Neonatal varicella zoster transmission from mother, management in a resource-limited setting: A case report

Neonatal varicella is a rare but potentially life-threatening condition resulting from vertical transmission of varicella-zoster virus from mother to newborn in the last 3 weeks of pregnancy or acquired after few days of delivery.

We present a case of a 15 days old male neonate who contracted varicella within the first two weeks of life, born to a mother with unvaccinated status and exposure to varicella zoster infection within family. Diagnosis was made clinically based on the characteristic rash all over the body and fever, despite the unavailability of gold standard diagnostic tests like polymerase chain reaction. In the absence of varicella-zoster immunoglobulin (VZIG), the neonate was successfully managed with intravenous acyclovir, antibiotics and supportive care. Prompt initiation of antiviral therapy and meticulous supportive care led to a favourable outcomes. This case demonstrates that: (1) Clinical diagnosis of neonatal varicella zoster can be made based on characteristic rash in the absence of gold standard diagnostic tests, facilitating timely management in resource-limited settings; (2) Intravenous acyclovir therapy, in combination with antibiotics and supportive care, is an effective treatment when VZIG is unavailable; and (3) Early recognition and prompt antiviral therapy is crucial in preventing complications and improving outcomes in affected newborns.

This case highlights the importance of clinical acumen in diagnosing neonatal varicella and the effectiveness of acyclovir therapy in resource-limited settings, where access to advanced diagnostic tests and specific immunoglobulins may be restricted.