Chickenpox Diagnosis: Clinical Features, Vesicular Rash, and Serological Confirmation of Varicella-Zoster IgM

Chickenpox, caused by the varicella-zoster virus (VZV), is a highly contagious disease primarily affecting children. Despite the availability of effective vaccines, it remains a medical concern due to its potential infectious complications and its ability to reactivate as herpes zoster in adulthood. Accurate chickenpox diagnosis is crucial for appropriate management and outbreak prevention.

Clinical Manifestations and Diagnosis

The clinical diagnosis of chickenpox is based on the identification of its characteristic vesicular rash, which typically begins on the trunk and spreads to the face and extremities. The skin lesions progress through several stages, including macules, papules, vesicles, pustules, and crusts, often coexisting in different phases within the same patient. This pattern is distinctive and aids in differentiating chickenpox from other exanthematous diseases such as monkeypox and smallpox.

Itching is a common symptom accompanying the vesicular lesions and can be severe, especially in children. Additionally, patients may present with fever, malaise, and mild respiratory symptoms prior to the appearance of the rash. In cases of primary infection, serological confirmation through the detection of varicella-zoster IgM antibodies is useful for confirming the diagnosis, particularly in atypical presentations or in immunocompromised patients.

Serological Confirmation and Diagnostic Considerations

Serological confirmation is particularly important in situations where the clinical diagnosis is uncertain. The presence of specific IgM antibodies for VZV indicates a recent infection, while IgG antibodies suggest a past infection or post-vaccination immunity. In cases of breakthrough chickenpox, where symptoms are milder due to prior vaccination, loop-mediated isothermal amplification (LAMP) tests can provide rapid and reliable diagnosis.

It is essential to consider the potential complications of chickenpox, such as necrotizing fasciitis and secondary bacterial infections, which can increase morbidity and mortality, especially in children and immunocompromised adults.

Conclusions

The diagnosis of chickenpox is based on a combination of clinical evaluation and serological confirmation. Early and accurate identification of the disease is essential for appropriate management and prevention of complications. Vaccination remains the best strategy to reduce the incidence of chickenpox and its associated complications. Understanding the clinical manifestations and utilizing appropriate diagnostic tools are fundamental for healthcare professionals in managing this disease.

Referencias

• [1] Comparison of human monkeypox, chickenpox and smallpox: a comprehensive review of pathology and dermatological manifestations.
• [2] The epidemiological trend of monkeypox and monkeypox-varicella zoster viruses co-infection in North-Eastern Nigeria.
• [3] Diagnosis, antiviral therapy, and prophylaxis of varicella-zoster virus infections.
• [4] Reliability of direct varicella zoster virus loop-mediated isothermal amplification method for rapid diagnosis of breakthrough varicella.
• [5] Going Out on a Limb: Do Not Delay Diagnosis of Necrotizing Fasciitis in Varicella Infection.

Created 6/1/2025