Tasty Morsels of EM 073 – #FRCEM Varicella

17 Jul

(Featured image credit: Wikimedia commons, Øyvind Holmstad CC license)

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

Describe some typical features and characteristics of VZV?

  • primary disease Chicken Pox
  • then remains latent in dorsal root ganglion
  • reactivation as shingles
  • Infectivity starts 3 days before the rash appears and lasts until the last lesion has crusted.
  • Incubation = 10-20 days
  • pneumonia in kids – usually Staph, in adults usually viral

What are the role of anti-virals?

  • in shingles reduced post herpetic pain if used in first 72 hrs
  • often used in immune suppression and eye disease
  • for chicken pox it is often considered in adolescents and adults

When would you consider using varicella immunoglobulin?

  • neonates
  • immunodeficiency
  • cystic fibrosis

How would you manage exposures in pregnancy?

(From the RCOG guideline)

  • if exposed and no known immunity then:
    • test for immunity
    • offer VZV IG within 10 days of exposure if no immunity confirmed
    • this seems to apply to all gestational ages even though the main risk seems to be before 28 weeks.
  • if develops chicken pox then:
    • aciclovir if >20 weeks and within 24 hrs of rash onset
    • “consider” aciclovir if <20 weeks
    • do not use IG if rash already present
  • Fetal varciella syndrome is the concern  in the first 28 weeks of pregnancy but it is rare



2 Replies to “Tasty Morsels of EM 073 – #FRCEM Varicella

  1. Hi!
    I think you are doing a wonderful job here. Your work has always inspired me. Could you share your resources and notes on the FRCEM Intermediate exam?
    Thanks a lot!

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