By Tedler D. Depaynos, MD
The patient is a young elementary school teacher in an isolated mountainous barangay in an adjacent town. She has been having on and off low grade fever with slight nasal congestion for a week which she interpreted as “slight colds” due to the cold mountainous wind. She just took “paracetamol” which was available in one of the stores near their school which gave her slight relief. Four or five days later, part of her skin, more on her trunk, became “reddish, slightly swollen” and “itchy”. She then developed nodules with “watery contents” which later became “pus-like”. It mainly affected her face and trunk and less on her extremities. She then diagnosed herself to have “toco” or chicken pox.
On consultation, her body is filled with macules, maculopapular and vesicular lesions, some with crusting and scab formation. They were the classical lesions of “chicken pox” in different stages.
She could recall that ten of her students manifested “toco” and some were even absent for the past two to three weeks. Because she thought that she either had this during her childhood or had vaccination when she was a child, she never expected acquiring this viral infection. Knowing that it is a viral infection and supposed to be self-limiting, she just convinced herself to seek consultation only when she started manifesting those “massive” skin lesions.
She has to take a public utility vehicle in going to the hospital in the city and not to spread the disease she has to cover herself completely with only her eyes peeping out. Because in their small barangay they are supposed to know each other she was happy that she remained incognito. Those who recognized her jokingly mentioned that perhaps she is already a converted Muslim not knowing that she was trying hard to cover her lesions.
Actually, what was bothering her was the spread of the disease. Although from her co-teachers, the number of the students affected were just ten and had not increased, she was openly wondering if they were like her who probably had no history of vaccination. Suppose it would suddenly affect more students and other teachers like her? Recalling what she had been reading about the Covid-19 and the ASF which still affects only the pigs yet made her multiply her uneasiness. Their school is a small one and there are only six teachers including the principal who also teaches.
She was thinking that parents should be interviewed carefully and required vaccination not only for this disease but for other pediatric diseases should be implemented. This is not only for the health of the school but the whole community. She was hoping that their principal informed the Municipal Health Center but she was not aware what they could do. Can a medical mission with this objective be done? The old consulted MD fully agreed because it was his first time to encounter a “chicken pox” infecting a teacher which came from her students!
Although she was an adult patient, she was referred to a pediatrician who was experienced with this disease. She was prescribed histaminic tabs and lotion to control the itchiness. Acetaminophen was emphasized to control the fever and aspirin is taboo because it may cause neurological problems. The classical anti-viral Acyclovir was likewise prescribed.
Although it was a viral disease, anti-bacterial drug was also prescribed because of the possibility of superimposed infection. The patient comes from a distant barangay and close monitoring and traveling for follow-up may not be convenient. She was warned then of the possible bacterial skin complications like impetigo, cellulitis and even skin abscesses. If her cough worsens with more phlegm and becomes yellowish or even greenish, pneumonia maybe a complication.
The pediatrician then lectured that in some of their pediatric patients with recent exposure to “chicken pox” passive immunization with Varicella-Zoster Immune Globulin may be given. Active immunization with Varicella Vaccine is usually given to one to 12 years old patients. Pregnant individuals should be extra careful in getting exposed to this viral infection because the fetus may manifest “congenital defects” when infected.
The consulted MD was confident however that he will not acquire the disease because for sure he is already immune to it because of his age. **
