welcome applicants! january 13, 2011. epstein-barr virus identified in 1964 in burkitt lymphoma ...
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![Page 1: WELCOME APPLICANTS! January 13, 2011. Epstein-Barr Virus Identified in 1964 in Burkitt lymphoma Lab technician became ill with mononucleosis EBV](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649e9e5503460f94b9f57a/html5/thumbnails/1.jpg)
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 Script
Infectious 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