Diarrhea due to chickenpox in children. What to do, does it happen

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Varicella or chickenpox is a highly contagious infectious disease caused by the herpetic virus type 3 Varicella Zoster.

Transmitted:

• by airborne droplets;
• by contact;
• from a pregnant woman to the fetus.

The virus is extremely volatile and travels up to 20 meters with the air, overcoming ventilation systems, elevator shafts and flights of stairs. A person is considered contagious for an average of 2 weeks. It becomes such before the first manifestations appear, the entire period of rashes, infectivity ends 5 days after the appearance of the last bubbles.

The incubation period (from the moment of infection to the first clinical appearance) is 5-21 days (on average 7-14 days).

The disease manifests itself as fever, intoxication and the appearance of specific vesicular rashes on the skin, including the scalp and mucous membranes (rash stages - spot, vesicle, crust). The Varicella Zoster virus primarily affects children, most often aged 4-6 years, but can also cause disease in adults who did not have chickenpox in childhood.

People with weakened immune systems, including pregnant women, are at risk. The disease is characterized by spring-autumn seasonality. After an illness, lifelong immunity is usually formed, but in some rare cases, a second illness is possible.

In 10-20% of those who have recovered from the disease, the virus remains in the nerve ganglia for life and later, at an older age, causes another disease - herpes zoster. Shingles is characterized by painful and prolonged neurological pain along the course of the rash, and also has a number of complications in the form of damage to the nervous system (paralysis, blurred vision). When the Varicella Zoster virus enters the body, it affects not only the skin and nerve endings, but also other organs - the lungs, brain, digestive tract, genitourinary system, and affects the fetus in utero.

If a pregnant woman gets chickenpox in the 1st trimester, the child may be born with chickenpox syndrome: underdevelopment of the limbs, short stature, eye malformations, scars on the skin, lag in psychophysical development. If in the 2-3 trimester, the child suffers chickenpox in utero, and subsequently he may develop herpes zoster as a relapse of this disease.

General information about the disease

Chickenpox or chickenpox is an acute infectious disease that primarily affects children.
Children aged 5–9 years are most often affected. Only 10% of the total are teenagers over 14 years of age and adults1. For them, children with chickenpox become the source of infection. The causative agent of the disease is human herpes virus type 3 - Varicella Zoster. It is transmitted by airborne droplets (along with droplets of saliva from sneezing, coughing, etc.) or by direct contact with the affected skin of a patient.

According to statistics, from 500 to 800 thousand new cases of chickenpox are recorded annually: this is 570 cases per 100 thousand people. Peak incidence is autumn and winter1.

Important! The chickenpox virus is unstable in the external environment and can remain active for no more than 15 minutes. Despite this, it is capable of spreading over long distances with air currents, including into adjacent rooms through the ventilation system.

Signs and symptoms of chickenpox

A child is likely to have chickenpox if they:

• The temperature has risen
• He feels tired and irritable
• The skin started to itch
• A characteristic chickenpox rash appeared on the skin

The rash usually appears 10 to 21 days after first contact with someone who has chickenpox. The rash usually appears first on the chest, back, or face. It can then move to other areas of the body, including the mucous membrane of the mouth. At first, the rash looks like small pimples. They later become blisters full of liquid.

Most children with chickenpox are sick for about five to seven days.

Is chickenpox a mild infection?

In the vast majority of cases, the disease has a mild to moderate course in childhood and a severe course in adults. However, complications of chickenpox in adults are rare - no more than 7% of the total number of cases.

Most often, complications develop with concomitant diseases that reduce the body’s immune strength (for example, diabetes mellitus, HIV infection, cancer) and during pregnancy.

Among the most common complications:

• inflammatory lesions of the lungs and brain;
• inflammation of the heart, liver and kidneys;
• bacterial infections of the skin, soft tissue and bones2.

Chickenpox and herpes zoster

With rare exceptions, people only get chickenpox once. However, this type of virus is able to remain in the body. Most often it hides in the nerve ganglia along the spine2.

When the immune system is weakened due to hypothermia or immunodeficiency states, the virus is reactivated, resulting in the development of herpes zoster. It manifests itself with characteristic skin lesions and pain.

Chickenpox during pregnancy

Chickenpox is a serious danger for pregnant women, especially in the first trimester. Intrauterine transmission of the virus can cause developmental abnormalities (limb deformities, microcephaly, hydrocephalus, soft tissue calcification, growth retardation) and intrauterine fetal death3.

A pregnant woman can get chickenpox, which poses a great danger to the baby. Photo: patchananp.gmail.com / Depositphotos

When a pregnant woman falls ill 1–4 weeks before giving birth, in 50% of cases chickenpox is transmitted to the child. Despite a high titer of passive antibodies obtained from the mother, 23% of newborns develop a clinically significant infection. Infection can occur both through the placenta and through the mucous membranes of the birth canal3.

If the pathology occurs within 1 week before or after birth, newborns are at high risk of infection, because maternal antibodies do not have time to be transmitted to the child. The most dangerous is the appearance of a characteristic skin rash in the mother 5 days before birth or within 2 days after. In these cases, a severe neonatal form of chickenpox develops with high mortality in newborns (up to 30%3).

The disease poses a risk to the expectant mother. According to statistics, pneumonia occurs in 10–20% of pregnant women with chickenpox and is more severe in the long term3.

Treatment

Diarrhea due to chickenpox in children is subject to outpatient treatment at home only if the gastrointestinal tract is disrupted by taking antibacterial drugs. In this case, the intestinal microflora is disrupted, and the child may complain of abdominal pain. There is also increased gas formation and the appearance of mucus in his stool.

The appearance of such symptoms becomes a signal for the doctor to change the treatment regimen for the disease and prescribe medications that help normalize the intestinal microflora and restore the water-salt balance of the body.

Medications

A small patient is prescribed:

Medicines are prescribed three times a day along with antibacterial drugs and taken for 7-14 days.

Along with taking medications, the child must be switched to a lighter diet rich in fermented milk products (kefir, acidolact, bio-yogurt), which accelerate the restoration of intestinal microflora and normalize the child’s stool.

In addition to specific treatment, parents need:

• spot treat rashes on the child’s skin with antiseptics with a drying effect (“Brilliant Green”, “Fukartsin”);
• give the child antipyretics (Nurofen) if the body temperature rises above 38.5°C;
• use antiviral drugs (Acyclovir);
• continue therapy with broad-spectrum antibacterial drugs used to prevent the possible addition of a secondary infection.

Also, according to experts, when caring for a child during chickenpox, it is important for parents to prevent scratching the skin and tearing off scabs.

Folk remedies

In addition to medications, traditional medicine methods, used in addition to the main treatment and helping to alleviate the condition of the sick child, can also be used to cope with diarrhea due to chickenpox.

Traditional medicine has an antiseptic and restorative effect, gently soothes the intestines and helps restore the child’s stool, as well as cleanse his body of toxins released by the herpes virus.

Decoctions can be used for no more than 2-3 days. If diarrhea persists for a long time, you should call a specialist.

Incubation period and course of the disease

The incubation period is the time interval between the time a person becomes infected and the first symptoms of the disease appear. With chickenpox, it can range from 10 to 21 days.

Important! A person becomes infectious at the end of the incubation period. Most often this happens even before the first signs of the disease develop. The patient ceases to be contagious 4–5 days after the last rash appears.

After the incubation period there are 3 others:

• prodromal: no rash yet, general weakness, lasts 1–2 days;
• period of rash (with extensive clinical symptoms): characteristic rash, lasts 7–10 days;
• recovery (convalescence period): the rash disappears, the general condition returns to normal, takes 1–2 weeks.

During the prodromal period, body temperature may rise, and the person begins to feel sick. However, there are no specific symptoms of chickenpox.

The recovery period for people with weakened immune systems can be up to 4 weeks.

First aid for diarrhea with chickenpox in children and adults

What first aid should be given to an adult or small patient with chickenpox and diarrhea?

First, you should call a doctor at home. Without examination by a pediatrician, a small patient cannot:

• start taking new medications;
• take antibiotics if they have not been prescribed by a doctor;
• feed the patient in the absence of appetite, but ensure constant drinking - at least 1.5-2 liters of fluid per day.

