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La varicela es una infección poco frecuente durante la gestación, el riesgo para el feto y las manifestaciones clínicas, variarán en función del momento del embarazo en que se produce la infección materna, cuando la erupción maculopapular materna se produce entre los 5 días previos al parto y las 48 horas posteriores, se habla de varicela neonatal tardía. La clínica es grave, con afectación visceral (pulmonar, cerebral, hepática, hemorragias cutáneas, etc.) y un 30 % de los casos desarrollarán una varicela fulminante. Se presenta el caso de neonato masculino que consultó por lesiones en piel, tipo pápulas eritematosas y vesiculares pleomorfas, de distribución dispersa. Con evolución clínica tórpida, permaneció 24 horas en la institución, con franco deterioro respiratorio y neurológico, compatible con cuadro de varicela neonatal tardía fulminante.

Introducción. Desde la introducción de la vacuna contra la varicela a Colombia no se ha logrado una cobertura mayor al 90%. El objetivo de este trabajo es identificar las barreras de vacunación contra varicela en niños. Metodología. Estudio descriptivo realizado en la Fundación Salud Bosque; se estudiaron 27 pacientes, 18 hombres (67%) y 9 mujeres (33%), incluyendo menores de 18 años con varicela, y excluyendo pacientes con enfermedades ampollosas distintas a varicela y quemaduras. Se hizo una caracterización demográfica. Para las variables cuantitativas se emplearon promedios y desviación estándar, y para las cualitativas la razón de proporción con Stata V12®. Resultados. La incidencia de varicela fue del 0.2%, solo 9 pacientes (33%) habían recibido la primera dosis de la vacuna, ninguno la segunda dosis. El 92.5% requirió incapacidad; el 89% analgésicos; el 63% antihistamínicos y el 26% antibióticos. Discusión. El estudio realizado demuestra una incidencia significativamente menor en contraste con otras cohortes internacionales. En Colombia no se ha alcanzado la cobertura de la vacunación contra la varicela lograda en Uruguay, Costa Rica, Estados Unidos, Australia, Europa y Taiwán, dadas las mismas barreras en su aplicación, mientras que en África no se ha introducido la vacuna contra la varicela porque existen otras prioridades como la desnutrición, la malaria y la infección por Virus de la Inmunodeficiencia Humana. Conclusiones. La cobertura de la vacunación no se ha logrado por barreras modificables que incrementan la incidencia y carga de la enfermedad por costos debido a incapacidad, manejo farmacológico y ausentismo escolar. Introduction. Ever since the introduction of the varicella vaccine in Colombia, coverage has not surpassed 90%. The objective of this work is to identify the barriers to varicella vaccination in children. Methodology. A descriptive study conducted at Fundación Salud Bosque. 27 patients were studied - 18 males (67%) and 9 females (33%) - including children under 18 years of age with varicella, and excluding patients with blistering diseases other than varicella and burns. A demographic characterization was conducted. Averages and standard deviations were used for quantitative variables, and the proportion ratio was used for qualitative variables with Stata V12®. Results. The incidence of varicella was 0.2%. Only 9 patients (33%) had received the first dose of the vaccine, and none had received the second dose. 92.5% required sick leave, 89% required painkillers, 63% required antihistamines, and 26% required antibiotics. Discussion. The conducted study shows a significantly lower incidence compared to other international cohorts. Colombia has not achieved the varicella vaccination coverage of Uruguay, Costa Rica, the United States, Australia, Europe and Taiwan due to the barriers to applying it. Meanwhile, the varicella vaccine has not been introduced in Africa because there are other priorities, such as malnutrition, malaria and the Human Immunodeficiency Virus infection. Conclusions. Vaccination coverage has not been achieved because of modifiable barriers that increase the incidence and burden of the disease due to costs of sick leave, pharmacological treatment and school absenteeism. Introdução. Desde a introdução da vacina contra varicela na Colômbia, não foi alcançada uma cobertura superior a 90%. O objetivo deste trabalho é identificar as barreiras à vacinação contra varicela em crianças. Metodologia. Estudo descritivo realizado na Fundação Salud Bosque. Foram estudados 27 pacientes, 18 homens (67%) e 9 mulheres (33%), incluindo crianças menores de 18 anos com varicela e excluindo pacientes com outras doenças bolhosas que não varicela e queimaduras. Foi feita uma caracterização demográfica. Média e desvio padrão foram utilizados para as variáveis quantitativas e, para variáveis qualitativas, a razão de proporção com Stata V12®. Resultados. A incidência de varicela foi de 0.2%, apenas 9 pacientes (33%) receberam a primeira dose da vacina, nenhum a segunda dose. 92.5% requeriam atestado; 89% analgésicos; 63% anti-histamínicos e 26% antibióticos. Discussão. O estudo realizado mostra uma incidência significativamente menor em comparação com outras coortes internacionais. A Colômbia não tem atingido a cobertura vacinal contra a varicela alcançada no Uruguai, Costa Rica, Estados Unidos, Austrália, Europa e Taiwan, dadas as mesmas barreiras em sua aplicação, enquanto na África a vacina contra a varicela não foi introduzida porque existem outras prioridades como a desnutrição, a malária e a infecção pelo Vírus da imunodeficiência Humana. Conclusões. A cobertura vacinal não foi alcançada dadas as barreiras modificáveis que aumentam a incidência e carga da doença devido aos custos por atestados, manejo farmacológico e absenteísmo escolar.

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Introdução: A varicela na gravidez é uma patologia pouco frequente em Portugal devido à alta taxa de imunidade da população em idade fértil. Associa-se a risco mais elevado de complicações maternas assim como a morbimortalidade fetal significativa, particularmente quando a infeção ocorre até às 20 semanas de gestação ou no período periparto. Descrição do caso: Mulher de 31 anos, natural da Rússia, grávida, 2G1P, vigiada na Unidade de Saúde Familiar e consulta de obstetrícia. Recorreu à consulta aberta da sua Unidade de Saúde Familiar às 27 semanas de gestação por contacto significativo com caso de varicela. Encontrava-se assintomática e não apresentava alterações ao exame objetivo. Desconhecia história prévia de varicela ou zona e não tinha registo de vacinação contra o vírus varicela zoster. Foi orientada para o serviço de urgência de obstetrícia, onde colheu serologias. Foi confirmada ausência de imunidade para o vírus varicela zoster, pelo que realizou profilaxia com imunoglobulina. Desenvolveu varicela às 29 semanas e dois dias de gestação, não tendo sido registadas complicações maternas associadas à varicela ou detetados sinais ecográficos de síndroma de varicela fetal. A gravidez decorreu sem outras intercorrências e terminou às 41 semanas e dois dias de gestação. O recém-nascido não apresentava alterações sugestivas de síndroma de varicela fetal. Comentários: O caso clínico descrito pretende enfatizar a necessidade do conhecimento do médico de família da abordagem das grávidas com contacto com varicela ou que desenvolvam a doença. Para além disso, tem como objetivo alertar para a importância da avaliação do estado de imunidade em idade fértil para a identificação de mulheres potencialmente não imunes e a sua atempada orientação.

