Aggiornamento monografico
La varicella
VARICELLA
PATRICIA PETAROS, FEDERICO MARCHETTI
Clinica Pediatrica, IRCCS “Burlo Garofolo”, Università di Trieste
Febbraio 2005 - pagg. 89 -98
Abstract
This is a review of varicella, its complications and management. Varicella is very contagious
and more then 90% of cases occur in individuals younger than 15 years of age. The average
incubation period is 14 days, transmission occurs via contact with aerosolised droplets
from nasopharyngeal secretions of an infected individual. The period of infectivity is generally
considered to last from 48 hours prior to the onset of rash until skin lesions have fully crusted.
Secondary bacterial infection of varicella lesions are the most common complications. Necrotizing
fasciitis and the toxic shock syndrome, due to Staphylococcus aureus or Streptococcus
pyogenes are the most severe complications. Viral dissemination and varicella pneumonia
are more common in adults, with a reported incidence of about 1/400 cases. Risk factors
linked to the development of varicella pneumonia include cigarette smoking, pregnancy,
immunosuppression and male gender. Neurological complications associated with varicella
are cerebellar ataxia (an immunologically mediated demyelinating process) and encephalitis,
the pathogenesis of which is not completely understood. Post-exposure prophylaxis with
Varicella-Zoster Immune Globulins is still recommended in immunocompromised children, susceptible
pregnant women, newborn infant and premature infants. Before antiviral drugs
were available, 30% of children with malignancies developed disseminated varicella and infection
was fatal in 7-17% of cases.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Fornaio P, Gandini F, Marin M, Pedrazzi C,
Piccoli P, Tognetti D, Assale BM, Ludioni C,
Mazzi S. Epidemology and cost analysis of varicella
in Italy: results of a sentinel study in the
pediatric practice. Italian Sentinel Group on Pediatric
Infectious Diseases. Pediatr Infect Dis J
1999;18(5):414-9.
2. Salleras L, Domingues A, Vdal J, Palns P, Salleras M, Yaberner JL. Seroepidemiology of varicella- zoster virus infection in Catalonia (Spain). Rationale for universal vaccination programmes. Vaccine 2000;19(2-3):183-8.
3. Kilgore PE, Kruszon-Moran D, Steward JF, Jumaan A, Van Loon FP,, Forghani B, McQuillan GM, Wharton M, Fehrs LJ, Cossen CK, Hadler SC. Varicella in Americans from NHANES III: implication for control through routine immunization. J Med Virol 2003;70 Suppl 1:S111-8.
4. Gabutti G, Penna C, Rossi M, Salmaso S, Rota MC, Bella A, Crovari P. The seroepidemiology of varicella in Italy. Epidemiol Infect 2001;126:433-40.
5. Finger R, Hughes JP, Meade BJ, Pelletier AR, Palmer CT. Age-specific incidence of chickenpox. Public Health Rep 1994;109(6):750-5.
6. Meyer PA, Steward JF, Jumaan AO, Wharton M. Varicella Mortality: Trends before vaccine licensure in the United States, 1970-1994. J Infect Dis 2000;182 :383-90.
7. Feldman S, Lott L. Varicella in children with cancer: impact of antiviral therapy and prophylaxis. Pediatrics 1987;80:465-72.
8. Nelson Textbook of Pediatrics. 17th Edition. Saunders Company, 2004:1057-62.
9. Bogger-Goren S, Baba K, Hurley P, Yabuuchi H, Takahashi M, Ogra PL. Antibody response to varicella-zoster virus after natural or vaccine induced infection. J Infect Dis 1982; 146:260-4.
10. Zaia JA, Levin MJ, Preblud SR, Leszczynski J, Wright GG, Ellis RJ, Curtis AC, Valerio MA, LeGore J. Evaluation of varicella-zoster immune globulin: protection of immunosuppressed children after household exposure to varicella. J Infect Dis 1983;147 :737-43.
11. Brunell PA. Varicella in pregnancy, the fetus and the newborn: problems in management. J Infect Dis 1992;166(Suppl 1.):S42-S47.
12. Arvin AM, Koropchak CM, Williams BRG, Grumet FC, Foung SKH The early immune response in healty and immunocompromised subjects with primary varicella-zoster virus infection. J Infect Dis 1986;154:422-9.
13. Pitel PA, McKormick KL, Fitzgerald E, et al. Subclinical hepatic changes in varicella infection. Pediatrics 1980;65:631.
