GAS necrotizing fasciitis
Varicella can serious complications including necrotizing fasciitis.
Necrotizing fasciitis can be polymicrobial including both aerobic and anaerobic bacteria. As such empiric antibiotics are often vancomycin for gram positive coverage with piperacillin/tazobactam or a carbapenem for broad gram negative and anaerobic coverage. Surgical management is critical and time sensitive.
If monomicrobial infection with group A streptococcus is confirmed the antimicrobial therapy of choice is penicillin with clindamycin.
Primary varicella has many potential complications including superinfection of skin wounds, bacteremia, pneumonia, stroke, and encephalitis.
Some patients including pregnant women, immunocompromised children, premature infants and newborns whose mothers had chickenpox within five days prior to delivery or 48 hours after delivery may be candidates for prophylaxis with immunoglobulin.
References:
Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52. PMID: 24973422
American Academy of Pediatrics. Varicella-Zoster Virus Infections. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2018; 869-883