The article analyzes the coverage and barriers of varicella vaccination in children in Colombia. It was found that only 33% of children had received the first dose of the vaccine and none had received the second dose. The identified barriers include costs, pharmacological management, and school absenteeism. It is recommended to improve education and communication about vaccination to increase coverage and reduce costs associated with the disease. Additionally, studies and reviews on the effectiveness of varicella vaccines in different contexts and countries are presented. [Extracted from the article]

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La infección por virus de varicela zóster (VVZ) durante el embarazo se engloba en el espectro de infecciones STORCH (acrónimo de sífilis, toxoplasmosis, otros, rubéola, citomegalovirus y herpes virus), debido a su potencial teratogénico y sus posibles repercusiones en el bienestar fetal. A pesar de que solo 2% de las pacientes con infección por VVZ en el embarazo tendrán fetos con síndrome congénito de varicela, su alta morbimortalidad hace necesario conocer posibles formas de prevención. En nuestro caso, una madre de 27 años da a luz un neonato con múltiples malformaciones óseas y lesiones cutáneas típicas, asociadas con malformaciones cardiacas y calcificaciones viscerales evidenciadas por imagenología. Ante la comprobación clínica y paraclínica de la infección, se diagnosticó síndrome congénito de varicela. El paciente presentó una evolución tórpida desde el nacimiento, con neumonía multirresistente, enterocolitis necrotizante y rápido deterioro de su patrón respiratorio con posterior fallecimiento. En la actualidad la vacunación y el uso de inmunoglobulina posexposición son los principales aliados para la prevención de este síndrome en recién nacidos.

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La humanidad ha visto con el pasar del tiempo, enfermedades infecciosas que han originado epidemias devastadoras. La intención del hombre sumergido en la ciencia por disminuir las tasas de mortalidad y sus graves secuelas, despertó interés por prevenir el contagio y propagación de estas afecciones. Tal es el caso de la varicela, enfermedad infecciosa y contagiosa que debe ser tratada con tiempo para evitar posibles complicaciones, donde el planificar programas de vacunación es considerado una estrategia de prevención que resulta beneficiosa para la salud pública. El objetivo de esta investigación es, conocer la confiabilidad de un cuestionario sobre los factores asociados a la prevalencia de la varicela bajo juicio de expertos, para la verificación de la calidad del servicio y niveles de comunicación del Centro de Salud Buena Fe, provincia Los Ríos, Ecuador, 2018-2019. El estudio presenta un enfoque cuantitativo, bajo una modalidad observacional de corte transversal, de tipo descriptivo. La población estuvo compuesta por 15 representantes de niños menores de 10 años, que han reportado varicela. Los resultados resaltan indicadores comunicacionales y de planificación sanitaria, que derivan en la falta de interés y desconocimiento por parte de los representantes, para que acudan al Centro de Salud y que los pequeños reciban su biológico para ser inmunizados. Las conclusiones denotan que, el cuestionario tuvo una confiabilidad aceptable con respecto al contenido e información investigada, siendo determinante para que el personal de salud defina estrategias y metodologías, para promocionar la implementación y prevención de la varicela en la población.

We describe a case of varicella in one immunocompetent man of 33 years, who consulted by cutaneous lesions consistent in maculopapular and vesicles generali-zed after 10 days of evolution, accompanied by fever and conjunctivitis. Diagnosis of varicella was confirmed by direct stain and biopsy with immunohistochemistry analysis. The patient improved without antiviral treatment and no complications. We consider this caes of interest because its inusual presentation in one man without immunodeficiency nor subjacent disease. We reviewed the situation of varicella in Colombia and of the vaccination programs.

Introduction: chickenpox is a common and highly contagious rash disease caused by the varicella-zoster virus. In general, its presentation is benign, but serious complications may occur. In this article we present an adolescent who developed thrombocytopenic purpura as a complication of chickenpox. Clinical case: previously healthy 12-year-old female patient. Before admission, she had fever for six days, varicelloid rash, and epistaxis. On physical examination, in addition to the characteristic varicella rash, petechiae and ecchymosis were observed. Thrombocytopenia of 2,000/mm3 was documented. Acyclovir, immunoglobulin, and systemic corticosteroids were administered, as well as platelet transfusions, remaining hospitalized for more than two weeks, until recovery was achieved. Conclusion: serious complications of chickenpox such as thrombocytopenic purpura can occur in previously healthy and non-immunosuppressed patients. [ABSTRACT FROM AUTHOR]

Given the lack of information on the incidence of chickenpox complications, and the use of non-steroidal anti-inflammatory drugs (NSAIDs), the following protocol was developed in the study of children hospitalized in the Infectology Department of the University Children's Hospital of Torreón, Coahuila, Mexico, between the years of 2008 to 2018. It was designated as a case that covered the clinical criteria of vesicles together with fever and later lesions such as pustules, with the epidemiological background of chickenpox in the community, which would have received during its evolution as an NSAID treatment, which were under 18 years of age, gender, if they were immunized for chickenpox, the type of complication, length of hospital stay and morbidity and mortality. A total of 38 cases of complicated chickenpox were documented. The most frequent was dermatology (61%), followed by respiratory (13%). The most affected gender was male (65.7%). A significant relationship was found between the history of NSAID administration and the appearance of complication (p = 0). No case of mortality was reported and none of the patients had the chickenpox vaccine. Based on the results, it is intended to demonstrate the need to make recommendations on the use of NSAIDs in viral exanthemas suspected of being chickenpox. The inclusion of the chickenpox vaccine in the vaccination schedule for Mexico is urgent. [ABSTRACT FROM AUTHOR]

