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Pt of 23 year old male with History of fever for 3 days which is at in morning and evening rise of temperature and after 3days there is appearance of transparent vesicle behind pinna and than abdomen what could be the diagnosis

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varicella AND diagnosis

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CDC chickenpox symptoms fever vesicular rash trunk adults

The most likely diagnosis is primary varicella (chickenpox) due to varicella-zoster virus if the lesions are spreading as itchy, clear fluid-filled vesicles, especially over the trunk/abdomen, with new lesions appearing in crops.
Typical varicella causes fever and malaise followed by a generalized rash that progresses to clear vesicles and then crusts. Lesions are usually most numerous on the trunk and can be at different stages at once, as described by the CDC clinical features.
However, this needs an in-person assessment because:
  • Herpes zoster (shingles) can cause grouped painful vesicles, but it normally stays one-sided in a dermatome. Vesicles near the ear plus severe ear pain, hearing change, dizziness, or facial weakness raises concern for herpes zoster oticus/Ramsay Hunt syndrome and needs urgent evaluation.
  • In a 23-year-old, chickenpox can be more severe than in young children, especially due to risk of pneumonia.
  • If the rash is atypical, a clinician can confirm VZV using a PCR swab from a fresh vesicle.
Until assessed: avoid close contact with pregnant people, newborns, immunocompromised people, and anyone not immune to chickenpox. The patient is contagious until all lesions have crusted. Seek urgent care now if there is breathlessness, chest pain/cough, severe headache, confusion, persistent vomiting, high fever, eye involvement, or facial weakness.

Routes of spread

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varicella transmission

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CDC varicella routes of transmission aerosol direct contact vesicular fluid

Varicella (chickenpox) spreads by:
  1. Airborne respiratory route
    Inhaling droplets/aerosols from an infected person’s respiratory secretions, especially with close indoor contact.
  2. Direct contact with vesicular fluid
    Touching the clear fluid in fresh chickenpox vesicles or shingles lesions.
  3. Rare indirect spread
    Freshly contaminated items may theoretically transmit infection, but this is much less important because VZV survives poorly outside the body.
The virus enters through the upper respiratory tract or conjunctiva. A non-immune person exposed to someone with chickenpox develops chickenpox, not shingles. CDC varicella guidance
Infectious period: from about 1-2 days before the rash until every lesion has crusted.
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