0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23
1516 Varicella-Zoster Varicocele■Some recommend oral acyclovir for secondary household cases -
disease is more severe. Complications
■Pneumonia: viral/bacterial
■Secondary bacterial infections (esp. invasive group A strep)
■Bacterial superinfection of skin lesions
■Hemorrhagic complications
■Encephalitis
■Immunosuppressed individuals (esp. children with leukemia) High
risk disseminated disease
■Maternal infection 1st trimester – congenital varicella syndrome
■Reyes syndrome (especially with use aspirin)
specific therapy
n/a
follow-up
Varicella vaccine – live attenuated virus. Recommended by ACIP for all
children at 12 months. Efficacy 85–95%. Not currently recommended
in immunosuppressed pts.
complications and prognosis
Bacterial skin infection, encephalitis and Reye syndrome, pneumonia
(rare in children, but common cause of varicella morbidity in adults).
Varicella is leading cause of vaccine-preventable pediatric death in US.
Adults have higher rate of complications overall than children.VARICOCELE
ARTHUR I. SAGALOWSKY, MD
history & physical
■an anatomic dilation of the pampiniform plexus due to valvular
incompetence
■prevalence – 10% of post-pubertal males
■left side most often affected
■may be associated with infertility
■sudden onset may be due to venous occlusion by retroperitoneal
tumor (renal, lymphoma, other)
■characteristic “bag of worms” in scrotum when patient is upright
tests
Tests for Unclear Cases
■ultrasound
■Valsalva maneuver