Objective: To describe the impact of the introduction of the viral tetra vaccine in the National Immunization Program in 2013 for 15‐month‐old children in mortality rates and hospitalization associated with varicella in Brazil. Methods: Mortality rates and hospitalizations rates associated with varicella were evaluated between 2010 and 2016 and described according to Brazilian macro regions and age. The population was stratified into age groups: < 1 year, 1‐4 years, and 5‐14 years. Data were collected from the Informatics Department of the Unified Health System. A percentage difference was calculated between rates of hospitalizations and mortality in the pre (2010‐2012) and post‐vaccination periods (2014‐2016) to estimate the approximate effectiveness of the vaccine. Data synthesis: At the national level, vaccination significantly reduced the mortality rates and hospitalizations rates in all age groups analyzed. Among those under 5 years of age, mortality rates and hospitalizations rates decreased 57‐49% and 40‐47%, respectively. There was a national decrease of up to 57% in the mortality rates due to the disease, with smaller decreases seen in the North and Northeast regions and the largest in the South and Southeast regions. The hospitalizations rates for varicella reached a maximum national decline of 47%. In children aged 1–4 years, with higher vaccination coverage, the highest reduction was observed in both mortality rates and hospitalizations rates, which decreased from 2.6 to 0.4/100,000/year. Conclusions: The tetra vaccine proved to be effective in reducing both mortality and hospitalizations of children and adolescents up to 15 years of age in the 2014‐2016 triennium. Resumo: Objetivo: Descrever o impacto da introdução da vacina tetra viral no Programa Nacional de Imunização em 2013 para crianças de 15 meses nas taxas de mortalidade e de internação hospitalar associadas à varicela no Brasil. Métodos: As taxas de mortalidade e de internação hospitalar associadas à varicela foram avaliadas entre 2010 e 2016 e descritas conforme macrorregiões brasileiras e idade. A população foi estratificada em grupos etários: < 1 ano; 1‐4 e 5‐14 anos. Os dados foram coletados do Departamento de Informática do Sistema Unificado de Saúde. Foi realizado um cálculo de diferença percentual entre taxas de internações e mortalidade nos períodos pré (2010‐2012) e pós‐vacinal (2014‐2016) para estimativa de impacto da vacina. Resultados: No nível nacional, a vacinação reduziu significativamente as taxas de mortalidade e de internação hospitalar em todas faixas etárias analisadas. Entre os menores de 5 anos, a taxas de mortalidade e de internação hospitalar diminuíram 57‐49% e 40‐47%, respectivamente. Houve uma queda nacional de até 57% nos índices de mortalidade pela doença, com menores quedas vistas nas regiões Norte e Nordeste e as maiores nas regiões Sul e Sudeste. As taxas de internação hospitalar por varicela atingiram queda nacional máxima de 47%. Em crianças de 1–4 anos, com maior cobertura vacinal, foi observada a maior redução tanto na taxa de internação hospitalar como na taxa de mortalidade, a qual passou de 2,6 para 0,4/100.000/ano. Conclusões: A vacinação se mostrou efetiva em reduzir tanto mortalidade quanto hospitalizações das crianças e adolescentes de até 15 anos no triênio 2014‐2016.

Chickenpox is a seemingly benign and vaccine-preventable disease, the reported compli-cations are multiple and many related to the use of NSAIDs, especially in skin and soft tis-sues. We report the case of female preschool who attends with chicken pox, which is pre-scribed Naproxen for 3 doses for thermal control. 48hrs later presents edema, erythema and enlargement in the right maxillary area. The medical review showed maculopapular lesions and vesicles on the neck, trunk and limbs, some of them impetiginized. Hours later it shows necrotic area and important edema of the mentioned region. Blood cultures and secretion culture are taken, and she was scheduled for urgent surgery. During the debridement, necrotic areas were shown; their medical and surgical management was intensive, and it included surgical washes, drainage systems and skin grafts, as well as germ-specific antimicrobials, for Streptococcus pyogenes. She has one favorable evolution. The best preventive therapy to prevent disease (chicken pox) is universal vaccination. As soon as it is not available, timely diagnosis of cases, monitoring of complications and avoiding the use of NSAIDs constitute secondary prevention measures. [ABSTRACT FROM AUTHOR]

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Antecedentes: La infección con la varicela zoster es mundial. La incidencia varía por grupos de edad, localización geográfica. En Colombia la transmisibilidad el virus se favorece por la multiplicidad de climas, aspectos geográficos y atmosféricos. En el año 2016 se notificaron 112.400 casos, 34.037 en población adulta, 744 fueron población privada de la libertad (PPL). La definición de brote en establecimientos carcelarios se da a partir de un caso. Condiciones de hacinamiento y el contexto social hacen interesante conocer el estudio de brote y las medidas de implementación realizadas. Objetivo: Describir los factores de riesgo, características demográficas y evaluar medidas de control de la varicela en el Centro de Prisiones y Prisiones de Seguridad Moderada (EPMSC) de Cali de 2017 a 2018 Métodos: Se realizó un estudio observacional descriptivo de corte transversal entre el 2017 al 2018 en PPL, mediante registros, entrevistas y fichas de notificación se analizaron variables de tiempo, lugar y persona, se realizaron distribuciones de frecuencias, se calcularon medidas de tendencia central, tasas de ataque y proporciones por pabellón. Resultados: Fue un brote de fuente propagada, se registraron 146 casos. La tasa de ataque del brote (2017) fue de 2.2% y en 2018 fue de 0.4%. El pabellon con mayor tasa de ataque (2017) fue el 5 (4.9%) y en 2018 el 1A (2.5%). El hacinamiento en el 2017 fue de 264% y en el 2018 de 192%. Conclusiones: El hacinamiento y las condiciones de salud en los centros penitenciarios dificultan el control oportuno de las epidemias.

Infecţia cu virusul varicelo-zosterian (VVZ) este o cauză importantă de morbiditate, cu răspândire la nivel global, ce determină două forme clinice distincte de boală: varicela şi herpesul zoster. Infecţia primară cu VVZ în timpul sarcinii poate avea consecinţe importante atât asupra sănătăţii materne, cât şi fetale. Datele epidemiologice arată că vaccinarea a redus semnificativ numărul infecţiilor cu VVZ atât la mame cât şi la nounăscuţi. Strategiile de vaccinare diferă în funcţie de individul la risc (mamă, nou-născut, copil), de momentul cu riscul cel mai mare de infectare (primul trimestru de sarcină, ultimul trimestru de sarcină sau postnatal) şi de durata imunităţii protectoare după vaccinare. Cea mai frecventă complicaţie a varicelei la mamă în timpul sarcinii este pneumonia variceloasă, care se manifestă cu tuse, dispnee, febră şi tahipnee. Efectele infecţiei VVZ asupra fătului pot fi: sindromul de varicelă congenitală, prematuritate sau avort spontan, varicela neonatală. Varicela congenitală a fost descrisă pentru prima dată în 1947. Ratele de avort spontan, naşterile premature şi decesul intrauterin nu sunt mai mari la mamele cu varicelă în sarcină comparativ cu cele fără varicelă. Infecţia neonatală rezultă din transmisia VVZ de la mamă la făt în perioada perinatală.