14. Laupland KB, davies HD, Low DE, Schwartz B, Green K, McGeer A. Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group. Pediatrics 2000;105:E60.
15. Zerr DM, Laexander ER, Duchin JS, Koutsky LA, Rubens CE. A case control study of necrotizing fasciitis during primary varicella. Pediatrics 1999;103:783-90.
16. Choo PW, Donahue JG, Platt R. Ibuprofen and skin and soft tissue superinfections in children with varicella. Ann Epidemiol 1997;7:440-5.
17. Bradley JS, Sclievert PM, Sample TG. Streptococcal toxic shock-like syndrome as a complication of varicella. Pediatr Infect Dis J 1991;10:77-9.
18. Hockberger RS, Rothstein RJ. Varicella pneumonia in adults: Spectrum of disease. Ann Emerg Med 1986;15:931.
19. Schlossberg D, Littman M. Varicella pneumonia. Arch Int Med 1988;148:1613.
20. Feldman S. Varicella-zoster pneumonitis. Chest 1994;106(Suppl):22S-27S.
21. Esmonde TF, Herdman G, Anderson G. Chickenpox pneumonia: an association with pregnancy. Thorax 1989;44:812-15.
22. Weber DM, Pellecchia JA. Varicella pneumonia: study of prevalence in adult men. JAMA 1965;192:572-73.
23. Mer M, Richards GA. Coticosteroids in lifethreatening varicella pneumonia. Chest 1988; 114:426-31.
24. Guess HA, Broughton DD, Melton LJ II, Kurland LT. Population based studies of varicella complications. Pediatrics 1987;78:723-27. 25.Hurwitz I, Goodman RA. A cluster of cases of Reye syndrome associated with chickenpox. Pediatrics 1982;70:901-10.
26. Echevarria JM, Tellez A, Martinex-Martin D. Subclass distribution of the serum and intrathecal IgG antibody response in varicella-zoster virus infection. J Infect Dis 1990;162:621-26.
27. Belay ED, Bresee JS, Holman RC et al. Reye’s syndrome in the United States from 1981 through 1997. N Engl J Med 1999;340: 1377.
28. Mayer JL, Beardsley DS. Varicella –associated thrombocytopenia: autoantibodies against platelet surface glycoprotein V. Pediatr Res 1996;40(4):615-9.
29. Kurugol Z, et al. Lupus anticoagulant and protein S deficiency in otherwise healthy children with acute varicella infection. Acta Pediatr 2000;89:1186.
30. Miceli Sopo S, Valentini P, Ranno O. Childhood glomeulonephritis assotiated with varicella and streptococcal infection. Minerva Pediatr 2000;52(7-8):375-9.
31. Stebbings A, Highton J, Croxson MC, Powell K, McKay J, Rietveld J. Chickenpox monoarthritis: demonstration of varicella-zoster virus in jont fluid by polimerase chain reaction. Br J Rheumatol 1998;37:311-13.
32. Waagner DC, Murphy TV. Varicella myocarditis. Pediatr Infect Dis J 1990;9(5):360-63.
33. Torre JA, Martin JJ, Garcia CB, Polo ER. Varicella infection as a cause of acute pancreatitis in a immunocompetent child. Pediatr Infect Dis J 2000:19(12):1218-19.
34. Liu HC, Tsai TC, Chang PY, Shih BF. Varicella orchitis: report of 2 cases and review of the literature. Pediatr Infect Dis J 1994;13(8): 748-50.
35. Choong K, Zwaigenbaum L, Onyett H.Severe varicella after low dose inhaled corticosteroids. Pediatr Infect Dis J 1995;14(9):809-11.
36. Nocerino G. Varicella emorragica con polmonite in corso di terapia con steroidi inalanti. Medico e Bambino 2003; n. 7; pagine elettroniche (www.medicoebambino.com).
37. Nursoy MA, Bakir M, Barman IB, Basaran MM. The course of chickenpox in asthmatic children receiving inhaled budesonide. Pediatr Infect Dis J 1997;1(16):75.
38. Guess HA, Broughton DD, Melton LJ, Kurland LT. Epidemiology of herpes zoster in children and adolescents: a population-based study. Pediatrics 1985;76(4):512-7.
39. Wacker P, Hartmann O, Benhamou E, Salloum E, Lemerle J. Varicella –zoster virus infections after autologous bone maroow trnsplantation in children. Bone Marrow Transplant 1989;4(2):191-94.
