Clinical progress note: Varicella Zoster

Varicella Zoster virus (VZV) is the etiologic agent responsible for varicella and herpes zoster (shingles). Nonimmune children and adults acutely infected with VZV typically experience a vesicular and pruritic rash that progresses from the face and trunk and generalizes to the extremities, accompanied by an oral enanthem along with symptoms of fever and malaise. Later, the virus may reactivate from dormancy in the dorsal root ganglia, leading to a stereotypical, unilateral, painful, vesicular rash limited to one or two dermatomes. While either pattern of infection is usually self-limited in healthy children, more severe complications including death may occur among immunocompromised, pregnant, or adult patients. VZV vaccines have greatly reduced morbidity and mortality since their introduction more than 30 years ago. Hospitalists should be prepared to recognize and treat patients with VZV infection, particularly in an era of increasing vaccine hesitancy.