{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:06:17Z","timestamp":1772168777039,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.124959.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000}},{"DOI":"10.12688\/f1000research.124959.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000}},{"DOI":"10.12688\/f1000research.124959.3","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000}}],"reference-count":31,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Chickenpox is an extremely contagious disease caused by a primary varicella-zoster virus (VZV) infection. This case report describes a rare transmission of chickenpox potentially linked to an indirect route via surface contamination rather than direct person-to-person contact. A 27-year-old adult Black African male health care worker presented with severe headache, intermittent weakness and inability to walk, intermittent nausea, fever, shortness of breath, itching, pruritus, lesions with pus on the skin, sleep disturbances, and nightmares for two days. In this case report, the patient\u2019s face, neck, and scapulae were the most infected areas of the body, and the rest of the body, except the legs, hands, genital areas, and buttocks, was also highly infected. Chickenpox was confirmed by positive polymerase chain reaction (PCR), positive IgM, viral culture, and low IgG. Acyclovir 800 mg orally, five times a day, was given for ten days to treat chickenpox infection because acyclovir inhibits varicella zoster virus replication. It is typically unable to eradicate VZV from the latent state in neurons. The patient showed marked improvement within a week and fully recovered without complications or post-herpetic sequelae. This case emphasizes the importance of strict infection control and hygiene protocols in preventing rare indirect transmission of the VZV, particularly in healthcare settings.<\/ns3:p>","DOI":"10.12688\/f1000research.124959.4","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T15:15:07Z","timestamp":1760541307000},"page":"1004","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A Case Report: Chickenpox Acquired Through Surface Contamination: A Rare Clincal Observation"],"prefix":"10.12688","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5982-9601","authenticated-orcid":false,"given":"Gudisa","family":"Bereda","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"21-23","DOI":"10.5455\/medarh.2012.66.s21-s23","article-title":"Therapeutic Approach to Chickenpox in Children and Adults-our Experience.","volume":"66","author":"R Baljic","year":"2012","journal-title":"Med. 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Dermatol."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/11-1004\/v4\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/11-1004\/v4\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/11-1004\/v4\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T18:40:12Z","timestamp":1763664012000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/11-1004\/v4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,15]]},"references-count":31,"URL":"https:\/\/doi.org\/10.12688\/f1000research.124959.4","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.124959.3","asserted-by":"subject"},{"id-type":"doi","id":"10.12688\/f1000research.124959.2","asserted-by":"subject"},{"id-type":"doi","id":"10.12688\/f1000research.124959.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.187832.r424455","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.187832.r426587","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.187832.r426587","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.187832.r424455","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,15]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/11-1004\/v4#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.137210.r158332, Anna Majewska, Department of Medical Microbiology, Medical University of Warsaw, Warszawa, 05 Jan 2023, version 1, 2 not approved","URL":"https:\/\/f1000research.com\/articles\/11-1004\/v1#referee-response-158332","order":0,"name":"referee-response-158332","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Gudisa Tola<\/b>; \n<i>Posted: 17 Nov 2024<\/i>; Reviewer 1 The need for a chickenpox modification method has become clearer since reports of a number of serious and sometimes fatal complications have been made public. These include primary varicella pneumonia in adults, visceral dissemination, neonatal chickenpox death, and others [1]. While chicken pox spots develop over a few days, mpox spots emerge all at once. In general, mpox lesions are deeper and larger than chickenpox lesions. While chickenpox blisters are simply itchy, mpox blisters can cause agony. Spots of mpox will simultaneously blister and crust over. With crusty sores, blisters, and chickenpox patches all at once. There are two distinct viruses that produce chickenpox and mpox. Chickenpox in this case report was confirmed by laboratory diagnosis [2, 3].  What this study adds This study provides comprehensive knowledge and insights about less common transmission of the varicella zoster virus (VZV), which causes chickenpox, via contaminated surfaces. In this case report, VZV was spread by coming into contact with surfaces contaminated with the virus via blister fluid from an infected person. Surface-contaminated route of transmission, when compared with direct contact with lesions and airborne distribution, was thought to be a less significant mechanism of transmission. This instance is occurring in a surprising age bracket, particularly in healthy adults who are not immunocompromised and have never had chickenpox.  How this study might be useful for other practitioners A more thorough examination of patient risk variables will help clinicians identify patients, particularly young adults, who may be more susceptible to problems. How they provided supportive care, such as controlling pruritus, managing fever, and taking care of the skin to avoid secondary infections. It included comprehensive instructions on how to avoid and treat complications like encephalitis, pneumonia, and bacterial infections, which could help medical professionals provide preventative care.  Physical examinations Throughout the assessment, his blood pressure was 121\/81 mmhg, his axillary temperature was 38.4 degrees Celsius, his peripheral pulse rate was 78 beats per minute, and his respiration rate was 19 cycles per minute. His blood tests revealed that his hemoglobin was 15.1 mg\/dl, his white blood cell count was 10540 cells\/mm3, his red blood cell count was 4.7 million\/mm, and his neutrophil count was 59%. Blood urea nitrogen was 44 mg\/dl, creatinine was 98 \u03bcmol\/L, alkaline phosphatase was 215 U\/L, gamma glutamyl transferase was 19 U\/L, and alanine transferase was 9 IU\/L. His liver and kidney function tests showed no appreciable acute alterations. The x-ray of his chest showed no signs of community-acquired pneumonia. Examinations of his heart, lungs, and abdomen revealed no noteworthy results. Results from polymerase chain reaction tests for VZV or skin lesions (a vesicle or scab material) were positive. He tested positive for VZV with both his skin swab and serology (IgG) antibodies. Serology (IgM) antibodies were positive, indicating a high level of recent VZV infection.  