Chickenpox: How It Starts and What Its First Symptoms Are

In 1772, the German scientist R. Vogel was the first to call "varicella" a disease that had previously been considered a form of smallpox — Italian physicians had described it that way as early as the mid-16th century. The causative agent was found in the contents of the vesicles only in 1911, and the virus was isolated in 1958. Today chickenpox is recognized by its rash, although it begins long before the first spots appear.

What chickenpox is and who gets it

Chickenpox, or varicella (Latin: varicella), is an acute, highly contagious viral disease transmitted by airborne droplets. The causative agent is the varicella-zoster virus, also known as human herpesvirus type 3 and the causative agent of shingles. People of all ages can get it, but mostly children: about half of children contract the infection at ages 5–9, and approximately 10% of cases are over 14 years old. Susceptibility to chickenpox is 70%, and contagiousness reaches 100% — everyone who has not previously encountered the virus becomes ill. A patient becomes contagious 48 hours before the rash appears and remains so until all lesions have crusted over.

How chickenpox begins: first symptoms

The incubation period lasts from 10 to 21 days, most often 14–16 days. A prodromal period occurs 1–2 days before the rash appears, although in children it may be absent altogether — in that case the disease manifests immediately with a rash, while in adults prodromal symptoms usually consist of fever and malaise. Before or simultaneously with the rash, high fever, aches and pains, general malaise, and loss of appetite appear. The main sign is an itchy macular rash, which can appear anywhere on the body.

What the rash looks like and how it changes by stage

The rash goes through three stages, but new spots may continue to appear while others are already turning into vesicles or crusting over. First there are small spots — all over the body, including the oral mucosa and the genital area, where they can be painful; the color depends on skin tone, and on dark skin such lesions are harder to notice. Then the spots fill with fluid and become vesicles: very itchy and easily ruptured. Finally, the lesions dry out and form crusts.

Signs of chickenpox in children and adults: how the course differs

In most children, chickenpox is mild: fever coincides with the mass appearance of the rash and may be wave-like, and recovery occurs on its own within 1–2 weeks. In people over 18, a more severe course and complications are more common; infants, adolescents, pregnant women, and immunocompromised people also have more severe illness. In adults, chickenpox leads to death 25–175 times more often than in children.

Possible complications of chickenpox

• bacterial superinfection of the skin;
• pneumonia and bronchitis;
• neurological disorders — neuralgia, aseptic meningitis, encephalitis, Ramsay Hunt syndrome;
• eye lesions — keratitis, uveitis, keratoconjunctivitis, up to blindness;
• middle ear inflammation, vasculitis, hepatitis, nephropathy.

Neurological complications occur in 1–7.5% of cases, and 70.5% of these are encephalitis, 10.6% are meningitis. Mortality in varicella encephalitis is 1–20%. Neonatal chickenpox, when the mother falls ill 5 days before delivery or within two days after it, ends in the death of the newborn in 30% of cases. The virus does not disappear from the body: in 10–20% of those who have had the disease, it persists in nerve tissue and can later cause shingles.

When to see a doctor

In mild cases, chickenpox resolves on its own. The doctor examines the rash and assesses the general condition, and if the picture is unclear, orders tests — antibody serology, tests for chickenpox and shingles. Consultation is needed if an adult, an infant, or an immunocompromised person is ill: these groups have a more severe course of the infection. If a pregnant woman or a woman in labor has chickenpox, she should see a doctor.

Chickenpox itself is not a reason to call an ambulance; 103/112 — if a severe complication (pneumonia, meningitis, or encephalitis) is suspected against its background and the condition is rapidly deteriorating.

This text is for reference: it explains how to recognize the onset of the disease, but does not replace consultation with a doctor, who, having seen the rash with his own eyes, will speak more precisely.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer