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In immunocompromised individuals, varicella-zoster virus (VZV) infections can be more severe in primary infections (varicella) and reactivated infections [herpes zoster (HZ)]. In individuals with varicella, cutaneous and visceral involvement can be more severe. In those with HZ, the infection may involve several contiguous dermatomes, have more extensive cutaneous necrosis, wide hematogenous dissemination to mucocutaneous structures as well as to the viscera, and often be associated with high morbidity and mortality rates.


Immunocompromised patients may develop severe skin eruption with or without hemorrhage. Healing of the cutaneous lesions takes three times longer than in the general population. Patients develop high fever.  Virus spreads to visceral organs causing hepatitis, pneumonitis, pancreatitis, small bowel obstruction and encephalitis. Bacterial superinfections including bacteremia can develop.


* The lesions appear on the trunk and face and rapidly spread centripetally to other areas of the body.

* Skin infections including cellulitis can be caused by many bacteria, including Group A streptococcus, which can be severe.

* The presenting manifestations are rash, low grade fever and malaise. A prodrome may appear 1 to 2 days before in some patients. In healthy children, illness is generally benign, lasting 3 to 5 days.  After the onset of the rash, malaise, pruritus, anorexia, or listlessness can develop.  

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