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CASE 1
An Asian infant boy was taken to the local hospital at 11 days of age, by which time he had had a three day history of increasing feeding difficulties and lethargy. On the day of admission he developed diarrhoea and a rash. He had been delivered at term, one day after his mother had developed varicella. The baby had been given 250 mg intramuscular varicella zoster immunoglobulin (VZIG) at 4 hours of age and was breastfed.
Examination showed that the baby had respiratory failure, was shocked, and jaundiced. He had an extensive erythematous maculo-papular rash with one vesicle present. He required immediate intubation, ventilation, and circulatory support and was given intravenous aciclovir and broad spectrum antibiotics.
He required six days of ventilation, including three days of high frequency oscillatory ventilation (HFOV). Once extubated, he required facial oxygen for a further week.
Immunofluorescence on endotracheal aspirate was strongly positive for varicella zoster virus (VZV), and VZV DNA was demonstrated by polymerase chain reaction of endotracheal aspirate, cerebrospinal and vesicle fluids. There were no positive bacterial cultures. The baby received a total of 16 days of intravenous aciclovir and made a complete recovery. He remained well 20 months later.
CASE 2
An Asian boy was delivered normally at term, two days after his mother developed varicella. He was given 250 mg intramuscular VZIG...