Objective: To assess the number of cases and the profile of hospitalizations from varicella after the introduction of the measles, mumps, rubella and varicella combination vaccine in the public health system. Methods: Retrospective study in an infectious diseases pediatric hospital of reference in Southeast Brazil. The cases with a clinical diagnosis of varicella, from January 2011 to June 2016, were assessed from pediatricians’ medical records. The hospitalizations were classified into a pre-vaccine group and post-vaccine group, based on the date the vaccine was introduced (September 2013). Both groups were compared by age, sex, time of hospitalization, reason for hospitalization, hospital complications, duration of intensive care, and clinical outcome. Results: A total of 830 hospitalizations were recorded; 543 in the pre-vaccine period and 287 in the post-vaccine period, a reduction of 47.1% (p<0.001). In both periods, a similar profile in the hospitalizations was noticed: majority male; aged between one to five years old; most complications due to secondary causes (mainly skin infections); main outcome was clinical improvement and discharge from the hospital. In the pre-vaccine period, six deaths were recorded and two were recorded in the post-vaccine period. Conclusions: The profile of the hospitalizations was expected to stay the same since this study did not compare vaccinated with unvaccinated children, but hospitalizations before and after the vaccine was introduced. In accordance with the medical literature, we found a significant fall in the number of hospitalizations from varicella. [ABSTRACT FROM AUTHOR]

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Objetivo: La vacuna frente a la varicela se recomendó en la Comunidad de Madrid (CM) a los 15 meses de edad entre noviembre de 2006 y diciembre de 2013. El objetivo fue describir el impacto de la vacunación sobre la incidencia de la varicela en la CM durante el período 2001-2015. Diseño: Estudio descriptivo de los casos de varicela notificados a la Red de Médicos Centinela de la CM y de los casos registrados en el Conjunto Mínimo Básico de Datos al alta hospitalaria. Se calculó la incidencia de casos y de ingresos de varicela, total y específica por edad y sexo. Resultados: La incidencia fue un 94,0% menor en el período 2012-2013 que en el período 2001-2003. En el período 2014-2015 la incidencia fue un 61,8% superior que en el período 2012-2013. La incidencia más alta se apreció en los niños de 0-4 años excepto en el período 2010-2014, en el que fue superada por la del grupo de 5-9 años. La tendencia de los ingresos hospitalarios también fue decreciente, siendo el grupo de menores de un año el de mayor incidencia. Conclusiones: La recomendación de vacunar a los 15 meses de edad ha producido un importante descenso de la incidencia de casos y de ingresos por varicela en todos los grupos de edad, lo que es compatible con la efectividad de una dosis y su capacidad para producir inmunidad de grupo. La retirada de esta recomendación en 2014 y 2015 ha conllevado un incremento de la incidencia.

This is a descriptive, quantitative and cross-sectional study to analyze the knowledge of child education and health professionals about chickenpox, previous to a health education workshop they attended. Data were collected through self-completion questionnaires and analyzed using the Epi Info® software, considering 5% statistically significant level. There were 92 participants from eight Child Day Care Centers and two Basic Health Care Centers in Londrina – PR. More than 52.0% of health professionals and 74.0% of child education professionals didn’t know the disease. To 76.0% of child education professionals and 38.1% of health professionals, chickenpox does not present complications and its viral etiology was reported in 75.0% and 50.0% of professionals, respectively. Chickenpox is a disease that can still be prevented, little known among these two categories of professionals, and requires adequate assistance and reductions of transmissibility through health education programs, besides immunization.

El objetivo es describir las características del brote de Varicela en la población asegurada de La Libertad. Mediante estudio descriptivo de 375 pacientes, según las variables epidemiológicas de persona, lugar y tiempo. El 50% de casos ocurrió en menores de 5 años, el 80% de casos procedieron de Trujillo, La Esperanza, El Porvenir, Moche, Virú, Florencia de Mora y Laredo; el 15% de niños tuvieron complicaciones; el 95% de niños no estuvieron vacunados; dos casos fueron infecciones asociadas a la atención de salud; fallecieron dos pacientes. Las conclusiones son, brote de fuente propagada; predominó en niños menores de 5 años; Trujillo fue el lugar de infección más frecuente, bajo porcentaje de complicaciones; alto porcentaje de niños no vacunados; se detectó transmisión nosocomial y ocurrieron dos fallecidos.

Objetivo. Evaluar el comportamiento epidemiológico de la varicela y el herpes zoster (HZ) para determinar políticas de salud y disminuir prevalencia y complicaciones. Material y métodos. La frecuencia de casos se estimó con datos del Sistema Único de Información para la Vigilancia Epidemiológica (SUIVE), periodo 2000-2013; para los egresos hospitalarios de varicela y HZ, se utilizaron datos del Sistema Nacional de Información en Salud (Sinais). Resultados. El promedio de casos de varicela anual fue 296 733, 57% menores de 9 años, la mayoría de marzo a mayo; de 2004 a 2012 los egresos hospitalarios de varicela fueron 17 398, de ellos 4.6% presentó meningoecefalitis, 2.5% neumonía y 18% otras complicaciones. Por herpes zoster 7 042 egresos, más afectados de 65 años o más, 1.3:1 la relación mujer:hombre. Las complicaciones: neuralgia (11%), afección ocular (7%), meningoencefalitis (5.4%), enfermedad diseminada (2.8%) y otras (5.4%); estancia hospitalaria entre 6.4 a 13.3 días. Conclusiones. Los datos coinciden con los de la literatura de otros países. Se discute el papel de la vacunación en la prevención de la infección en niños y adultos.

Herpes zoster is an infectious disease caused by the varicella zoster virus. It is known as a relatively common condition characterized by lancinating cutaneous manifestations. Some risk factors can be pointed as closely linked to the appearance of this pathology, such as age, sex, race and family history of virus positivity. Currently, studies indicate an increase in the prevalence of cases of herpes zoster, and despite this fact, there is still a lack in studies on it. In this sense, the objective of the present study is to demonstrate, although briefly, the main features and factors associated with Herpes zoster, as well as to point out the main methods of diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective: To report a case of varicella complicated by acute osteomyelitis in order to remind of a rare and potentially serious complication of a very common pediatric disease. Case description: A previously healthy 3-month-old female infant with 10-day history of varicella was admitted to the hospital for fever, groan and prostration. The initial laboratorial evaluation was compatible with bacterial sepsis. By the third day after admission, a swelling of the seventh left rib had developed. The ultrasound and scintigraphy evaluation suggested rib osteomyelitis. Blood cultures were negative. The patient completed six weeks of antibiotics with favorable clinical, laboratorial and imaging evolution. Comments: Varicella is one of the most frequent exanthematic diseases of childhood and it is usually self-limited. The most frequent complication is bacterial infection of cutaneous lesions. Osteoarticular complications are rare, and rib osteomyelitis is described in less than 1% of cases. The main route of dissemination is hematogenic, and the most frequent etiological agent is Staphylococcus aureus. The prognosis is generally good and depends on early detection and antibiotic initiation. [ABSTRACT FROM AUTHOR]

