Glandular Fever

Question 1

What is Glandular Fever also known as?

Answer 1

• Infectious Mononucelosis

Question 2

What are the CO for GF?

Answer 2

• Epstein-Barr virus (human herpesvirus 4) -80%
• Cytomegalovirus
• Human herpesvirus 6
• Toxoplasmosis
• HIV
• Adenovirus

Question 4

What type of setting is mostly affected with GF?

Answer 4

• College students
• Active military personel

Question 5

What cells will the EBV target?

Answer 5

• B lymphocytes (lifelong latent infection)
• Squamous epithelial cells - oropharynx

Question 6

What is the incubation period of EBV?

Answer 6

4-8 weeks

Question 7

What are the clinical presentation of GF?

Answer 7

• Low-grade fever, fatigue, prolonged malaise
• Sore throat
• Tonsillar enlargement, exudative
• Fine macular rash
• Transient bilateral upper lid oedema
• Lymphadenopathy, especially neck glands

Later signs include:

• Mild hepatomegaly and splenomegaly with tenderness over the spleen.
• Jaundice- more common in infected elderly patients.

Question 8

What are the differential diagnosis of GF?

Answer 8

• group A streptococcal pharyngitis - exudative tonsils
• kawasaki disease - can present with bilateral periorbital oedema
• leukaemia, H&N cancers - any causes of lymphadenopathy

Question 9

What Ix would you order specific for GF?

Answer 9

• < 12 years, and immunocompromised at any age
  
  • check EBV viral serology after the person has been ill for at least 7 days
• >12 years and immunocompetent adults
  
  • FBC + monospot test
• Paul-bunnell test
• Viral Capsid Antigen (VCA) test
• EBV nuclear antigen test (EBNA)

Question 10

What will the FBC look like for GF?

Answer 10

• monospot test positive
• FBC > 20% atypical or ‘reactive’ lymphocytes
• > 10% atypical lymphocytes
• lymphocyte count > 50% of the total white cell count

Question 12

What other Ix would you consider in GF?

Answer 12

• real time PCR for IM(infectious mononucleosis) DNA
• ESR
• LFT
• Throat swab
• Abdo US - for splenomegaly

Question 13

What diseases are associated with EBV?

Answer 13

• Burkitt’s lymphoma.
• B-cell lymphomas in patients with immunosuppression.
• Undifferentiated carcinomas - eg, cancer of the nasopharynx and cancer of the salivary glands.
• Duncan’s syndrome: rare, X-linked recessive; defective T cells fail to destroy EBV-infected cells; associated development of autoimmune disease and lymphoma.
• Multiple sclerosis

Question 14

How would you mx glandular fever?

Answer 14

• avoid contact sports for three weeks because of the risk of splenic rupture
• Avoid alcohol for the duration of the illness
• Paracetamol
• aciclovir and valaciclovir ?trials
• vitamin D

Question 15

What are the cx of GF?

Answer 15

• Extreme tonsillar enlargement may result in upper airway obstruction.
• Myocarditis
• Splenic rupture
• Haemolytic anaemia, thrombocytopenia.
• Acute interstitial nephritis, glomerulonephritis.
• optic neuritis, transverse myelitis, aseptic meningitis, encephalitis and meningoencephalitis, cranial nerve palsies (especially facial palsy) or Guillain-Barré syndrome.
• Prolonged fatigue

Question 16

What is the prognosis of GF like?

Answer 16

• self limiting 2-4weeks
• life long latent carrier
• can reactivate - not necesarrily cause sx