You should only eat foods that will not cause gastrointestinal irritation.

Chickenpox symptoms

All clinical manifestations of chickenpox can be divided into two groups: general and specific. General ones include symptoms that are also observed in other pathologies, such as:

• increased body temperature, usually in the range of 37-39°C;
• headache, general weakness and malaise;
• loss of appetite;
• feeling of aching muscles;
• swollen lymph nodes, mainly in the neck and behind the ears;
• less often - diarrhea, abdominal pain, nausea and vomiting.

Specific manifestations of chickenpox (in both adults and children) are skin rashes (exanthema). They are characterized by stages of development.

Due to the fact that the rash appears on different parts of the body at different times (with an interval of 1-2 days), it seems that the rashes are different. In fact, they are the same, just at different stages. This phenomenon is called false polymorphism.

Possible rashes with chickenpox

Chickenpox affects not only the skin, but also the mucous membranes of the mouth and genitals. Such a rash (enanthema) is possible in severe cases of the disease. The rashes are similar to skin rashes, but are more pliable and break open more easily, leaving painful erosions. When the mouth is affected, severe pain occurs when eating, and enanthema of the genital organs is accompanied by pain when urinating4.

Stages of development of skin rash with chickenpox

• Red spots no larger than the diameter of a match head. Most often they occur on the face, neck, behind the ears, scalp and hands.
• Papules and vesicles. After a few hours of appearance, the spot turns into a small formation (papule) raised above the skin level. A cloudy liquid (vesicle) begins to accumulate there. There is a chaotic spread of rashes throughout the body, and severe itching occurs. The vesicles are soft to the touch and rupture easily when pressed.
• Pustules. A feature of chickenpox in adults is suppuration of the vesicles, resulting in pustules. There is a pronounced enlargement of the lymph nodes. The temperature rises to 39-40°C (observed in approximately half of patients4).
• Crusts. 2-3 days after the appearance, the elements of the rash open up on their own, leaving erosions. A yellowish or brown crust quickly forms on the surface. It gradually dries out and disappears in 10–20 days.

Important! The rash usually remains on the skin for 7–10 days. Rashes should never be scratched or squeezed. Mechanical damage to the resulting crusts is one of the reasons for the appearance of age spots and scars on the skin.

Figure 1. Chickenpox skin rash stages: from red spots to vesicles (blisters) that break open and become crusty. Photo: rob3000/Depositphotos

When does diarrhea occur?

Diarrhea is the result of concomitant diseases that occur in the weakened body of the baby. But there may be other reasons, the symptoms of which are diarrhea and vomiting.

Individual reaction to intoxication

The herpes virus, entering the child’s body, can immediately begin its life activity. It penetrates the cells, absorbs their contents and begins to divide. Then it moves into other cells and destroys them.

During the life of herpes, toxins are produced that enter the blood and can be transported through the bloodstream to all internal organs. Intoxication of the body occurs, the symptoms of which are:

• temperature increase;
• feeling of trembling and chills;
• joint weakness;
• general malaise.

In rare cases, pediatricians noted in children individual intolerance to intoxication of the body, expressed by attacks of nausea, vomiting and diarrhea.

If the feeling of discomfort (diarrhea and nausea) does not go away within a few days, you should call an ambulance. If these symptoms are ignored for a long time, brain damage may occur.

Diarrhea is a symptom of complications

Chickenpox diarrhea is a symptom of a bacterial or viral disease. After such signs occur, it is necessary to urgently call a doctor and determine what disease is associated with chickenpox and prescribe the correct treatment. Self-medication in this case is not only harmful, but also dangerous.

False diagnosis of chickenpox

The initial stage of chickenpox can be confused with the onset of another viral infection - enterovirus. This disease also begins with a sharp increase in temperature, general lethargy and malaise. The main differences between this disease and chickenpox:

• no rash with blisters;
• loss of appetite;
• nausea and vomiting;
• bloating;
• severe diarrhea.

If the respiratory tract is affected by this virus, the following may appear:

• rhinitis;
• cough and shortness of breath;
• sore throat, ears.

Treatment of a child with these symptoms is carried out according to a different principle.

