eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Chicken Pox or Varicella: Differential Diagnoses & Workup

Author: Richard Lichenstein, MD, Associate Professor, Pediatric Emergency Department, University of Maryland School of Medicine
Contributor Information and Disclosures

Updated: Dec 8, 2009

Differential Diagnoses

Encephalitis
Pediatrics, Hand-Foot-and-Mouth Disease
Henoch-Schonlein Purpura
Scabies
Herpes Simplex
Stevens-Johnson Syndrome
Herpes Zoster
Toxic Shock Syndrome
Impetigo

Other Problems to Be Considered

Measles
Meningococcemia (can be confused with hemorrhagic varicella)
Other common viral exanthems (eg, coxsackievirus, echovirus)
Smallpox (no cases since 1949; virus officially destroyed in 1996)
Drug eruption
Papular urticaria
Dermatitis herpetiformis
Eczema herpeticum

Workup

Laboratory Studies

  • Varicella is usually a clinical diagnosis.
  • Laboratory tests, such as those listed below, are available for confirmation, but they are rarely required.
  • The WBC count may be normal, low, or mildly elevated.
  • Marked leukocytosis suggests a secondary infection.
  • Culture of the base of the vesicle, direct electron microscopy, and immunofluorescence staining of the base of the lesion may be performed for detection of varicella-zoster virus but are usually not necessary.

Imaging Studies

  • Imaging studies are not required for varicella unless secondary complications are a concern (eg, chest radiography for varicella pneumonia).

Other Tests

  • Bacterial culture of lesions may be indicated if signs of superinfection are present.
  • A lumbar puncture for culture, cytology, and chemistries may be performed if signs of CNS involvement are present.

Procedures

  • If the diagnosis is equivocal, a Tzanck smear may be performed from a scraping of the base of the varicella lesion. Presence of multinucleated giant cells is suggestive of a herpes virus infection but is not specific for varicella-zoster virus.
  • Infections with other herpes viruses, such as herpesvirus 1 and 2, also display similar multinucleated giant cells.

More on Pediatrics, Chicken Pox or Varicella

Overview: Pediatrics, Chicken Pox or Varicella
Differential Diagnoses & Workup: Pediatrics, Chicken Pox or Varicella
Treatment & Medication: Pediatrics, Chicken Pox or Varicella
Follow-up: Pediatrics, Chicken Pox or Varicella
Multimedia: Pediatrics, Chicken Pox or Varicella
References
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References

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  2. Shah SS, Wood SM, Luan X, Ratner AJ. Decline in Varicella-Related Ambulatory Visits and Hospitalizations in the United States Since Routine Immunization Against Varicella. Pediatr Infect Dis J. Nov 25 2009;[Medline].

  3. Ozaki T, Nagai H, Kimura T, et al. The age distribution of neutralizing antibodies against varicella-zoster virus in healthy individuals. Biken J. Mar 1980;23(1):9-14. [Medline].

  4. Perella D, Fiks AG, Jumaan A, et al. Validity of reported varicella history as a marker for varicella zoster virus immunity among unvaccinated children, adolescents, and young adults in the post-vaccine licensure era. Pediatrics. May 2009;123(5):e820-8. [Medline].

  5. [Guideline] Marin M, Guris D, Chaves SS, Schmid S, Seward JF, Advisory Committee on Immunization Practices, et al. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. Jun 22 2007;56(RR-4):1-40. [Medline].

  6. American Academy of Pediatrics Committee on Infectious Diseases. The use of oral acyclovir in otherwise healthy children with varicella. Pediatrics. 1993;91(3):674-6. [Medline].

  7. Arvin A. Progress in the treatment and prevention of varicella. Curr Opin Infect Dis. 1993;6:553-557.

  8. Braun I. Varicella zoster virus: trends and treatment. MCN Am J Matern Child Nurs. Jul-Aug 1996;21(4):187-90. [Medline].

  9. Cowan MR, Primm PA, Scott SM, et al. Serious group A beta-hemolytic streptococcal infections complicating varicella. Ann Emerg Med. Apr 1994;23(4):818-22. [Medline].

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  17. Resnick SD. New aspects of exanthematous diseases of childhood. Dermatol Clin. 1997;15:257-66. [Medline].

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Further Reading

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Keywords

chickenpox, varicella-zoster virus, herpes virus, vesicular rash, human herpesvirus 3, varicella-zoster immune globulin, varicella, encephalitis, pneumonia, Reye syndrome, aseptic meningitis, Guillain-Barré syndrome, treatment, symptoms

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Contributor Information and Disclosures

Author

Richard Lichenstein, MD, Associate Professor, Pediatric Emergency Department, University of Maryland School of Medicine
Richard Lichenstein, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Kirsten A Bechtel, MD, Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital
Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Wayne Wolfram, MD, MPH, 
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD, Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston
Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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