Introduction: Varicella o chickenpox is a highly contagious disease. Varicella is spread worldwide and is caused by the varicella zoster virus. Despite the perception that it is a benign pediatric disease, complications are expected in about 2 to 5%. The neurological involvement may vary from aseptic meningitis to encephalitis. Viruses are the most common infectious agents associated with acute encephalitis, of which 22% occur due to chickenpox. Objective: To report a varicella case of a seven-year-old male patient who developed acute encephalitis. Case description: A seven-year-old patient admitted to the emergency department due to a history of vesicular-papule-crusted skin lesions on the face, trunk and limbs. Three days later, the patient evolved with prostration, altered alertness, drowsiness and vomiting. The established therapy was with intravenous acyclovir, resulting in improvement of neurological symptoms and skin lesions. Conclusions: Every patient with chickenpox should be carefully evaluated for possible complications, including the neurologicals. Where appropriate, timely detection will help to offer specific treatment to avoid further damage. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the clinical and economic burden associated with varicella in Peru. Methods: This was a multicenter, retrospective chart review study of patients aged 1-14 years with a varicella diagnosis between 2011 and 2016. Healthcare resource utilization (HCRU) associated with varicella, unit costs, and work loss were used to estimate direct and indirect costs, presented in USD ($). The cost and HCRU data was combined with estimates of varicella disease burden to estimate the overall annual costs of management of varicella in Peru. Results: A total of 179 children with varicella (101 outpatients, 78 inpatients) were included. Among outpatients, 5.9% experienced ≥1 complication, compared with 96.2% of inpatients. HCRU estimates included use of over-the-counter (OTC) medications (72.3% vs. 89.7% of outpatient and inpatients, respectively), prescription medications (30.7% vs. 94.9%), tests/procedures (0.0% vs. 80.8%). Among outpatients, direct and indirect costs per case were $36 and $62, respectively; among inpatients, respective costs were $548 and $222. The total annual cost associated with varicella was estimated at $ 13 907 146. Conclusion: Varicella is associated with substantial clinical complications and high HCRU in Peru, supporting the need for implementation of a routine childhood varicella vaccination plan. [ABSTRACT FROM AUTHOR]

Antecedentes: La vigilancia de varicela es necesaria para identificar de manera oportuna los casos y brotes de este evento viral, y así brindar las herramientas para la toma de medidas de control que contribuyan a disminuir la incidencia de la enfermedad. Objetivo: Describir el comportamiento de la varicela entre 2010-2014 en el departamento de Casanare (Colombia). Materiales y métodos: Estudio descriptivo transversal a partir de los registros de notifica - ción del evento al Sistema de Vigilancia en Salud Pública (Sivigila) en el departamento. Se recopilaron los casos confirmados del período tras su depuración, para ser analizados mediante estadística descriptiva con el programa Microsoft Excel® 2013 y obtener medidas relativas, de tendencia y dispersión. Resultados: 2 949 casos individuales de varicela fueron notificados, con edad promedio 16,2 ± 12,7 años; 1 540 casos (52,2 %) fueron varones. El grupo etario más afectado fue el de 15- 44 años (1 261 casos; 42,8 %); por ciudades/municipios, Yopal reportó 1 200 casos (40,7 %); por áreas de residencia, prevaleció la urbana, con 2 395 casos (81,2 %). La tasa de incidencia promedio fue de 175,9 casos por 100 000; la letalidad fue de 0,1 % (2/2 949). Conclusiones: La distribución de frecuencias de varicela entre 2011 y 2014 sugiere un mayor compromiso de ambos sexos en la población económicamente activa ubicada en la capital del departamento o en el casco urbano de los municipios, y falta de oportunidad en las medidas de prevención primaria. Dado su alto poder epidémico, se recomienda mantener y fortalecer la vacunación, las acciones de vigilancia, prevención y control del evento, y el manejo de casos ya establecidos a través de la higiene personal y el aislamiento temporal.

El edema de papila es una manifestación de enfermedad neurooftalmológica cuyo diagnóstico etiológico en niños difiere del adulto, puede ser de causa vascular, infecciosa, autoinmune, tóxica, isquémica y compresiva. En el paciente pediátrico se puede relacionar con condiciones sistémicas como pseudotumor cerebri, hipertensión arterial, diabetes juvenil y neoplasias. Presentamos el caso de una paciente de 10 años de edad que acudió al servicio de consulta prioritaria de la Asociación Para Evitar la Ceguera en México, Hospital Dr. Luis Sánchez Bulnes, por presentar en el ojo izquierdo un escotoma paracentral temporal de 5 días de evolución, acompañado de cefalea parietal leve ocasional y refiriendo haber presentado un cuadro gripal resuelto 2 semanas previas. Antecedentes de importancia negados para el padecimiento actual. A la exploración oftalmológica con agudeza visual conservada de ambos ojos, encontrando edema de papila en ojo izquierdo (OI). Se solicitan campos visuales 30-2, encontrando en el OI escotoma cecal. Se diagnostica edema de papila sin baja visual, por lo cual se inició tratamiento con prednisona vía oral, se solicitó resonancia magnética nuclear (RMN) de cráneo y órbitas con resultado normal, posteriormente comienza con exantema maculopapular generalizado y lesiones vesiculares, se diagnostica varicela, se inicia tratamiento con aciclovir y se suspende la prednisona. Dos semanas después presenta resolución del cuadro de varicela y edema de papila. En este caso se asocia el edema de papila a enfermedad viral, descartando previamente otras causas en pacientes pediátricos.

Abstract Objective: To characterize varicella zoster virus-related deaths and hospitalizations in Brazil before universal vaccination with the tetravalent (measles, mumps, rubella, and varicella) vaccine, attempting to collect baseline data on varicella morbidity and mortality in order to evaluate the impact of the varicella vaccination program. Methods: Varicella-associated mortality data were evaluated between 1996 and 2011 and varicella zoster virus-associated hospitalizations between 1998 and 2013. Data were gathered from the Informatics Department of the Unified Health System, considering the International Classification of Diseases, 10th Revision, code B01. All age groups were assessed. Varicella-specific mortality rates were calculated and seasonality of varicella-zoster virus-associated hospitalizations was described. Results: There were 2334 varicella deaths between 1996 and 2011, 19.3% in infants aged less than 1 year and 36% in children from 1 to 4 years. In infants under 1 year, varicella mortality rates reached 3.2/100,000/year. In children aged 1–4 years, varicella mortality rates reach 1.64/100,000/year. Average annual mortality rates for varicella in Brazil are 0.88/100,000 in infants under 1 year and 0.40/100,000 in children aged 1–4 years. The total number of hospitalizations associated with varicella zoster virus was 62,246 from 2008 to 2013. Varicella-associated hospitalizations have a seasonal distribution in children, peaking in November. In the elderly, monthly averages of herpes zoster-associated hospitalizations present no significant seasonal variation. Conclusions: Varicella is associated, in the pre-vaccine period, to significant morbidity and mortality in Brazil. The universal vaccination program is expected to decrease the disease burden from varicella.

