FEVER & LYMPHADENOPATHY

Question 1

fever and non-tender lymphadenopathy DDX

Answer 1

Malignancy

• Metastatic
• Lymphoproliferative disorders

Autoimmune/connective tissue disorders

• Systemic lupus
• Sarcoidosis

Drug reactions

Question 2

Adenovirus

Answer 2

• dsDNA, nonenveloped
• First isolated from human adenoid tissue:“adeno”virus
• Transmission by respiratory secretions, fecal oral, fomites (lives up to 3 months!)
• Outbreaks in daycare, summer camps, military recruits
• Many serotypes responsible for different symptoms

Clinical syndromes

• Pharyngitis
• Conjunctivitis
• Diarrhea

Question 3

Mumps

Answer 3

• Paramyxoviridae family
• Epi: Highest attack rate was for the age group of 18 to 24 yo

Etiopath

• Replicates in respiratory tract
• Spreads to lymphoid tissue
• Viremia

Sx:

• 2-3 week prodrome
• Fever, malaise, myalgia
• Spread to salivary glands (parotitis)
• Cervical, submandibular LAD
• Pancreatitis
• Orchiitis

Question 4

ACUTE RETROVIRAL SYNDROME DDx

Answer 4

• Acute HIV: can also give Monospot+ (not to misdx w mono)
• Mononucleosis/viral syndrome
• Bacterial pharyngitis
• Toxoplasmosis
• Syphilis

Question 5

T. gondii in immunocompromised individuals

Answer 5

• CD4<100
• Encephalitis
• Chorioretinitis
• Pneumonitis

Question 6

CASE: 17 year old man from Ecuador presents with ~8 months painless mass in his left neck.

• Recently he noticed some overlying redness and drainage from the mass.
• He denies cough, weight loss, fever, or swelling elsewhere.

Answer 6

MYCOBACTERIA

Tuberculous lymphadenitis - “Scrofula” (cervical LAD)

• Extrapulmonary reactivation of Mycobacterium tuberculosis
• Hematogenous dissemination during primary infection
• Other possible sites of extrapulmonary reactivation
• Spine – osteomyelitis, paraspinal abscesses (Pott’s disease)
• CNS – meningitis, tuberculomas
• GU – sterile pyuria
• Pericarditis

**Sx: **Usually otherwise asymptomatic

Dx:

• CXR negative
• PPD positive
• Associated with HIV
• Seen in children, young adults
• Diagnosis
• LN biopsy
• AFB stain, culture, MTB PCR if culture negative

Question 7

Paracoccidiodes

Answer 7

• Central & South America
• Mold in nature
  
  • Inhalation
  • Dissemination
  • Granulomas
• Yeast in tissue

Sx

• Pneumonia
• LAD
• Draining fistulas
• Hepatosplenomegaly
• Marrow dysfunction

Dx

• Microscopy: “mariner’s wheel”,“pilot’s wheel”
• Serology

Question 8

Answer 8

Coccidiodes imitis

• Spherule with endospores

Sx:

• Skin: E. nodosum
• Pneumonia
• Valley fever
• Desert rheumatism
• Fatigue
• Arthralgia
• Lymphadenopathy

Diagnosis

• Culture
• Pathology
• serology