Antibiotic therapy and dysbacteriosis

If chickenpox was complicated by diseases caused by pathogenic bacteria, in this case a course of antibiotics is prescribed (usually for at least 7 days). During treatment, these drugs can disrupt the functioning of the gastrointestinal tract (together with pathogenic bacteria, they also kill beneficial microorganisms) and cause dysbiosis. Therefore, the child may develop diarrhea.

To restore damaged gastrointestinal microflora, the pediatrician prescribes probiotics and prebiotics simultaneously with antibiotics.

Coincidence of chickenpox with other diseases

Chickenpox can accompany other infectious diseases. As a result, some symptoms may overlap with others. In this case, it is very dangerous to try to treat the child on your own. When new symptoms appear, it is necessary to call a doctor at home and tell them what new symptoms accompany the underlying disease. The pediatrician will order additional tests. Based on a general examination of the results of clinical studies, he will make the correct diagnosis and prescribe the correct treatment.

Typically, diarrhea with chickenpox occurs in 20% of all infected people. The most common causes of diarrhea are diseases that accompany chickenpox:

• the occurrence of general sepsis in the patient - pathogenic bacteria have affected most of the body;
• pneumonia due to the underlying disease;
• encephalitis is a complication of the brain. With this disease, those receptors that are responsible for the gag reflex are affected.

Combination of high fever with diarrhea

Diarrhea with chickenpox may be accompanied by a high fever. These two symptoms can cause your baby to become dehydrated. Therefore, the main thing that parents should provide is to regularly give the baby water to drink throughout the day (up to 2 liters per day).

It is not always possible to understand that an infant has become dehydrated. The main symptoms of this condition are:

• crying without tears;
• dry tongue and lack of saliva in the mouth;
• lack of urine (less than 2-3 times a day).

In severe cases, the child may experience seizures and indigestion.

The appearance of impurities in stool

You should especially carefully examine stool during diarrhea, and if there are impurities in it (blood, mucus, pus, green foul-smelling masses), you should immediately report this to your doctor. The appearance of these impurities indicates that an intestinal infection has been added to the herpes virus, which should be treated urgently.

The specific infection and further treatment will be prescribed only by a specialist after receiving the results of a stool analysis.

Diagnostics

In most cases, the diagnosis of chickenpox is made based on a conversation with the patient and specific symptoms. The doctor asks if there has been recent contact with an infected person and examines how the rash looks and develops.

If the clinical picture is unclear, the doctor will additionally prescribe laboratory tests confirming the presence of Varicella Zoster activity in the body. Usually carried out:

• Enzyme-linked immunosorbent assay (ELISA). Allows you to detect high levels of IgM and IgG antibodies to the causative virus and an increase in their titer by more than 4 times within 10 days.
• Polymerase chain reaction (PCR). Makes it possible to determine the presence of DNA of the Varicella Zoster virus in the patient's blood.

Differential diagnosis

Chickenpox should be distinguished from other pathologies with similar skin rashes.

Diseases with similar symptoms:

Mild forms of chickenpox are treated at home; in case of moderate and severe forms or the development of complications, hospitalization in an infectious diseases hospital is indicated.

Hospitalization is indicated for severe chickenpox or if complications occur. Photo: Wavebreakmedia / Depositphotos

In severe cases of the disease, drug therapy is carried out using the following drugs:

• Antiherpetic drugs - acyclovir, famciclovir, valacyclovir. Aimed at suppressing the herpes virus and accelerating recovery. Used in a course of 7 to 14 days.
• Non-steroidal anti-inflammatory drugs (NSAIDs) - paracetamol, ibuprofen. Allows you to reduce body temperature and eliminate headaches.
• Antihistamines - loratadine, desloratadine. Prescribed for severe skin itching.

Additionally, doctors can use antibiotics, immunomodulators, vitamin complexes, etc.

What to apply to the rash?

In mild forms of the disease, the only treatment may be local treatment of the rash elements and personal hygiene.

The most common alcohol dyes used for topical treatment are brilliant green or methylene blue. The doctor can also use antiseptics (chlorhexidine, fucorcin) and cosmetics containing zinc (calamine). The latter not only act as an antiseptic, but also eliminate itching.