40. Fanaroff AA, Martin RJ. Neonatal-Perinatal Medicine. Diseases of the fetus and Infant. 7th Edition. Mosby Inc. I vol. 2002:376-77.
41. Suga S, Yoshikawa T, Ozaki T, Asano Y. Effect of oral acyclovir against primary and secondary viraemia in incubation period of varicella. Arch Dis Child 1993;69(6):639-42.
42. Asano Y, Yoshikawa T, Suga S, Kobayashi I, Nakashima T, Yazaki T, Ozaki T, Yamada A, Imanishi J. Postexposure prophylaxis of varicella in family contact by oral acyclovir. Pediatrics 1993;92(2):219-22.
43. Suga S, Yoshikawa T, Ozaki T, Asano Y. Dose- dipendent effects of oral acyclovir in the incubation period of varicella. Acta Pediatr 1996; 85(12):1418-21.
44. Lin TY, Huang YC, Ning, HC, Hsueh C. Oral acyclovir prophylaxis of varicella after intimate contact. Pediatr Infect Dis J 1997; 16(12):116-5.
45. Kumagaj T, Kamada M, Igarashi C, et al. Varicella- Zoster Virus specific cellular immunity in subjects given acyclovir after household chickenpox exposure. J Infect Dis 1999;180: 834-7.
46. Goldtein SL, Somers MJ, Lande MB, Brewer ED, Jabs KL. Acyclovir prophylaxis of varicella in children with renal disease receiving steroids. Pediatr Nephrol 2000;14(4):305-8.
47. American Academy of Pediatrics. Varicella- Zoster Infections. In: Pickering LK. Red Book: Report of the Committee on Infectious Diseases, 2003.
48. Dunkle LM, Arvin AM, Whitley RJ, et al. Controlled trial of acyclovir for chickenpox in normal children. N Engl J Med 1991;325:1529.
49. Balfour HH, Kelly JM, Suarez CS, Heussner RC, Englund JA, Crane DD, McGuirt PV, Clemmer AF, Aeppli DM. Acyclovir treatment of varicella in otherwise healthy children. J Pediatr 1990;116(4):633-9.
50. Balfour HH, Rotbart HA, Feldman S, Dunkle LM, Feder HM, Pober CG, Hayden GF, Steinberg S, Whitley RJ, Golberg L, et al. Acyclovir treatment of varicella in otherwise healthy adolescents. The Collaborative Acyclovir Varicella Study Group. J Pediatr 1992; 120(4 pt 1):627-33.
51. Klassen TP, Belsek EM, Wiebe N, Hartling L. Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane database SySt Rev 2002;(4):CD00298.
52. Volpi A, Gentile G, Pica F, Suligoi B. Antiviral treatment of varicella in pediatric practice in the Latium region of Italy: results of an observational study. Pediatr Infect Dis J 2002;21: 739-42.
53. Walace MR, Bowler WA, Murray NB, Brodine SK, Oldfield EC. Treatment of adult varicella with oral acyclovir. A randomized, placebo- controlled trial. Ann Intern Med 1992; 117(5):358-63.
54. American Academy of Pediatrics Committee on Infectious Diseases: The use o oral acyclovir in otherwise healthy children with varicella. Pediatrics 1993;91(4):858.
55. Ogilvie MM. Antiviral prophylaxis and treatment in chickenpox. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. J Infect 1998;36 Suppl 1:31-8.
56. American Academy of Pediatrics Committee on Infectious Diseases. The use of oral acyclovir in otherwise healthy children with varicella. Pediatrics 1993;91(3):674-6.
57. Kesson AM, Grimwood K, Burges MA, Ferson MJ, Gilbert GL, Hogg G, Isaacs D, Kakakios A, Melntyre P. Acyclovir for the prevention and treatment of varicella zoster in children, adolescents and pregnancy. J Pediatr Child Health 1996;32(3):211-7.
58. Carcao MD, Lau RC, Gupta A, Huerter H, Koren G, King SM. Sequential use of intravenous and oral acyclovir in the therapy of varicella in immnucompromised children. Pediatr Infect Dis J 1998;17(7):626-31.
59. Pacini-Edelstein SJ, Mehra M, Ament ME, Vargas JH, Martin MG, McDiarmid SV. Varicella in pediatric liver transplant patients: a retrospective analysis of treatment and outcome. J Pediatr Gastroenterol Nutr 2003;37(2):183-6.
