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Patient case: Chickenpox

Patient case: Chickenpox

Discussion

A 5-year-old girl is brought to the pediatric clinic with a two-day history of fever, irritability, and an itchy rash. Her parents report that the rash started on her chest and back as small red spots, but it quickly spread to her face, arms, and legs. Over time, the spots turned into fluid-filled blisters, some of which have started to crust over. The child has no significant medical history, but her older sibling had a similar illness a week ago.

On examination, she appears mildly uncomfortable due to itching. Her temperature is 38.3°C (100.9°F), and her skin shows lesions in different stages, including red macules, vesicles, and crusted scabs. No signs of bacterial superinfection or complications are noted.

A clinical diagnosis of varicella (chickenpox) is made. The parents are advised to manage the symptoms with antihistamines for itching, fever control with acetaminophen, and maintaining good skin hygiene to prevent secondary infections. They are also counseled on preventing the spread of the virus to other unvaccinated individuals. The child recovers fully within ten days, with no complicChatGPT said:

Questions
1. What is the most likely diagnosis in this child?

a) Measles

b) Chickenpox

c) Hand, foot, and mouth disease

d) Scarlet fever

2. What is a distinguishing feature of chickenpox?

a) Rash appears in different stages of development simultaneously

b) Rash is limited to the palms and soles

c) Rash consists of only maculopapular lesions

d) Rash starts on the legs and spreads to the trunk

3. What is the most important aspect of treatment for chickenpox in an otherwise healthy child?

a) Antiviral therapy for all cases

b) Supportive care with antihistamines and fever control

c) High-dose antibiotics

d) Corticosteroid therapy

4. How can chickenpox be prevented?

a) Isolation of infected individuals only

b) Vaccination with the varicella vaccine

c) Avoiding cold weather

d) Drinking plenty of fluids

Reveal answers

Answers

1. Answer: b) Chickenpox

The presence of fever, an intensely itchy rash that progresses from macules to vesicles to crusted scabs, and a history of recent exposure strongly suggest chickenpox (varicella). Other conditions like measles have different rash patterns.

2. Answer: a) Rash appears in different stages of development simultaneously

A key feature of chickenpox is the presence of lesions at various stages (macules, vesicles, and crusts) at the same time, distinguishing it from conditions like smallpox, where lesions progress uniformly.

3. Answer: b) Supportive care with antihistamines and fever control

Most cases of chickenpox in healthy children are mild and self-limiting. Symptomatic treatment, including fever control and relief from itching, is the mainstay of management. Antivirals are reserved for high-risk cases.

4. Answer: b) Vaccination with the varicella vaccine

The varicella vaccine is the most effective way to prevent chickenpox and its complications. It is part of routine childhood immunization programs in many countries.