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Is This Chickenpox?

By / / acetaminophen, aspirin, breakthrough chickenpox, chickenpox complications, chickenpox rash, febrile purpura, hemorrhagic varicella, ibuprofen, necrotising fasciitis, Reye syndrome, Vaccine Preventable Diseases, varicella zoster

Would you recognize a case of chickenpox?

This actually does look like chickenpox… Perhaps a bit more severe than usual, but that’s what chickenpox can do.

After all, chickenpox has been a vaccine-preventable disease for some time now, so few people actually see it anymore.

This is Chickenpox!

Not surprisingly, folks who are against vaccinating and protecting their kids try to minimize just how bad chickenpox can be.

That explains their reaction when a mom posted about her daughter’s chickenpox case. She was exposed at daycare, when she was too young to be vaccinated.

Again, this is chickenpox.

But instead of accepting that it was chickenpox, folks from several anti-vaccine Facebook groups descended on this mom’s page and called her a liar and actually blamed her for making her child sick!

Is this what happens when you give a child with chickenpox acetaminophen, ibuprofen, or antibiotics?

Nope.

Is this what happens when a fully vaccinated child gets chickenpox?

Nope. Although the chickenpox vaccine is not 100% effective, it is very effective against severe chickenpox. Most breakthrough cases are very mild.

Is this a bad case of chickenpox?

Actually, as bad as it looks, the baby doesn’t look to be in any distress and isn’t hospitalized, so it might be one of those things that looks worse than it is.

“An estimated 4,000 to 6,000 otherwise normal children are hospitalized with varicella each year. National data on varicella-associated complications are available only for encephalitis, Reye’s syndrome, and death. Children 1 to 14 years of age account for 84% of the encephalitis cases, 98% of Reye’s syndrome cases, and 63% of deaths. Infants younger than 1 year of age have a death rate that is four times that for older, normal children. However, uncomplicated cases of varicella in the infant age group may be underreported. Approximately 100 varicella-related deaths are reported annually. A review of death certificates mentioned an underlying malignancy in only 16%. The majority of deaths occur in normal individuals.”

Miller et al on Hemorrhagic Varicella: A Case Report and Review of the Complications of Varicella in Children

Could this be hemorrhagic varicella?

“Charkes describes “febrile purpura” as the most common and benign hemorrhagic eruption in varicella.”

Miller et al on Hemorrhagic Varicella: A Case Report and Review of the Complications of Varicella in Children

It actually does look like it and would explain why it looks a little worse than a classic case.

Febrile Purpura: According to Stroh, “A hemorrhagic eruption in vari-cella… occurs in about two percent of cases.” Comby states, “Sometimes the bullae of varicella become hemorrhagic,” and another author notes, “A violet tint in the papules, a few intravesicular hemorrhages, and scattered petechiae may frequently be observed in varicella.” Such benign bleeding, occurring in conjunction with temperature elevation, may be termed “febrile purpura.”

N David Charkes on Purpuric Chickenpox: Report of a Case, Review of the Literature, and Classification by Clinical Features

In addition to this benign form of purpura (if that is what she has), kids can also get malignant or progressive chickenpox with purpura, but fortunately, this child doesn’t appear to be that sick.

“In most children, chickenpox is a common childhood illness with low morbidity and mortality. Even previously healthy children can develop life-threatening complications of varicella. The presence of a hemorrhagic or cellulitic rash, bleeding, tachypnea, vomiting, ataxia, or mental status changes should alert the clinician to approach the patient with concern for potential progression to life-threatening illness. “

Miller et al on Hemorrhagic Varicella: A Case Report and Review of the Complications of Varicella in Children

Getting back to the idea that complications of chickenpox are caused by giving kids antibiotics, acetaminophen, or ibuprofen…

The only possible risk some experts do actually talk about is with ibuprofen and of course aspirin (Reye syndrome).

Charkes wrote about febrile purpura and chickenpox in 1961, just after acetaminophen was invented and well before ibuprofen was first marketed. The studies he cites, which also describe this complication of varicella were from 1902 though!

And again, the possible association with NSAIDs is with necrotising fasciitis and severe secondary infections, if there even is an association, and this child doesn’t have that.

“No good conclusions can be made as no good quality controlled trials exist on this topic and in the studies that do exist, the results are mixed. The majority of papers included show an increased risk of complications secondary to NSAID use. However, in many cases it is noted that NSAID use occurred after the onset of symptoms of secondary infection. This suggests a potential indication bias whereby NSAIDs are given as a response to infections in patients with severe disease rather than being a cause of the severity of the illness.”

Stone et al on BET 2: NSAIs and Chickenpox

It’s best to avoid ibuprofen if your child has chickenpox, but understand that it is likely not ibuprofen that might make them worse if you do.

“Treatment with ibuprofen is controversial, because it has been associated with life-threatening streptococcal skin infections, perhaps because of delays in recognition, and should be avoided if possible. “

Red Book Online on Varicella-Zoster Virus Infections

The bottom line is that chickenpox, even when it isn’t severe, can be pretty bad. And there are plenty of books and papers describing chickenpox complications and deaths before acetaminophen and ibuprofen were ever invented.

As much as some folks would like to deny it, going so far to attack this mom, racking up over 25,000 messages on her personal Facebook page, her child had chickenpox – a vaccine preventable disease.

And the best way to avoid chickenpox complications is to get vaccinated and protected, something this family didn’t have a chance to do.

More On Chickenpox

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