bacteria infection occurs. Some studies have shown that as low as 6% of affected infants develop superseding bacteria infections concurrently.

Prevention

Basic procedures like handwashing, avoiding exposure to symptomatic individuals, good hygiene and maintain a strong immune system are the best forms of protection against the Respiratory Syncytial Virus. Breast milk contains antibodies from the mother and hence confer immunity to the infant, especially during the first month of life. Immunizations for premature infants are also available but it should only be administered to infants that meet specific criteria.

Treatment

High flow oxygen therapy with a high flow device that can provide precise flow/FiO2 and medical grade vapor forms an important part of the management of bronchiolitis.

As mentioned, treatment for Bronchiolitis is primarily symptomatic and supportive. Some drugs like Bronchodilators have been used with a fair margin of success.

Bronchodilators

Inhaled Epinephrine has been shown to reduce total length of Hospital stay when compared to Salbutamol. Salbutamol, on the other hand, when administered via the inhalation route, has also been shown to reduce initial hospital admission rates in some studies but has no no clear effect on the length of hospital stay.

The routine use of bronchodilators in children with bronchiolitis is however not recommended as there has been no clear effect on any important outcomes in children but carries with it a small risk of potential adverse effects from the administered drugs and hence should be used with care and under medical supervision.

Currently other medications do not yet have evidence to support their use.  Antiviral drugs like Ribavirin have not been shown to be effective. Administration of Antibiotics in the event of a complicating bacterial infection will have no effect on the underlying viral infection. Corticosteroids also have not shown proven benefits in Bronchiolitis.

Epidemiology

90% of the people affected are between 1 and 9 months old. Bronchiolitis is the most common cause of hospitalization up to the first year of life especially during winters in temperate countries.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.