CBM - Lymphadenopathy

Question 1

Lymphadenopathy

Causes?

Answer 1

• Most commonly viral infection
• Characterised by tender, freely mobile lymph nodes.
• Generalised lymphadenopathy
• Localised lymphadenopathy can be more sinister.
• Size shape and consistency of lymph node should be examined.
• Irregular shaped, non tender, rubbery and fixed nodes should raise suspicion of malignancy
• Supraclavicular nodes usually always abnormal

Question 2

Lymphadenopathy

Epstein Barr Virus?

Answer 2

Epstein Barr virus (EBV) is a member of the herpes family:

• It is the causative agent of infectious mononucleosis and has been implicated in the pathogenesis of various types of human tumour:
• Burkitt’s lymphoma
• B-cell lymphomas in immunocompromised individuals
• undifferentiated nasopharyngeal carcinoma
• recent studies have identified other virus-associated malignancies, including Hodgkin’s lymphoma, various T-cell lymphomas, and some carcinomas (undifferentiated carcinomas of the nasal type have been observed in the stomach, salivary glands, thymus and the lungs; although these tumours are not invariably associated with EBV)

Question 3

Epstein Barr Virus

Glandular Fever?

Answer 3

• Infectious mononucleosis (or glandular fever) is usually a self-limiting disease caused generally by the Epstein-Barr virus (EBV), a member of the herpes virus family.
• The virus replicates mainly in B – lymphocytes and in some instances in the epithelial cells of the pharynx and parotid duct

The virus is excreted for some months in nasopharyngeal secretions (primarily by saliva) which are responsible for person-to-person transmission:

• many asymptomatic carriers may spread the virus intermittently through out their life
• it is often called the kissing disease since kissing can spread the virus
• it may also be spread by coughing, sneezing, or sharing a glass or food utensil
• chewing contaminated toys may cause infections in children

Question 4

Epstein Barr Virus

Glandular Fever

Complications?

Answer 4

These include:

• persistent fatigue – appears to be present in 9% to 22% of cases at six months after illness onset
• hepatitis - probably occurs in all cases and abnormal liver function tests are usual
• splenic rupture - in 0.1 to 0.2 % of cases
• thrombocytopaenia
• haemolytic anaemia
• cardiac involvement - 10% of patients develop minor T-wave changes
• meningitis - benign
• encephalitis - 33% mortality of an 11 case series
• single nerve palsies
• Guillain-Barre syndrome
• depression and malaise
• airway blocked by pharyngeal oedema - rare
• nephritis - extremely rare and excellent prognosis
• pneumonitis
• acute interstitial nephritis
• myocarditis and cardiac conduction abnormalities
• neurologic abnormalities
• cranial nerve palsies
• retrobulbar neuritis

Infection may be fatal in males with the rare Duncan’s syndrome.(X-linked lymphoproliferative disease)