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Heininger U et al Varicella Lancet 2006 Oct 14;368(9544): 1365 76 [PMID: 17046469] Jumaan AO et al Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992 2002 J Infect Dis 2005 Jun 15;191(12):2002 7 [PMID: 15897984] Klassen TP et al Acyclovir for treating varicella in otherwise healthy children and adolescents Cochrane Database Syst Rev 2004;(2):CD002980 [PMID: 15106185] Nguyen HQ et al Decline in mortality due to varicella after implementation of varicella vaccination in the United States N Engl J Med 2005 Feb 3;352(5):450 8 [PMID: 15689583] Opstelten W et al Managing ophthalmic herpes zoster in primary care BMJ 2005 Jul 16;331(7509):147 51 [PMID: 16020856] Oxman MN et al; Shingles Prevention Study Group A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults N Engl J Med 2005 Jun 2;352(22):2271 84 [PMID: 15930418]

A live attenuated VZV vaccine is available and helps prevent herpes zoster in persons 60 years and older The vaccine reduces the incidence of postherpetic neuralgia and herpes zoster by 67% and 51%, respectively

If, like many UNIX users, you have the command-line version of gnuplot installed, but not the Mac OS X version described in this section, you may get the cryptic error message Application.applescript:140: No user interaction allowed. (-1713) when you build the project.

Patients with varicella should be isolated until primary crusts have disappeared and kept at bed rest until afebrile Hospitalized patients with herpes zoster should be isolated, and caregivers should wear gowns, gloves, and masks when in contact with them The skin is kept clean Pruritus can be relieved with antihistamines, calamine lotion, and colloidal oatmeal baths As an antipyretic, acetaminophen is used Gabapentin is useful for postherpetic neuralgia

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For the infrequent varicella infection for which antiviral therapy is indicated, the mainstay of therapy is acyclovir; its analogs (the prodrug valacyclovir and the related drug famciclovir) are approved only for immunocompetent individuals (Table 32 1) These agents reduce the severity and shorten the duration of chickenpox and herpes zoster in adults and in children, but do not prevent the development of postherpetic neuralgia In immunocompromised patients, in pregnant women during the third trimester, and in patients with extracutaneous disease (encephalitis, pneumonitis), antiviral therapy with high-dose acyclovir (30 mg/kg/d in three divided doses intravenously for at least 7 days) should be started once the

Malaise, fever, and sore throat, sometimes with exudates Palatal petechiae, lymphadenopathy, splenomegaly, and, occasionally, a maculopapular rash

Heterophil (sheep cell agglutination) antibody tests and the correlated mononucleosis spot (Monospot) test usually become positive within 4 weeks after onset of illness and are specific but often not sensitive in early illness Titer rises in antibodies directed at several EBV antigens can be detected During acute illness, there is a rise and fall in immunoglobulin M (IgM) antibody to EB virus capsid antigen (VCA) and a rise in IgG antibody to VCA, which persists for life Antibodies to EBV nuclear antigen (EBNA) appear at 3 4 weeks after onset and also persist The most sensitive, specific, and expensive assays are generally either the EBV VCA or EBNA A false-positive rapid plasma reagin (RPR) occurs in 10% PCR for EBV DNA appears to be more sensitive than EBNA in children and is useful in immunocompromised patients in the differential diagnosis of CNS processes and perhaps in monitoring disease Hepatic aminotransferases and bilirubin are commonly elevated In aseptic meningitis, the cerebrospinal fluid may show increased opening pressure, lymphocytosis with abnormal morphology, and increased protein concentration

The point of this exercise is that when the A signal is received, the action in the if statement is taken and then the program breaks out of the loop, without raising the alarm. When the signal is 0, it is also undesirable to raise the alarm, so the program continues from the top of the loop.

Positive heterophil agglutination test (Monospot) Atypical large lymphocytes in blood smear; lymphocytosis Possible complications: hepatitis, myocarditis, neuropathy, encephalitis, airway obstruction secondary to lymph node enlargement, anti-i hemolytic anemia, thrombocytopenia

Infectious mononucleosis is usually due to the EBV (HHV-4, found as two variants, EBV-1 and EBV-2, with multiple strains present in disease) It is universal in distribution and may be seen at any age but usually occurs in the United States in persons between the ages of 10 and 35 years, sporadically or in epidemic distribution In the developing world, acute infections occur at much younger ages and tend to be less symptomatic Rare cases occur in the elderly, usually without the full complex of symptoms Its mode of transmission is largely by saliva, and occasionally by genital secretions Saliva may remain infectious during convalescence for 6 months or longer from symptom onset The incubation period probably lasts several weeks

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