60. Stango S, Whitley RJ. Herpes simplex virus and varicella-zoster virus infections. N Engl J Med 1985;313:1327.
61. Pastuszak AL, Levy M, Schick B, et al. Outcome after maternal varicella infection in the first 20 weeks of pregnancy. N Engl J Med 1994;330:901:5.
62. Endeers G, Miller E, Cradock-Watson J, et al. Consequences of varicella and herpes zoster in pregnancy: Prospective study of 1739 cases. Lancet 1994;343:1548.
63. Harger JH, Ernest JM, Thurnau GR, et al. Frequency of congenital varicella syndrome in a prospective cohort of 347 pregnant women. Obstet Gynecol 2002;100:260.
64. Remington JS, Klein JO. Infectious Disease of the fetus and newborn infant. 5th Edition. WB Saunders Company, 2001:684-708.
2. Salleras L, Domingues A, Vdal J, Palns P, Salleras M, Yaberner JL. Seroepidemiology of varicella- zoster virus infection in Catalonia (Spain). Rationale for universal vaccination programmes. Vaccine 2000;19(2-3):183-8.
3. Kilgore PE, Kruszon-Moran D, Steward JF, Jumaan A, Van Loon FP,, Forghani B, McQuillan GM, Wharton M, Fehrs LJ, Cossen CK, Hadler SC. Varicella in Americans from NHANES III: implication for control through routine immunization. J Med Virol 2003;70 Suppl 1:S111-8.
4. Gabutti G, Penna C, Rossi M, Salmaso S, Rota MC, Bella A, Crovari P. The seroepidemiology of varicella in Italy. Epidemiol Infect 2001;126:433-40.
5. Finger R, Hughes JP, Meade BJ, Pelletier AR, Palmer CT. Age-specific incidence of chickenpox. Public Health Rep 1994;109(6):750-5.
6. Meyer PA, Steward JF, Jumaan AO, Wharton M. Varicella Mortality: Trends before vaccine licensure in the United States, 1970-1994. J Infect Dis 2000;182 :383-90.
7. Feldman S, Lott L. Varicella in children with cancer: impact of antiviral therapy and prophylaxis. Pediatrics 1987;80:465-72.
8. Nelson Textbook of Pediatrics. 17th Edition. Saunders Company, 2004:1057-62.
9. Bogger-Goren S, Baba K, Hurley P, Yabuuchi H, Takahashi M, Ogra PL. Antibody response to varicella-zoster virus after natural or vaccine induced infection. J Infect Dis 1982; 146:260-4.
10. Zaia JA, Levin MJ, Preblud SR, Leszczynski J, Wright GG, Ellis RJ, Curtis AC, Valerio MA, LeGore J. Evaluation of varicella-zoster immune globulin: protection of immunosuppressed children after household exposure to varicella. J Infect Dis 1983;147 :737-43.
11. Brunell PA. Varicella in pregnancy, the fetus and the newborn: problems in management. J Infect Dis 1992;166(Suppl 1.):S42-S47.
12. Arvin AM, Koropchak CM, Williams BRG, Grumet FC, Foung SKH The early immune response in healty and immunocompromised subjects with primary varicella-zoster virus infection. J Infect Dis 1986;154:422-9.
13. Pitel PA, McKormick KL, Fitzgerald E, et al. Subclinical hepatic changes in varicella infection. Pediatrics 1980;65:631.
14. Laupland KB, davies HD, Low DE, Schwartz B, Green K, McGeer A. Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group. Pediatrics 2000;105:E60.
15. Zerr DM, Laexander ER, Duchin JS, Koutsky LA, Rubens CE. A case control study of necrotizing fasciitis during primary varicella. Pediatrics 1999;103:783-90.
16. Choo PW, Donahue JG, Platt R. Ibuprofen and skin and soft tissue superinfections in children with varicella. Ann Epidemiol 1997;7:440-5.
17. Bradley JS, Sclievert PM, Sample TG. Streptococcal toxic shock-like syndrome as a complication of varicella. Pediatr Infect Dis J 1991;10:77-9.