Introducción: a pesar de la vacunación universal antivaricela al año de vida (1999), en nuestro país persisten brotes de varicela modificada. Objetivos: 1) Realizar una descripción clínico epidemiológica de un número inusualmente alto de casos de varicela en menores de 15 años en todos los centros educativos del departamento de Paysandú, Uruguay, durante un período de ocho meses. 2) Comparar las características clínicas y epidemiológicas de los infectados. Material y método: estudio descriptivo, observacional, retrospectivo de casos de varicela en menores de 15 años, informados en los centros educativos de Paysandú, entre marzo y octubre del 2013. Resultados: se detectaron 151 casos. El 97% ocurrió en niños vacunados. La edad media fue de 7,4 años. No hubo casos graves. El mayor número de lesiones se asoció a mayor edad y mayor persistencia de la fiebre (p

Infecţia cu virusul varicelo-zosterian (VVZ) este o cauză importantă de morbiditate, cu răspândire la nivel global, ce determină două forme clinice distincte de boală: varicela şi herpesul zoster. Infecţia primară cu VVZ în timpul sarcinii poate avea consecinţe importante atât asupra sănătăţii materne, cât şi fetale. Datele epidemiologice arată că vaccinarea a redus semnificativ numărul infecţiilor cu VVZ atât la mame cât şi la nounăscuţi. Strategiile de vaccinare diferă în funcţie de individul la risc (mamă, nou-născut, copil), de momentul cu riscul cel mai mare de infectare (primul trimestru de sarcină, ultimul trimestru de sarcină sau postnatal) şi de durata imunităţii protectoare după vaccinare. Cea mai frecventă complicaţie a varicelei la mamă în timpul sarcinii este pneumonia variceloasă, care se manifestă cu tuse, dispnee, febră şi tahipnee. Efectele infecţiei VVZ asupra fătului pot fi: sindromul de varicelă congenitală, prematuritate sau avort spontan, varicela neonatală. Varicela congenitală a fost descrisă pentru prima dată în 1947. Ratele de avort spontan, naşterile premature şi decesul intrauterin nu sunt mai mari la mamele cu varicelă în sarcină comparativ cu cele fără varicelă. Infecţia neonatală rezultă din transmisia VVZ de la mamă la făt în perioada perinatală. [ABSTRACT FROM AUTHOR]

Objective: To determine the cases admitted by Varicella to the Municipal Hospital of the Child Mario Ortiz Suarez (HMNMOS) and to analyze the frequency of the complications presented during the year 2016 from January 1st to December 31st. Methodology: A cross-sectional retrospective descriptive study, about cases of varicella at the Municipal Hospital of the Child Mario Ortiz Suarez during 2016 from January 1st to December 31st, were quantified and analyzed. Results: A total of 683 patients minors 12 years of age with diagnosis of varicella were registered, who presented complications such as cutaneous superinfection, neurological alterations, pneumonias and others, being more affected between 2 and 5 years old. Conclusions: The complications of varicella can lead to serious clinical symptoms and neurological sequelae. This situation can be avoided with vaccination, taking into account that since its introduction, the incidence has decreased over the years. However, this vaccine is not included in the Expanded Immunization Program (PAI), so its implementation as prophylaxis in adolescents who not been infected is essential. [ABSTRACT FROM AUTHOR]

A varicela, é uma patologia comum na infância, habitualmente benigna e auto-limitada. Embora pouco frequentes, podem ocorrer complicações, nomeadamente a nível neurológico, cutâneo, pulmonar e, mais raramente, muscoloesquelético.Descrevemos um caso de osteomielite a streptococcus pyogenes (s.pyogenes) em contexto de varicela, numa criança previamente saudável.Pretendemos chamar a atenção para a possível ocorrência de complicações graves nesta patologia frequente e globalmente benigna.

Introducción. Las acciones para enfrentar la varicela, tradicionalmente, se han concentrado en el componente asistencial y en el seguimiento de los brotes y las epidemias. No obstante, los padres de familia han tejido patrones de respuesta distantes a las medidas sanitarias establecidas, como estrategia de supervivencia. Objetivo. Explorar las percepciones de los padres de familia frente a la varicela en tres localidades de Bogotá, reconociendo los mecanismos de afrontamiento y los vínculos existentes con las directrices emanadas por los organismos de salud del país. Materiales y métodos. Estudio cualitativo con diseño metodológico. La información se recolectó mediante entrevistas semiestructuradas y un grupo focal en el ámbito comunitario, específicamente, jardines infantiles. La muestra fue seleccionada por conveniencia, hasta lograr el criterio de saturación. Resultados. Los sujetos de investigación reconocen la varicela tal como la describen los postulados científicos. Los individuos perciben que esta enfermedad no es una situación alarmante; se comprende como parte del crecimiento del ser humano, lo que conlleva a que los grupos sociales asuman el riesgo con cuidados rápidos y simples que les permitan seguir con su vida cotidiana. Conclusiones. La forma como se afronta la situación denominada “varicela” en un entorno social dado, se relaciona con la configuración simbólica que los sujetos hacen del evento y las representaciones mentales que se construyen socialmente, en una estructura de redes que tiene diversos ‘nodos’ y vínculos, con formas de conexión también diversas y cambiantes.

Introdução: As crianças são frequentemente alvo de quadros infeciosos, não só pelo seu contexto epidemiológico mais vulnerável, mas também pela imaturidade do seu sistema imunitário. As doenças exantemáticas são frequentes nesta fase da vida, impondo ao médico uma enorme dificuldade diagnóstica no que concerne a patologias dermatológicas. O objetivo deste relato de caso prende-se com a importância do médico de família reconhecer alterações cutâneas de maior gravidade, que se comportem como emergências dermatológicas. Descrição do Caso: Criança do género feminino, cinco anos, sem antecedentes pessoais de relevo. Em agosto de 2015 recorreu a consulta de medicina geral e familiar por febre, mal-estar geral e com duas lesões eritematosas e ulceradas no lábio inferior com três dias de evolução. Esta situação foi encarada como um quadro de varicela. Dois dias depois verificou-se agravamento da situação, com surgimento de lesões semelhantes na mucosa vaginal, edema palpebral e exsudação mucopurulenta ocular bilateral. Por recusa alimentar total recorreu a um serviço de urgência privado, onde ficou internada. Dada a ausência de melhoria foi transferida para o hospital da área de residência três dias depois, encontrando-se prostrada, com múltiplas lesões aftosas na mucosa oral e vaginal, hemorragias subconjuntivais dispersas e queratite. Ficou internada no serviço de pediatria. Atendendo ao quadro clínico de estomatite ulcerativa, conjuntivite purulenta e vulvovaginite foi assumido o diagnóstico clínico de síndroma de Stevens-Johnson. Comentário: A síndroma de Stevens-Johnson caracteriza-se por uma reação de hipersensibilidade cutânea tardia que atinge a pele e as mucosas. Constitui uma emergência dermatológica com potencial elevado de morbimortalidade, difícil de diagnosticar na prática clínica diária do médico de família. Assim, sempre que surjam lesões cutâneas ou mucosas associadas a toma de fármacos, infeções virais, neoplasias ou simplesmente lesões que concernem algum grau de suspeição, não deve ser adiada a referenciação hospitalar urgente.

