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Transcript of mono crome
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Infectious Mononucleosis
Adam Stern, PGY IIIUNC Hospitals
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Infectious Mononucleosis
Virology Epstein Barr Virus (EBV)
Herpes Family (linear DNA virus HHV4)
Surrounded by nucleocapsid and glycoproteinenvelope
Also associated w/ nasopharyngeal
carcinoma, Burkitts lymphoma,Hodgkins Disease,B cell lymphoma.
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Infectious Mononuclosis
Epidemiology Worldwide Prevalence of EBV Infections peak in early childhood and late
adolescence/young adulthood. By adulthood , 90% of individuals have
been infected and have antibodies to thevirus.
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Infectious Mononucleosis
TransmissionThe Kissing Disease
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Infectious Mononucleosis
Pathogenesis EBV infects the epithelium of the
oropharynx and salivary glands.
Lymphocytes in the tonsilar crypts aredirectly infected -> BLOODSTREAM.
Infected B cells and activated T cells
proliferate and expand. Polyclonal B cells produce antibodies tohost and viral proteins.
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Infectious Mononucleosis
Pathogenesis
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Infectious Mononucleosis
Pathogenesis Memory B cells (not epithelial cells) are
reservoir for EBV. EBV receptor is CD21 (found on B cell
surface) Cellular immunity (suppressor T cells, NK
cells, cytotoxic T cells) more important thanhumoral immunity in controlling infection
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Infectious Mononucleosis
Pathogenesis
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Infectious Mononucleosis
Signs & Symptoms Incubation in adults 4-6 wks Prodrome (1-2 weeks before illness)
Fatigue, Malaise, Myalgias Symptoms Sore throat, Malaise, Headache, Abdominal Pain,
Nausea/Vomiting, Chills
Signs Lymphadenopathy, Fever, Pharyngitis, Splenomegay,
Hepatomegaly, Rash, Periorbital Edema, PalatalEnanthem, Jaundice.
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Infectious Mononucleosis
Diagnosis Lymphocytosis (>50% Lymphs) Atypical Lymphocytes (>10%, mostly CD8+ T
cells) +Heterophile Antibodies (human serumagglutinates the erythrocytes of non-humanspecies) (75% sens, 90% spec) (FP = lymphoma,
CTD, viral hepatitis, malaria) Monospot -rapid agglutination assay lower sens Confirm dx w/ antibodies to viral capsid antigen
(VCA), early antigens (EA) and EBNA
LFTs abnormal in 90%
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Infectious Mononucleosis
Diagnosis
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Infectious Mononucleosis
Treatment Rest Analgesics Avoid excessive physical activity (risk for
splenic rupture). Prednisone for severe airway obstruction,
hemolytic anemia, or thrombocytopenia. No role for acyclovir
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Infectious Mononucleosis
Prognosis Most cases are self limited Complications include
Meningitis/Encephalitis (
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References
Harrisons Principles of Internal Medicine16 th ed, Kasper et al, c 2005
Emedicine