{"id":2165,"date":"2022-08-04T17:17:15","date_gmt":"2022-08-04T05:17:15","guid":{"rendered":"https:\/\/www.awanuilabs.co.nz\/south\/otagosouthland\/?page_id=2165"},"modified":"2022-08-04T17:17:16","modified_gmt":"2022-08-04T05:17:16","slug":"chicken-pox-fetal-varicella-syndrome","status":"publish","type":"page","link":"https:\/\/www.awanuilabs.co.nz\/south\/otagosouthland\/referrers\/microbiology-resources\/how-do-i-diagnose\/chicken-pox-fetal-varicella-syndrome\/","title":{"rendered":"Chicken pox \/ fetal varicella syndrome"},"content":{"rendered":"\n<p><strong>Infection:<\/strong> &nbsp;Maternal chicken pox, maternal primary varicella (VZV), fetal varicella syndrome<\/p>\n\n\n\n<p>Also refer to: <a href=\"https:\/\/www.awanuilabs.co.nz\/south\/otagosouthland\/referrers\/microbiology-resources\/how-do-i-diagnose\/chicken-pox\/\">How do I diagnose &#8211; Chickenpox<\/a><\/p>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Brief description:<\/summary><div class=\"ab-accordion-text\">\n<ul><li>Chicken pox (primary varicella) is a common childhood illness that rarely causes significant complications, however is important in relation to pregnancy for these reasons:<ul><li>Risk of severe disease in the mother<\/li><\/ul><ul><li>Risk of congenital infection and fetal varicella syndrome<\/li><\/ul><ul><li>Risk of severe infection in neonate if acquired at or around time of birth<\/li><\/ul><\/li><li>Secondary varicella infection (shingles\/zoster) in the mother does not pose these risks.<\/li><li>Fetal varicella syndrome can manifest in several ways, with skin scars and limb abnormalities being commonest.<\/li><li>The risk of FVS depends on gestation at time of maternal infection:<ul><li>&lt;1% if prior to 12 weeks<\/li><\/ul><ul><li>1-2% if between 12-28 weeks<\/li><\/ul><ul><li>Does not occur if&nbsp; &gt;28 weeks<\/li><\/ul><\/li><\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Did you know?<\/summary><div class=\"ab-accordion-text\">\n<ul><li>A good history of prior chickenpox in a pregnant woman has been shown to be highly predictive of immunity, and serology to confirm is not required.<\/li><li>Another potential indicator of immunity is if the mother has previously been exposed to an older child in the family with chickenpox and not gone on to develop it herself.<\/li><\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Diagnostic approach &amp; test of choice: maternal exposure to varicella during pregnancy<\/summary><div class=\"ab-accordion-text\">\n<ul><li>Potential routes of <strong>exposure:<\/strong><ul><li>Contact with a person with <strong><a href=\"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/chickenpox\/\">chickenpox<\/a><\/strong><\/li><\/ul><ul><li>Contact with a person with <strong>active <\/strong><a href=\"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/shingles\/\"><strong>shingles<\/strong><\/a> (generally requires close exposure to uncovered lesions)<\/li><\/ul><ul><li>The above two conditions can usually be diagnosed based on characteristic clinical appearance. However, due to the implications of exposure in pregnancy, if there are <strong>atypical features<\/strong>, confirmation of the diagnosis is <strong>recommended<\/strong> (see links above).<\/li><\/ul><\/li><li>If exposure has occurred, does mother have a <strong>history of past chickenpox <\/strong>or<strong> vaccination<\/strong>?<ul><li>Yes &#8211; consider <strong>immune<\/strong>, testing not required<\/li><\/ul><ul><li>No\/uncertain &#8211; arrange urgent <a href=\"https:\/\/scg.aphg.co.nz\/#!\/WEL\/details\/VZA\"><strong>Varicella IgG serology<\/strong><\/a><\/li><\/ul><\/li><\/ul>\n\n\n\n<ul><li>Varicella IgG <strong>detected<\/strong> &#8211; consider <strong>immune<\/strong>, no further action required<\/li><li>Varicella IgG <strong>not detected<\/strong> &#8211; consider <strong>susceptible<\/strong>. Discuss <strong>urgently<\/strong> with obstetrics regarding requirement for immunoglobulin and\/or antiviral.