Differential diagnosis In this case report, the differential diagnosis of chickenpox includes smallpox, drug eruptions, hand, foot, and mouth disease, herpes simplex virus, and disseminated herpes zoster. Grouped vesicles, particularly on the lips or vaginal area, are caused by the herpes simplex virus. As opposed to being ubiquitous like chickenpox, it typically affects specific locations. Although drug eruptions frequently feature mucosal lesions and systemic symptoms different from chickenpox, they can also result in a widespread vesicular or bullous rash. There was no sign of angioedema, skin necrosis, or erosions of the mucosal membranes in the patient. Before the rash appeared, the patient had not started taking any medicines. Disseminated herpes zoster, also known as shingles, is a reactivation of the varicella zoster virus that does not initial infection in chickenpox and occurs in older or immunocompromised patients. Hand, foot, and mouth disease (HFMD), as opposed to a broad body rash, is characterized by vesicular lesions on the hands, feet, and mouth. Unlike chickenpox, impetigo does not cause systemic symptoms, although it may cause pustules or vesicles. Chickenpox lesions manifest in many phases of development, whereas smallpox lesions are more consistent in their stages.  Follow-up Healthcare providers monitor signs to make sure that he recovered without any issues related to complications. He recommended taking the medication as directed by a doctor and refraining from scratching lesions in order to prevent bacterial infections. The blisters and rash he had experienced completely healed and had no lasting complications. Usually, ten days pass before his rash goes away. He did not acquire dormant shingles, which is latent in neurons. He recovered without any issues like skin infections, encephalitis, pneumonia, or neurological problems. After a 10-day follow-up, he was sent home.  References Ross AH: Modification of chicken pox in family contacts by administration of gamma globulin.N Engl J Med. 1962; 267: 369-76&nbsp; Rasizadeh&nbsp;R,&nbsp;Shamekh&nbsp;A, Shiri&nbsp;Aghbash&nbsp;P, et al.: Comparison of human monkeypox, chickenpox, and smallpox: A comprehensive review of pathology and dermatological manifestations. Current Medical Research and Opinion. 2023;39(5):751-60. Class MM, McCoy K, Hafeez F, et al. Case Letter. Cutis. 2024 Oct;114(4): E29-31.","URL":"https:\/\/f1000research.com\/articles\/11-1004\/v4#referee-comment-12837","order":1,"name":"referee-comment-12837","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.177401.r367292, Charles Grose, The University of Iowa, Iowa City, Iowa, 06 Mar 2025, version 2, 1 approved, 2 not approved","URL":"https:\/\/f1000research.com\/articles\/11-1004\/v2#referee-response-367292","order":2,"name":"referee-response-367292","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.187832.r424455, Kathrin Sutter, University of Duisburg-Essen, Essen, 06 Nov 2025, version 4, indexed","URL":"https:\/\/f1000research.com\/articles\/11-1004\/v4#referee-response-424455","order":3,"name":"referee-response-424455","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.182839.r401722, Theresa Paul, Medicine, Hamad Medical Corporation, Doha, 26 Aug 2025, version 3, 1 approved, 3 not approved","URL":"https:\/\/f1000research.com\/articles\/11-1004\/v3#referee-response-401722","order":4,"name":"referee-response-401722","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Gudisa Tola<\/b>; \n<i>Posted: 06 Sep 2025<\/i>; Reviewer Comment 1: The incubation period for chickenpox is usually between 10 to 21 days, most often around two weeks. So, it\u2019s very unlikely that the patient developed symptoms within 24 hours of using the public shower\u2014it doesn\u2019t fit the expected timeline for infection.  Author Response: The author acknowledges that the typical incubation period for varicella-zoster virus ranges from 10 to 21 days. However, in this case, the early onset of symptoms may reflect either prior unnoticed exposure or an unusually rapid viral replication. While uncommon, accelerated presentations have been reported in certain adult cases, which we have highlighted in the discussion. Lesions swiftly develop within approximately 12 hours into 1 to 3 mm clear vesicles encircled by narrow red halos (\u201cdew drops on a rose petal\u201d) [1]. Saleh HM, Ayoade F, Kumar S. Varicella-Zoster Virus (Chickenpox) [Updated 2025 Apr 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK448191\/  Reviewer Comment 2: Even though there was no known direct contact at work, chickenpox spreads through the air, and people can be contagious even before they show any signs of illness. That makes it hard to completely rule out workplace exposure, especially from someone in the early stages of infection.  Author Response: The author agrees that airborne transmission in the workplace cannot be completely excluded. The patient may have been exposed to an asymptomatic or pre-symptomatic individual, and we have added this consideration to the discussion to acknowledge the limitations in tracing the exact source of infection.  Reviewer Comment 3: As for transmission through surfaces like in a shower facility\u2014chickenpox doesn\u2019t survive well outside the body. While it\u2019s not impossible, fomite transmission is extremely rare and not considered a significant route. That\u2019s why linking this case to a shower exposure is questionable and less likely than airborne spread in a shared space.  Author Response: The author concurs that fomite transmission of varicella-zoster virus is extremely rare and typically not a primary route. Nevertheless, given the temporal association with shower use, we have presented surface exposure as a possible, albeit unlikely, indirect transmission route, while emphasizing that airborne spread remains the more probable mode of infection.","URL":"https:\/\/f1000research.com\/articles\/11-1004\/v4#referee-comment-14512","order":5,"name":"referee-comment-14512","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.187832.r426587, James Andrawus, Federal University Dutse, Dutse, Jigawa, 06 Nov 2025, version 4, indexed","URL":"https:\/\/f1000research.com\/articles\/11-1004\/v4#referee-response-426587","order":6,"name":"referee-response-426587","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":7,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}