18. Hockberger RS, Rothstein RJ. Varicella pneumonia in adults: Spectrum of disease. Ann Emerg Med 1986;15:931.
19. Schlossberg D, Littman M. Varicella pneumonia. Arch Int Med 1988;148:1613.
20. Feldman S. Varicella-zoster pneumonitis. Chest 1994;106(Suppl):22S-27S.
21. Esmonde TF, Herdman G, Anderson G. Chickenpox pneumonia: an association with pregnancy. Thorax 1989;44:812-15.
22. Weber DM, Pellecchia JA. Varicella pneumonia: study of prevalence in adult men. JAMA 1965;192:572-73.
23. Mer M, Richards GA. Coticosteroids in lifethreatening varicella pneumonia. Chest 1988; 114:426-31.
24. Guess HA, Broughton DD, Melton LJ II, Kurland LT. Population based studies of varicella complications. Pediatrics 1987;78:723-27. 25.Hurwitz I, Goodman RA. A cluster of cases of Reye syndrome associated with chickenpox. Pediatrics 1982;70:901-10.
26. Echevarria JM, Tellez A, Martinex-Martin D. Subclass distribution of the serum and intrathecal IgG antibody response in varicella-zoster virus infection. J Infect Dis 1990;162:621-26.
27. Belay ED, Bresee JS, Holman RC et al. Reye’s syndrome in the United States from 1981 through 1997. N Engl J Med 1999;340: 1377.
28. Mayer JL, Beardsley DS. Varicella –associated thrombocytopenia: autoantibodies against platelet surface glycoprotein V. Pediatr Res 1996;40(4):615-9.
29. Kurugol Z, et al. Lupus anticoagulant and protein S deficiency in otherwise healthy children with acute varicella infection. Acta Pediatr 2000;89:1186.
30. Miceli Sopo S, Valentini P, Ranno O. Childhood glomeulonephritis assotiated with varicella and streptococcal infection. Minerva Pediatr 2000;52(7-8):375-9.
31. Stebbings A, Highton J, Croxson MC, Powell K, McKay J, Rietveld J. Chickenpox monoarthritis: demonstration of varicella-zoster virus in jont fluid by polimerase chain reaction. Br J Rheumatol 1998;37:311-13.
32. Waagner DC, Murphy TV. Varicella myocarditis. Pediatr Infect Dis J 1990;9(5):360-63.
33. Torre JA, Martin JJ, Garcia CB, Polo ER. Varicella infection as a cause of acute pancreatitis in a immunocompetent child. Pediatr Infect Dis J 2000:19(12):1218-19.
34. Liu HC, Tsai TC, Chang PY, Shih BF. Varicella orchitis: report of 2 cases and review of the literature. Pediatr Infect Dis J 1994;13(8): 748-50.
35. Choong K, Zwaigenbaum L, Onyett H.Severe varicella after low dose inhaled corticosteroids. Pediatr Infect Dis J 1995;14(9):809-11.
36. Nocerino G. Varicella emorragica con polmonite in corso di terapia con steroidi inalanti. Medico e Bambino 2003; n. 7; pagine elettroniche (www.medicoebambino.com).
37. Nursoy MA, Bakir M, Barman IB, Basaran MM. The course of chickenpox in asthmatic children receiving inhaled budesonide. Pediatr Infect Dis J 1997;1(16):75.
38. Guess HA, Broughton DD, Melton LJ, Kurland LT. Epidemiology of herpes zoster in children and adolescents: a population-based study. Pediatrics 1985;76(4):512-7.
39. Wacker P, Hartmann O, Benhamou E, Salloum E, Lemerle J. Varicella –zoster virus infections after autologous bone maroow trnsplantation in children. Bone Marrow Transplant 1989;4(2):191-94.
40. Fanaroff AA, Martin RJ. Neonatal-Perinatal Medicine. Diseases of the fetus and Infant. 7th Edition. Mosby Inc. I vol. 2002:376-77.
41. Suga S, Yoshikawa T, Ozaki T, Asano Y. Effect of oral acyclovir against primary and secondary viraemia in incubation period of varicella. Arch Dis Child 1993;69(6):639-42.
42. Asano Y, Yoshikawa T, Suga S, Kobayashi I, Nakashima T, Yazaki T, Ozaki T, Yamada A, Imanishi J. Postexposure prophylaxis of varicella in family contact by oral acyclovir. Pediatrics 1993;92(2):219-22.
43. Suga S, Yoshikawa T, Ozaki T, Asano Y. Dose- dipendent effects of oral acyclovir in the incubation period of varicella. Acta Pediatr 1996; 85(12):1418-21.