Introducción: La vacunación frente a la varicela ha sido un tema de gran controversia y debate en los últimos años. Actualmente no existe una estrategia común definida, concreta y dada por válida por todos los organismos implicados. En España hasta ahora la vacunación se realizaba únicamente a mayores de 12 años que no hubieran pasado la varicela. El pasado septiembre, el Ministerio de Sanidad anunció una nueva estrategia de vacunación, con dos dosis en edades tempranas. El objetivo fue valorar qué estrategia de vacunación tiene una mayor efectividad según la bibliografía disponible. Metodología: Se ha realizado una búsqueda bibliográfica en las bases de datos de Medline, IBECS y The Cochrane Library de los artículos publicados desde el año 2005 hasta diciembre de 2015. Se identificaron un total de 227 artículos (tras eliminar duplicados), de los cuales se revisaron 9 estudios que cumplieron con los criterios de inclusión. Resultados: La efectividad de dos dosis de la vacuna frente a la varicela, administradas en edades tempranas, está entre el 80% y el 100%. Discusión: Los resultados de esta revisión coinciden con la bibliografía existente y son consistentes con la nueva estrategia propuesta por el Ministerio de Sanidad. Esta revisión respalda un calendario que comprenda una primera dosis de la vacuna a edades tempranas (12-15 meses de edad) y una segunda dosis entre los 2 y los 4 años Palabras Clave: efectividad vacunal, varicela, vacuna, vacunación, calendario vacunal, virus varicela-zóster.

Descreveu-se aqui o caso de um homem de 30 anos de idade com quadro de varicela grave, hipoxemia refratária, vasculite do sistema nervoso central e insuficiência renal anúrica. Foi necessário transporte por ambulância com suporte respiratório extracorpóreo veno-venoso, sendo este utilizado até a recuperação do paciente. Discute-se o potencial uso de oxigenação por membrana extracorpórea em países em desenvolvimento para o controle de doenças comuns nestas áreas.

Objective. To evaluate the epidemiological behavior of varicella and herpes zoster (HZ) to determine the need of health policies to diminish prevalence and avoid complications. Materials and methods. To assess frequency, we analyzed data from the National Information System for Epidemiological Surveillance (SUIVE) from 2000 to 2013; to assess the discharge data of varicella and HZ, we evaluated information from the National System of health information (Sinais). Results. The average annual cases of chickenpox were 296 733, 57% mostly children under 9 years, most of them from March to May. From 2004 to 2012 hospital discharge of varicella were 17 398, of which 4.6% had meningoecephalitis, 2.5% pneumonia and 18% other complications. For herpes zoster 7 042 discharges, mostly affected were patients 65 years or older, 1.3:1 the woman-man relationship. Main complications were: neuralgia (11%), eye involvement (7%), meningoencephalitis (5.4%), disseminated disease (2.8%) and others (5.4%); hospital stay was between 6.4 and 13.3 days. Conclusions. Data is consistent with that of the literature in other countries. The role of vaccination to prevent infection in children and adults is discussed. [ABSTRACT FROM AUTHOR]

Kaposi's varicelliform eruption is a rare and potentially fatal viral infection occurring in patients with preexisting chronic dermatoses. Clinically it is characterized by the rapid onset and evolution of cutaneous lesions with potential dissemination to internal organs, which is considered a medical emergency. Here we report the case of a 19-year-old male with a history of atopic dermatitis, recurrent oral herpes and recent exposure to a sibling that had chickenpox, in which the accurate diagnosis and treatment of the viral infection resulted in an adequate response without sequelae or complications. [ABSTRACT FROM AUTHOR]

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Aims: Chickenpox is a frequent and contagious disease in healthcare and social assistance settings, and there are limited data on seropreva-lence among workers in this sector. We estimated susceptibility to chickenpox among workers, by demographic and occupational variables, and measured the rate of seroprotection after vaccination. Methods: A retrospective seroprevalence study of chickenpox (varicella) and serological vaccine response. The earliest recorded varicella se-rology, analyzed by the ELISA method, was identified for each worker from a health surveillance database of a group of medical and healthcare companies in Catalonia, recorded between 2004 and 2013. The total study population consisted of 2958 workers, analyzed by gender, age, birth cohort preceding and following the introduction of the vaccine in the vaccination schedule of Catalonia (born after 1993), and occupational category, regardless of exposure risk. Vaccine effectiveness was determined in a group of 59 initially seronegative workers by measuring ELISA-based varicella titers, obtained at least 2 months after receiving a second dose of the VARIVAX® vaccine. Results: 2820 workers (95.3%) had protective titers (PT) to chickenpox; 507 were men (97.1%) and 2313 were women (95%). The 1993 and earlier birth cohorts had a PT of 95.4% and those born after 1993 had a PT of 80.0%. Among at-risk categories, the PT was 95.2%, whereas among those not at risk it was was 96%. By birth decade, the lowest PT was among those age 60 years or older (93.3%). The post-vaccination serological response was 89.8%. Conclusions: The prevalence of protective varicella serologies among healthcare and social assistance workers was similar to that found in recent seroprevalence studies in the general population in Catalonia. Men have significantly higher rates of protection than women. Those born after 1993 have significantly lower rates of protective titers than those born in 1993 or earlier. [ABSTRACT FROM AUTHOR]

Objetivo: Determinar las variabilidad estacional de hospitalizaciones por varicela. Diseño: Serie de casos. Institución: Instituto Nacional de Salud del Niño (INSN) del Perú. Participantes: Niños hospitalizados por varicela. Intervenciones: Se estudió las hospitalizaciones por varicela de niños atendidos en el INSN del Perú desde el año 2001 hasta el 2011, país sin implementación de la vacunación contra la varicela; se identificó a los pacientes de la oficina de estadística. Principales medidas de resultados: Variabilidad estacional de hospitalizaciones de los niños atendidos por varicela. Resultados: Se estudió a 1 566 niños hospitalizados por varicela, siendo la mediana de edad de 2 años 6 meses, 46,4% (727/1 466) de sexo femenino, mediana de estancia hospitalaria seis días (RIQ:9,4). El grupo etario más afectado fue de 0 a 2 años, correspondiendo al 55% (864/1 566). En la curva de frecuencias de hospitalizaciones por varicela por meses evidenciamos la distribución estacional, con una tendencia al incremento cada vez mayor por año. Las hospitalizaciones por varicelas con al menos alguna complicación correspondieron a 68,5%(1 073/1 566). El porcentaje de fallecidos fue 0,83% (13/1 493). Conclusiones: Las hospitalizaciones por varicela en el INSN es una causa importante de morbilidad, con una tendencia estacional, siendo más frecuente en los meses de noviembre a febrero, con el incremento cada vez mayor por año y supone una importante carga económica.