Calamine is used for various skin diseases, including chickenpox. Photo: benedamiroslav / Depositphotos

Care and treatment at home

Children with chickenpox can usually be cared for and treated at home. Because chickenpox is a virus, it cannot be treated with antibiotics. Treatment is to control the itching of the rash and other symptoms associated with viral illnesses. There are many medications and creams that can relieve itchy skin.

It is important to ensure that your child drinks enough fluids and does not become dehydrated. Give your child liquids in various forms: clean water, jellies, sorbets, soups and other liquids.

Children with chickenpox may have a fever and feel tired and irritable. Important to know: Aspirin is contraindicated for a child with chickenpox. Children with very severe infections or serious illnesses may receive additional antiviral medications as prescribed by their doctor.

Prevention

Preventive measures are divided into nonspecific and specific.

Nonspecific prevention includes general measures to prevent the spread of infectious diseases, including:

• avoid contact with a sick adult or child;
• Regularly carry out wet cleaning and ventilation of the room in which the sick person is staying.

Specific prevention is represented by a vaccine with a weakened live virus. Depending on the specific drug, the chickenpox vaccine is given to adults in one or two doses.

Should I get vaccinated against chickenpox?

The chickenpox vaccine is not included in the National Preventive Vaccination Calendar, but doctors recommend getting vaccinated.
Especially if there was contact with a sick person (within 72 hours) or there are concomitant pathologies or conditions that increase the risk of complications. These include immunodeficiency, cancer, diabetes mellitus, bronchial asthma and chronic renal failure. Absolute contraindications to chickenpox vaccination include:

• allergy to chicken eggs, since a similar protein is used in the preparation of the vaccine;
• individual intolerance to antibiotics from the aminoglycoside group;
• severe immunodeficiency, in which even a weakened virus can trigger the development of chickenpox;
• pregnancy.

As an emergency prophylaxis, immunoglobulin is administered to those who have contraindications to vaccination.

The chickenpox vaccine contains a weakened live virus. Photo: pixs4u / Depositphotos

For people who have already had chickenpox but have a weakened immune system, and people aged 50 years and older, vaccination against herpes zoster is recommended5.

The US Centers for Disease Control and Prevention recommends using the recombinant Shingrix vaccine produced by the British pharmaceutical company (GlaxoSmithKline). Russia does not yet have its own vaccine against herpes zoster. Its production, according to media reports, will begin in 20276.

Vaccination in preparation for pregnancy and after it

A woman who plans to become pregnant and has not previously had chickenpox can be vaccinated at least 3 months in advance of her intended conception. However, breastfeeding is not a contraindication to vaccination. If necessary, the vaccine can be administered in the first months after birth.

Frequently asked questions

Frequent loose stools

Too frequent diarrhea is especially dangerous. This symptom usually indicates some kind of serious infection in the human body, which needs to be combated with special drugs.

Frequent diarrhea removes fluid from the body in large quantities, which is also very harmful for the patient. In this case, without waiting to visit the doctor, the patient should drink more fluid.

Until the exact cause of such diarrhea is determined, you should not give special medications, you need to wait for a doctor’s prescription.

Sources

1. Chicken pox: adults at risk. Excerpts from the state report “On the state of sanitary and epidemiological well-being of the population of the Russian Federation.” Publishing house “Russian Doctor”, November, 2022.
2. Chickenpox. Mayo Clinic.
3. Chebalina, E. A., et al. “Chicken pox in pregnant women: risk, prevention, diagnosis, management tactics (clinical lecture).” Medical and social problems of the world 19, no. 4 (2014): 74-82.
4. Yushchuk N.D. et al. “Chickenpox in adults” Attending physician #01/00 (2000).
5. Scott Frothingham. Chickenpox in Adults. Healthline. 2018
6. TASS News Agency, “Production of a domestic vaccine against herpes zoster will begin in 2027.”
7. Rusakov, V. A., A. V. Chebykina, and V. A. Maidan. “Methods of medical control of chickenpox incidence.” Bulletin of the Russian Military Medical Academy S1 (2018): 170-172.