Varicella-zoster virus is an exclusively human α-herpesvirus, known as the aetiological factor of chickenpox which is usually linked with childhood. The disease occurs with a worldwide geographic distribution, and in temperate climates shows a seasonal pattern with epidemics occurring mostly during late winter and spring. The annual incidence is estimated at 80–90 million cases worldwide. Children usually acquire varicella during the first five to 10 years of life, and the highest risk of infection is related to household contacts without a history of vaccination. Although the disease is commonly considered benign, varicella-zoster virus bears the potential of causing a wide range of complications, including the most serious ones of central nervous system manifestations. The neuropathogenesis of varicella-zoster virus infections is not well understood. Based on a wide spectrum of clinical syndromes, multiple theories explaining the pathways of spread of the virus, and host immune response to the viral presence have been proposed, including direct retrograde trafficking of the virus and haematogenous spread as well as inflammatory response with vasculitis. Neurological complications related to varicella-zoster virus infection are the second most common indication for hospitalisation in immunocompetent children with varicella, following skin superinfections. In this paper, the neurological aspects of chickenpox in children are discussed. The characteristics of the clinical syndromes, pathogenesis, methods of diagnosis and treatment, as well as long-term consequences are presented.
The aim of the study was to draw attention to the danger of vitamin D overdose. The beneficial effects of vitamin D are described in both scientific literature and popular science journals. On the other hand, papers on the symptoms of excess intake of vitamin D are scarce. Since vitamin D preparations are easily accessible, they are widely used in both adults and children without any medical supervision. We present a case of a 2-year-old boy with life-threatening hypercalcaemia due to excess vitamin D intake. The boy required prolonged hospital stay, intensive therapy to reduce blood calcium, complex pharmacotherapy and hemofiltration. Abdominal ultrasonography performed after therapy completion showed enlargement of both kidneys and persistent hyperechogenicity of renal cortex. Expert recommendations specify the route of administration and the dose of vitamin D. In the era of the Internet, however, opinions suggesting doses that are inconsistent with recommendations may be found. Such management may have serious health consequences and even be life-threatening in some cases.
Aim of the study: Varicella is a disease with potentially severe complications. The objective of this study was to assess the specific clinical picture of neurological complications of VZV in the form of encephalitis, meningitis, and acute cerebellar ataxia among hospitalised children. Material and methods:The study was designed as a retrospective analysis, based on reviewing the medical records and collecting post-hospitalisation questionnaires of children admitted to the hospital for varicella complications between January 2009 and December 2018. None of the patients was vaccinated. Patients were divided into groups based on the type of neurological diagnosis. We analysed the results of the additional tests performed, their significance for the final diagnosis, and predictive validity. Statistical analysis of data was performed, and the results were compared with available data. Results: A link between age and type of neurological complication was found. Diversity in the length of hospitalisation as well as in the number of additional tests necessary for a final diagnosis was established. None of the analysed clinical parameters and additional tests was found to be a potential predictor linked with the possibility of sequels in our study. Children with encephalitis had a significantly higher risk of neurological sequelae at the moment of discharge. Conclusions: Acute cerebellar ataxia was the most frequent neurological complication, while encephalitis was associated with increased risk of neurological sequel. Direct presence of VZV-DNA was observed in patients with meningitis, while acute cerebellar ataxia and encephalitis were a result of an immune response. The presented results serve as a reminder of the potential severity of chickenpox in unvaccinated, otherwise immunocompetent children.
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