<\/li><\/ul>\n\n\n\n<p><a id=\"_msocom_1\"><\/a><\/p>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Diagnostic approach &amp; test of choice: maternal chickenpox during pregnancy<\/summary><div class=\"ab-accordion-text\">\n<ul><li>The diagnosis can usually be made clinically, especially if there has been a known exposure to chickenpox, however if there are <strong>atypical features<\/strong> or <strong>diagnostic uncertainty<\/strong>, then testing is <strong>recommended<\/strong>.<\/li><li><strong>Viral swab of vesicle fluid for <a href=\"https:\/\/scg.aphg.co.nz\/#!\/WEL\/details\/VZV\">VZV PCR<\/a><a> <\/a><\/strong>(usually requires de-roofing of vesicle to obtain fluid)<ul><li>Good<strong> sensitivity &#8211;  <\/strong>a <strong>negative<\/strong> result on an<strong> adequately collected sample <\/strong>makes<strong> <\/strong>the diagnosis <strong>very<\/strong> <strong>unlikely<\/strong><\/li><\/ul><ul><li>Excellent<strong> specificity &#8211; <\/strong>a <strong>positive<\/strong> result <strong>confirms<\/strong> the diagnosis<\/li><\/ul><ul><li>Note: swabs run for VZV PCR in our laboratory are <strong>run for HSV PCR in parallel<\/strong>, as these viruses can mimic each other.<\/li><\/ul><\/li><li><strong>All cases<\/strong> of chickenpox in pregnancy should be <strong>discussed urgently with obstetrics<\/strong>, as there is a risk of <strong>severe disease in the mother<\/strong>, and further <strong>USS follow-up<\/strong> will usually be required.<\/li><\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Diagnostic approach &amp; test of choice: fetal varicella syndrome<\/summary><div class=\"ab-accordion-text\">\n<ul><li>This should be led by a maternal-fetal medicine specialist.<\/li><li>Lab testing is <strong>not usually required if USS is normal<\/strong> at least 5 weeks post maternal infection.<\/li><li>If testing is required, <strong>amniocentesis for <a href=\"https:\/\/scg.aphg.co.nz\/#!\/WEL\/details\/VZV\">VZV PCR<\/a><\/strong>&nbsp;is the test of choice<ul><li>Excellent <strong>sensitivity<\/strong> &#8211; a negative result makes diagnosis <strong>extremely unlikely<\/strong><\/li><\/ul><ul><li>Moderate <strong>specificity<\/strong> &#8211; a positive result <strong>doesn\u2019t necessarily confirm<\/strong> the diagnosis, but if USS also suggests FVS then makes diagnosis likely.<\/li><\/ul><\/li><\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Tests to avoid\/specialist tests:<\/summary><div class=\"ab-accordion-text\">\n<ul><li><strong>Serology for the diagnosis of chickenpox<\/strong><ul><li><strong>IgM<\/strong> and <strong>IgG<\/strong> serology are <strong>not recommended<\/strong> for the diagnosis of chicken pox, as IgM is prone to <strong>false positives<\/strong>, and IgG seroconversion requires paired sampling, resulting in <strong>delayed diagnosis<\/strong>.<\/li><\/ul><\/li><\/ul>\n<\/div><\/details><\/div>\n","protected":false},"excerpt":{"rendered":"Infection: &nbsp;Maternal chicken pox, maternal primary varicella (VZV), fetal varicella syndrome Also refer to: How do I diagnose &#8211; Chickenpox","protected":false},"author":18,"featured_media":0,"parent":2060,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-left-sidebar.php","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Chicken pox \/ fetal varicella syndrome &#8212; Awanui Labs \u2013 Otago, Southland<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.awanuilabs.co.nz\/south\/otagosouthland\/referrers\/microbiology-resources\/how-do-i-diagnose\/chicken-pox-fetal-varicella-syndrome\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Chicken pox \/ fetal varicella syndrome &#8212; Awanui Labs \u2013 Otago, Southland\" \/>\n<meta property=\"og:description\" content=\"Infection: &nbsp;Maternal chicken pox, maternal primary varicella (VZV), fetal varicella syndrome Also refer to: How do I diagnose &#8211; 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