El objetivo de estudio fue describir las características clínicas y epidemiológicas de los casos de varicela complicada atendidos en el Instituto Nacional de Salud del Niño (INSN) del Perú durante los años 2001 al 2011. Se realizó una serie de casos que incluyó un total de 1073 niños con varicela complicada. La mediana de la edad fue de 2,5 años (RIQ 1,1-4,8 años); 578 (54%) fueron de sexo masculino. El tipo de complicación más frecuente fueron las infecciones secundarias de piel y partes blandas con 768 casos (72%), se registró 13 (1,4%) fallecidos. En conclusión, en el INSN se hospitalizan con mayor frecuencia casos de varicela complicada en niños menores de cinco años, con un tiempo de hospitalización corto y con una baja proporción de fallecidos, la mayoría de complicaciones siendo relacionadas con las infecciones secundarias de piel y partes blandasThe objective of the study was to describe the clinical and epidemiological characteristics of complicated chickenpox cases seen at the National Institute of Children’s Health (INSN, Spanish acronym) of Peru from 2001 to 2011. A case series was collected, including a total of 1,073 children with complicated chickenpox. The median age was 2.5 years (IQR 1.1-4.8 years), of which 578 (54%) were male. The most frequent complications were secondary skin and soft tissue infections with 768 cases (72%). 13 deaths (1.4%) were recorded. In conclusion, the hospitalizations due to complicated chickenpox in the INSN included mostly children under five, with a short stay and a low proportion of deaths most complications being related to secondary skin and soft tissue infections

Chickenpox is an acute viral infectious disease that is highly contagious and very common in children. When it occurs in adults, age increases severity, with complications that can lead to death in a short period of time. Among the most lethal complications we can find pneumonia and bronchopneumonia, injuries overinfection caused by streptococci and staphylococci with severe sepsis, diverse bleeding, encephalitis, shock, hemorrhagic nephritis with renal failure and necrotizing fasciitis, among others. The case of an 83 years old male patient, with a history of chronic obstructive pulmonary disease and ischemic cerebrovascular atherosclerotic disease that contracted chickenpox and whose evolution was very rapid, with acute respiratory failure and bronchopneumonia massive hemorrhagic shock, to the point of death, is presented. Given the increased incidence of chickenpox, according to reports of the Pedro Kouri Institute of Tropical Medicine, we decided to have this case published.

Introducción: el virus de la Varicela zoster causa infecciones primarias y recurrentes. Es una enfermedad aguda, generalizada, altamente contagiosa, caracterizada por la aparición de síntomas constitucionales y la presencia de un rash especifico. Objetivos: instruir a los estudiantes y médicos en el caso de una presentación poco frecuente y poco disponible en la literatura mundial, para determinar manifestaciones clínicas de la Varicela zoster, así como los medios diagnósticos empleados en la actualidad, sus complicaciones y tratamiento. Presentación del caso: se presentó un preescolar de 4 años de edad, con hallazgos clínicos de Varicela zoster en la región anterior del tórax, se hace una revisión de la presentación clínica de la enfermedad, su evolución y tratamiento. Conclusiones: la Varicela sigue siendo una enfermedad dermatológica infecciosa, de etiología viral, por lo que requiere diagnóstico y tratamiento oportuno, con vistas a evitar sus complicaciones, por lo que es importante un adecuado diagnóstico.Introduction: the virus of the chicken pox - zoster causes primary, latent infections and appellants. The primoinfección shows as a result the establishment of a latent infection of for life of the neurons of the spinal sensitive ganglions. Its study has interest v as its frequency, as the possible confusion with other illnesses with similar exanthema, as some complications that can be serious and for cause of embriopatias is possible. Objective: to instruct the students and doctors in the case of a not very frequent and not very available presentation in the world literature, to determine clinical manifestations of the chicken pox zoster, as well as the diagnostic means used at the present time, their complications and treatment. Presentation of the case: 4-year-old age student presented a pre to himself, with injuries in the skin in the shape of vesicles, with clinical Chicken pox finds zoster in the previous region of the thorax, at 48 hours edemas are stated in both regions periorbitrarias, with presence of vesiculosas injuries and crusts. Conclusions: the chicken pox constitutes an epidemiologic clinical infectious picture, of viral, slightly frequent etiology its complication and of turning out to be this, they need of diagnosis and opportune treatment.

The case of a 12 years child old child, white skin, obese, from urban procedence and with a history of Crohn's disease who was admitted to the Intensive Care Unit at the "Paquito González Cueto” Pediatric University Hospital because of bloody diarrhea and severe dehydration is presented. After controlling the acute phase, the patient was taken to the gastroenterology room where he began presenting vesicular lesions on the trunk, diagnosed as varicella. A further complication appeared when the patient developed a severe pneumonia that quickly evolved into an acute respiratory distress syndrome which required transfer to intensive care unit with intensive therapeutic intervention, especially ventilatory management. Both radiologic and laboratory parameters were very characteristic, similar to those described in the literature. Despite intensive sustained treatment, the patient died a month after diagnosis was performed. Considering how infrequent this complication is in the case of children, it was decided to have the case published.

There are few social epidemiologic studies on chickenpox outbreaks, although previous findings suggested the important role of social determinants. This study describes the context of a large outbreak of chickenpox in the Cauca Valley region, Colombia (2003 to 2007), with an emphasis on macro-determinants. We explored the temporal trends in chickenpox incidence in 42 municipalities to identify the places with higher occurrences. We analyzed municipal characteristics (education quality, vaccination coverage, performance of health care services, violence-related immigration, and area size of planted sugar cane) through analyses based on set theory. Edwards-Venn diagrams were used to present the main findings. The results indicated that three municipalities had higher incidences and that poor quality education was the attribute most prone to a higher incidence. Potential use of set theory for exploratory outbreak analyses is discussed. It is a tool potentially useful to contrast units when only small sample sizes are available.Hay pocos estudios de epidemiología social sobre epidemias de varicela, aunque resultados previos sugieren un importante rol de los determinantes sociales. Este estudio describe el contexto de una gran epidemia de varicela en la región del Valle del Cauca, Colombia (2003 a 2007), con énfasis en algunos macro-determinantes. Exploramos las tendencias temporales de la incidencia de varicela en 42 municipios para identificar los lugares con mayor ocurrencia. Analizamos las características municipales (calidad de educación, cobertura de vacunación, desempeño de los servicios de salud, inmigración relacionada con violencia, y área cultivada con caña de azúcar) mediante análisis basados en teoría de conjuntos. Diagramas de Venn de Edward fueron usados para presentar los principales hallazgos. Los resultados indicaron que tres municipios tuvieron las mayores incidencias y que la educación de pobre calidad fue el atributo más propenso a mayor incidencia. El uso de la teoría de conjuntos para análisis exploratorio de epidemias con pocas unidades de análisis es discutido.