44. Lin TY, Huang YC, Ning, HC, Hsueh C. Oral acyclovir prophylaxis of varicella after intimate contact. Pediatr Infect Dis J 1997; 16(12):116-5.
45. Kumagaj T, Kamada M, Igarashi C, et al. Varicella- Zoster Virus specific cellular immunity in subjects given acyclovir after household chickenpox exposure. J Infect Dis 1999;180: 834-7.
46. Goldtein SL, Somers MJ, Lande MB, Brewer ED, Jabs KL. Acyclovir prophylaxis of varicella in children with renal disease receiving steroids. Pediatr Nephrol 2000;14(4):305-8.
47. American Academy of Pediatrics. Varicella- Zoster Infections. In: Pickering LK. Red Book: Report of the Committee on Infectious Diseases, 2003.
48. Dunkle LM, Arvin AM, Whitley RJ, et al. Controlled trial of acyclovir for chickenpox in normal children. N Engl J Med 1991;325:1529.
49. Balfour HH, Kelly JM, Suarez CS, Heussner RC, Englund JA, Crane DD, McGuirt PV, Clemmer AF, Aeppli DM. Acyclovir treatment of varicella in otherwise healthy children. J Pediatr 1990;116(4):633-9.
50. Balfour HH, Rotbart HA, Feldman S, Dunkle LM, Feder HM, Pober CG, Hayden GF, Steinberg S, Whitley RJ, Golberg L, et al. Acyclovir treatment of varicella in otherwise healthy adolescents. The Collaborative Acyclovir Varicella Study Group. J Pediatr 1992; 120(4 pt 1):627-33.
51. Klassen TP, Belsek EM, Wiebe N, Hartling L. Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane database SySt Rev 2002;(4):CD00298.
52. Volpi A, Gentile G, Pica F, Suligoi B. Antiviral treatment of varicella in pediatric practice in the Latium region of Italy: results of an observational study. Pediatr Infect Dis J 2002;21: 739-42.
53. Walace MR, Bowler WA, Murray NB, Brodine SK, Oldfield EC. Treatment of adult varicella with oral acyclovir. A randomized, placebo- controlled trial. Ann Intern Med 1992; 117(5):358-63.
54. American Academy of Pediatrics Committee on Infectious Diseases: The use o oral acyclovir in otherwise healthy children with varicella. Pediatrics 1993;91(4):858.
55. Ogilvie MM. Antiviral prophylaxis and treatment in chickenpox. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. J Infect 1998;36 Suppl 1:31-8.
56. American Academy of Pediatrics Committee on Infectious Diseases. The use of oral acyclovir in otherwise healthy children with varicella. Pediatrics 1993;91(3):674-6.
57. Kesson AM, Grimwood K, Burges MA, Ferson MJ, Gilbert GL, Hogg G, Isaacs D, Kakakios A, Melntyre P. Acyclovir for the prevention and treatment of varicella zoster in children, adolescents and pregnancy. J Pediatr Child Health 1996;32(3):211-7.
58. Carcao MD, Lau RC, Gupta A, Huerter H, Koren G, King SM. Sequential use of intravenous and oral acyclovir in the therapy of varicella in immnucompromised children. Pediatr Infect Dis J 1998;17(7):626-31.
59. Pacini-Edelstein SJ, Mehra M, Ament ME, Vargas JH, Martin MG, McDiarmid SV. Varicella in pediatric liver transplant patients: a retrospective analysis of treatment and outcome. J Pediatr Gastroenterol Nutr 2003;37(2):183-6.
60. Stango S, Whitley RJ. Herpes simplex virus and varicella-zoster virus infections. N Engl J Med 1985;313:1327.
61. Pastuszak AL, Levy M, Schick B, et al. Outcome after maternal varicella infection in the first 20 weeks of pregnancy. N Engl J Med 1994;330:901:5.
62. Endeers G, Miller E, Cradock-Watson J, et al. Consequences of varicella and herpes zoster in pregnancy: Prospective study of 1739 cases. Lancet 1994;343:1548.
63. Harger JH, Ernest JM, Thurnau GR, et al. Frequency of congenital varicella syndrome in a prospective cohort of 347 pregnant women. Obstet Gynecol 2002;100:260.
64. Remington JS, Klein JO. Infectious Disease of the fetus and newborn infant. 5th Edition. WB Saunders Company, 2001:684-708.