![Page 1: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/1.jpg)
Glandular FeverThe Kissing Disease !!!!!
Why ???
![Page 2: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/2.jpg)
Glandular FeverCaused by infection with the Epstein-Barr virusvery low infectivity ratebecause the virus is “environmentally fragile” in that it’s survival outside the human body is very poor
![Page 3: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/3.jpg)
Glandular FeverSpreads by:•Coughing•Sneezing•Kissing
![Page 4: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/4.jpg)
Clinically:
Glandular Fever
Age of presentation: 15 - 40 (usually)
Symptoms: None (usually)(The infection is usually subclinical)
Occassionally….
![Page 5: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/5.jpg)
Glandular FeverClinically:
In Symptomatic cases:
Bilateral cervical lymphadenopathy in 75% of symptomatic casesGeneralized lymphadenopathy in 50% of symptomatic cases
Sore throat >50% of symptomatic cases.
Fever of varying severity
Visual Problems - photophobia – conjuctivitis - peri-orbital oedema
![Page 6: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/6.jpg)
Glandular FeverClinically:
More rarely:Spleno-hepatomegaly
• About 15% of symptomatic cases•About 5% of symptomatic cases are jaundiced
Haemato-pathology
•About 1% of symptomatic cases there is: •Severe anaemia (auto-immune)•Purpura due to thrombocytopenia
![Page 7: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/7.jpg)
Glandular FeverLaboratory Findings:
Nothing abnormal…..
If the patient presents very early in the course of the disease, there will be no
abnormalities evident.
![Page 8: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/8.jpg)
Glandular FeverLaboratory Findings:
An atypical lymphocytosis
•Lymphocyte count of 10 - 20 x10 9 cells/litre is usual in symptomatic cases.
•These cells appear reactive
•Usually evident after a week or so.
![Page 9: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/9.jpg)
In most symptomatic cases of glandular fever there is circulating heterophile antibody.
These are absorbed by ox red cells but not by guinea pig kidney cells
and agglutinate formalized horse red cells
Who thinks this up ??????
Glandular FeverThe Paul – Bunnell Test: (historically)
![Page 10: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/10.jpg)
The GF test
Two drops of plasma
![Page 11: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/11.jpg)
The GF test
Two drops of plasma
Drop some minced guinea pig
in this one
![Page 12: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/12.jpg)
The GF test
Two drops of plasma
Drop some minced guinea pig
in this one
And some minced ox in this one
![Page 13: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/13.jpg)
The GF test
Two drops of plasma
Drop some minced guinea pig
in this one
And some minced ox in this one
![Page 14: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/14.jpg)
The GF test
Two drops of plasma
Drop some minced guinea pig
in this one
And some minced ox in this one
![Page 15: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/15.jpg)
The GF test
Two drops of plasma
Drop some minced guinea pig
in this one
And some minced ox in this one
Mix it in
![Page 16: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/16.jpg)
The GF test
Two drops of plasma
Mix it in
![Page 17: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/17.jpg)
The GF test
Two drops of plasma
Leave for thirty seconds
![Page 18: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/18.jpg)
The GF test
Two drops of plasma
Leave for thirty seconds
The minced ox absorbs the heterophile
antibody
![Page 19: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/19.jpg)
The GF test
Two drops of plasma
Leave for thirty seconds
The minced ox absorbs the heterophile
antibody
The minced guinea pig does
not
![Page 20: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/20.jpg)
The GF test
Two drops of plasma
Add some formalized horse
cells
![Page 21: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/21.jpg)
The GF test
Two drops of plasma
Add some formalized horse
cells
![Page 22: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/22.jpg)
The GF test
Two drops of plasma
Add some formalized horse
cells
![Page 23: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/23.jpg)
The GF test
Two drops of plasma
And mix for one minute
![Page 24: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/24.jpg)
The GF test
Two drops of plasma
![Page 25: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/25.jpg)
The GF test
Two drops of plasma
The heterophile antibody has not been absorbed by the minced guinea
pig
![Page 26: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/26.jpg)
The GF test
Two drops of plasma
And so agglutinates the formalised horse
cells
![Page 27: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/27.jpg)
The GF test
Two drops of plasma
And so agglutinates the formalised horse
cells
The heterophile antibody has been absorbed by the minced ox cells
![Page 28: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/28.jpg)
The GF test
Two drops of plasma
And so agglutinates the formalised horse
cells
And so is no longer present to agglutinate the
formalised horse cells
![Page 29: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/29.jpg)
The GF test - Nowadays
One drop of plasma – “one stage”
One drop of plasma
Add latex coated with purified Paul-Bunnell antigen and mix
Presence of IM heterophile antibody causes agglutination
![Page 30: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/30.jpg)
The GF test - Nowadays
One drop of plasma – one stage
![Page 31: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/31.jpg)
Is this test a good test for glandular fever ?
It doesn’t test for glandular fever
It tests for the body’s reaction to it
Therefore it has limitations
![Page 32: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/32.jpg)
Glandular FeverClinical Chemistry Findings:
Liver function deranged in extreme cases
![Page 33: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/33.jpg)
No treatment The majority of cases are sub clinical
Symptomatic cases have symptomatic treatmentThe condition is self limiting
The very few severe cases may be treated with corticosteroids.
Glandular FeverTreatment:
![Page 34: Glandular Fever The Kissing Disease !!!!! Why ???](https://reader036.vdocuments.site/reader036/viewer/2022062504/5a4d1bba7f8b9ab0599d0626/html5/thumbnails/34.jpg)
•Takes 4 - 6 weeks•convalescence is slow•severe malaise & lethargy•Wait for negative GF test….?
Glandular FeverRecovery: