Conditions With Serological Findings Flashcards
Infectious Mono-Epidemiology & Incidence
• Ages: 10-30
• By young adult life, up to 95% of people are seropositive
Infectious Mono: Clinical Findings
Main: Fatigue • High fever • Sore throat • Generalized lymphadenopathy
• Other possible findings: Splenomegaly, Flu-like malaise, Headache, Anorexia, Myalgia, Hepatomegaly
Infectious Mono: Lab Findings
CBC
• RBC/Hb/Hct: typically normal
• Total WBCs: Leukocytosis
• WBC Differential: Lymphocytosis (>50%), Reactive Lymphocytes (>10%), Abnormal Monocytes
• Thrombocytopenia possible
• Chem panel: Elevated liver function tests
Infectious Mono: Special Tests
• Heterophile antibody tests (Monospot)
• Specific Epstein-Barr virus titers
• Anti-VCA antibody
• Anti-EBNA antibody: Elevates after acute phase
Infectious Mono: Management
• No specific treatment • Supportive – saline gargles
Infectious Mono: Contraindications
• Avoid strenuous exercise, contact sports, heavy lifting
• Aspirin/acetylsalicylic acid (associated with Reye syndrome if <18 yoa)
Acute Rheumatic Fever (ARF)
Inflammatory disease (autoimmune): Heart, Joints, Skin, CNS
• Untreated Group A Streptococcal infections
• Recurrence common without prophylactic antibiotic treatment
ARF is most common in:
Children (5-15 years)
ARF: Clinical Findings
• Arthritis: Joints painful and tender, may be red, hot, swollen
• Carditis:Tachycardia common, High fever, chest pain possible, Pancarditis – valvulitis
most consistent, Appears w/in 2 weeks, lasts 6 wks-6months, Damage can be permanent
• Skin: Subcutaneous nodules (Extensor surfaces of knees, elbows, wrists)
• Erythema marginatum: Flat, painless rash
• Sydenham chorea: Late finding
ARF: Lab Findings
• Elevated acute phase reactants (CRP) and ESR
• CBC: Leukocytosis, Neutrophilia
• Additional: Throat culture for GABHS: often (-) by time ARF develops (ASO titer elevated/DNAase B elevated)
• Other testing: EKG
ARF: Diagnosis
• Diagnosis made on fulfilling modified Jones criteria
• Need 2+ major criteria or 1 major and 2+ minor criteria:
• Evidence of preceding group A streptococcal infection
• Major Criteria
• Carditis, arthritis, chorea, erythema marginatum, subcutaneous nodules
• Minor Criteria: Fever, arthralgia, previous rheumatic fever, acute phase reactant labs (ESR, CRP,
leukocytosis), prolonged P-R interval on ECG
ARF: Management
• Limit activity with symptoms of arthritis, chorea, or carditis
• If carditis is absent, no physical restrictions needed after resolution of
symptoms
• Treatment aimed at eliminating streptococcal infection, prophylactic
prevention, pain reduction, anti-inflammatory
SLE
• Multi-system, autoimmune inflammatory condition of the connective
tissue • Fluctuating, chronic course • Mild to severe
SLE: Epidemiology/Risk Factors
• Female > male (10:1)
• Possible in all ages, 15-45 most common
SLE: Clinical findings
• General symptoms: Fatigue, Fever, Arthralgia, Loss of appetite and weight, Malaise, Myalgia, Headache
• Joints: Metacarpophalangeal, interphalangeal, wrist, and knee most impacted
• Dermatologic: Malar “butterfly” erythema, Photosensitivity, Alopecia, Maculopapular lesions of face, neck, upper chest, elbows, Mottled erythema – sides of palms
into fingers
• Vascular • GI • Cardiac • Obstetrics • CNS • Renal involvement
• Often asymptomatic
• Progressed: hypertension, edema, weight gain
