Download - Welcome Applicants!
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WELCOME APPLICANTS!
January 13, 2011
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Epstein-Barr Virus Identified in 1964 in Burkitt lymphoma
Lab technician became ill with mononucleosis EBV seroconversion
Ubiquitous Harbored by nearly all adults
No seasonal variation or clustering of cases
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Epstein-Barr Virus Most infected by oral route
“kissing disease” Other modes of transmission
Blood transfusions Bone Marrow transplants Sexually transmitted
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Epstein-Barr Virus Incubation period 30-50 days Age at infection varies with living
conditions Age 2 to 3
20% to 80% infected Industrialized countries:
More common primary EBV in adolescents IM in 30% to 50% of these cases
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Infectious Mononucleosis
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Illness ScriptInfectious Mononucleosis
FeverSore Throat (exudative pharyngitis)MalaiseLymphadenitis (Cervical)+/- HepatosplenomegalyAtypical Lymphocytosis
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Infectious Mononucleosis Highly suggestive findings
Palatal petechiae Splenomegaly Posterior cervical adenopathy
Absence of cervical lymphadenopathy and fatigue make the diagnosis much less likely.
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Clinical Manifestations Rash
4% of older patients With antibiotic
(ampicillin) administration Nonallergic
morbilliform rash Seen in nearly 100%. Benzyl-penicilloyl-
specific IgM
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Rare Clinical Manifestations CNS (5%)
Aseptic meningitis Encephalitis Optic neuritis CN palsies Transverse myelitis Guillian-Barre
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Rare Clinical Manifestations Hematologic
Splenic rupture Thrombocytopenia Neutropenia Hemolytic anemia
Others Respiratory Compromise Pneumonia Orchitis Myocarditis
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Diagnostic Tests Viral culture is difficult Diagnosis implicated by:
Characteristic clinical signs Lymphocytosis (>50%)
Absolute (> 4500/mL) Atypical Lymphocytosis (>10%)
Confirmed by: Criteria above + positive heterophile
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Heterophile Test (Monospot) Heterophile antibodies react to antigens
from unrelated species Monospot- Latex agglutination assay
using horse erythrocytes and patient serum. Peak levels at 2-6 weeks May remain elevated for up to 1 year Sensitivity 85%
Less sensitive in children < age 3. Specificity 100%
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Diagnostic Testing Other antibody Testing (useful if
heterophile negative) anti-VCA IgM
Some evidence for active/recent infection anti-EBNA
Excludes active primary infection
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Treatment “Take it easy” No contact sports until spleen no longer
palpable Avoid ampicillin and amoxicillin Steroids reserved for most severe of
cases
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Associated Conditions X-linked Lymphoproliferative Disease
(XLP) Defect in signaling lymphocytic activation
molecule-associated protein Characterized by
Nodular B-cell lymphomas +/- CNS involvement Profound hypogammaglogulinemia Aplastic anemia Severe infectious mono early in life
4% survival
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Associated Conditions EBV associated B-Cell
Lymphoproliferative Disease 10% of transplant recipients Donor organ is common vehicle of EBV
infection Occurs early after transplant
Time of most severe immunosuppression
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Other Associated Conditions Hemophagocytic Lymphohistiocytosis Chronic Active EBV Infection Malignancies
Burkitt Lymphoma Nasopharyngeal Carcinoma Hodgkin Disease T-Cell Lymphoma Gastric carcinoma