glandular fever the kissing disease !!!!! why ???
DESCRIPTION
Glandular Fever Caused by infection with the Epstein-Barr virus very low infectivity rate because the virus is “environmentally fragile” in that it’s survival outside the human body is very poorTRANSCRIPT
Glandular FeverThe Kissing Disease !!!!!
Why ???
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
Glandular FeverSpreads by:•Coughing•Sneezing•Kissing
Clinically:
Glandular Fever
Age of presentation: 15 - 40 (usually)
Symptoms: None (usually)(The infection is usually subclinical)
Occassionally….
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
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
Glandular FeverLaboratory Findings:
Nothing abnormal…..
If the patient presents very early in the course of the disease, there will be no
abnormalities evident.
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.
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)
The GF test
Two drops of plasma
The GF test
Two drops of plasma
Drop some minced guinea pig
in this one
The GF test
Two drops of plasma
Drop some minced guinea pig
in this one
And some minced ox in this one
The GF test
Two drops of plasma
Drop some minced guinea pig
in this one
And some minced ox in this one
The GF test
Two drops of plasma
Drop some minced guinea pig
in this one
And some minced ox in this one
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
The GF test
Two drops of plasma
Mix it in
The GF test
Two drops of plasma
Leave for thirty seconds
The GF test
Two drops of plasma
Leave for thirty seconds
The minced ox absorbs the heterophile
antibody
The GF test
Two drops of plasma
Leave for thirty seconds
The minced ox absorbs the heterophile
antibody
The minced guinea pig does
not
The GF test
Two drops of plasma
Add some formalized horse
cells
The GF test
Two drops of plasma
Add some formalized horse
cells
The GF test
Two drops of plasma
Add some formalized horse
cells
The GF test
Two drops of plasma
And mix for one minute
The GF test
Two drops of plasma
The GF test
Two drops of plasma
The heterophile antibody has not been absorbed by the minced guinea
pig
The GF test
Two drops of plasma
And so agglutinates the formalised horse
cells
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
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
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
The GF test - Nowadays
One drop of plasma – one stage
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
Glandular FeverClinical Chemistry Findings:
Liver function deranged in extreme cases
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:
•Takes 4 - 6 weeks•convalescence is slow•severe malaise & lethargy•Wait for negative GF test….?
Glandular FeverRecovery: