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Infectious diseases > Infectious mononucleosis > Flashcards

Infectious mononucleosis Flashcards

1
Q

What receptor does EBV bind to and what is the DNA structure of EBV?

A

CD21 receptors
Linear double-stranded DNA

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2
Q

Which malignant conditions is EBV associated with?

A

Burkitt’s lymphoma
Hodgkin’s lymphoma (is differentiated from Burkitt’s due to presence of Red-Sternberg lymphocytes)
Nasopharyngeal carcinoma
HIV associated central nervous system lymphomas

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3
Q

Where is CD21 expressed?

A

On B-cells and some epithelial cells of the nasopharynx and oropharynx

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4
Q

How is EBV spread?

A

Saliva

Sexual contact

Blood transfusion

Organ transplant

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5
Q

What happens when someone is infected with EBV (latent and re-activation are clues)?

A

Upon infection, the virus can spread for weeks without any symptoms.Once inside, the virus can remain in a latent state.Upon re-activation, the virus can spread again (even if it was latent for a long time).

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6
Q
A
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7
Q

Which is a better marker for liver damage: AST or ALT? Why?

A

ALT
Unlike AST, it is mainly in liver cells and is a relatively specific indicator of hepatocellular damage. It is released early in liver damage and remain elevated for weeks

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8
Q

How can patients with infectious mononucleoisis develop a maculopapular pruritic rash?

A

99% of pts with infectious mononucleoisis can develop this rash if they are taking amoxicillin/ampicillin

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9
Q

What is the classic triad of symptoms for infectious mononucleosis?

A

Sore throar,pyrexia and lymphadenopathy (anterior and posterior triangles of neck but in tonsilitis is found in upper anterior cervical chain)

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10
Q

What are some other clinical features that can be seen in patients with infectious mononucleosis apart from the classical triad?

A

Malasise,anorexia,headache

Palatal petechiae

Splenomegaly (occurs in around 50% of pts and may rarely predispose to splenic rupture)

Hepatitis,transient rise in ALT

Lymphocytosis: Presence of 50% lymphocytes with at least 10% atypical lymphocytes

Haemolytic anaemia secondary to cold agglutins (IgM)

Maculopapaular,pruritic rash develops in around 99% of pts who take amoxicillin/ampicillin whilst they have infectious mononucleoisis.

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11
Q

Why would patients be given amoxicillin if they have infectious mononucleosis?

A

A streptococcal (strep) infection sometimes goes along with the sore throat of mononucleosis. You may also develop a sinus infection or an infection of your tonsils (tonsillitis). If so, you may need treatment with antibiotics for these accompanying bacterial infections.

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12
Q

What is the incubation period for EBV (infectious mononucleosis)? Is it contagious during this period?

A

The incubation period is about 4–7 weeks. The disease is contagious during the incubation period and while symptoms are present; some people may be contagious for as long as 18 months after having the infection.

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13
Q

What age group tends to develop infectious mononucleoisis? Are the symptoms severe when they usually present? How about in children?

A

Adolescents and young adults (15-24yrs old)

The symptoms range from mild to severe. However in children, the infection is usually asymptomatic.

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14
Q

How do you diagnose infectious mononucleoisis? How is it done?

A

Heterohpil antibody test (monospot test)

In infectious mononucleoisis, the body produces heterophile antibodies.They are NOT specific to the EBV antigens. It takes up to 6 weeks for these antibodies to be produced.

So you can test for these heterophile antibodies using the MONOSPOT test:

Involves introducing patient’s blood to RBC from horses. If heterophile antibodies are present, they will react with the horse’s RBC and give a positive result.

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15
Q

What is the management plan for infectious mononucleoisis?

A

Rest,lots of fluids and avoiding alcohol.Simple analgesia for aches or pains

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16
Q

What should patients with infectious mononucleosis avoid during and after they have recovered?Why?

A

Contact sports and heavy lifting . Due to risk of splenic rupture.

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17
Q

What type of virus is hep A?

A

RNA

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18
Q

How is Hep A transmitted?

A

Through faecal-oral route

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19
Q

What is the incubation period of Hep A?

A

2-4 weeks

20
Q

How do you diagnose Hep A?

A

Antibody test to look for IgM

21
Q

What is Hep A likely to cause?What are the symptoms of it?

A

Cholestasis (Cholestasis is defined as a decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts. Therefore, the clinical definition of cholestasis is any condition in which substances normally excreted into bile are retained).

Pruritis
Significant jaundice
Dark urine
Pale stools

22
Q

How do you manage Hep A?

A

Management is supportive with basic analgesia.It usually resolves without treatment and rarely leads to acute liver failure

23
Q

What are the KEY antigen/antibody markers to detect Hep B?

A

Surface antigen (HBsAg) – active infection

E antigen (HBeAg) – a marker of viral replication and implies high infectivity

Core antibodies (HBcAb) – implies past or current infection

Surface antibody (HBsAb) – implies vaccination or past or current infection

Hepatitis B virus DNA (HBV DNA) – a direct count of the viral load

24
Q

What does HBcAb look for in Hep B investigation?

A

For previous infection

25
Q

What does HBsAg look for in Hep B investigation?

A

For current infection

26
Q

What is HBcAb use for in Hep B testing?

A

To distinguish acute,chronic and past infections

27
Q

What surface antigens does the Hep B vaccination contain?

A

HBsAg (hepatitis B surface antigen)

28
Q

How many times do you need to vaccinate someone against Hep B?

A

3 times (at different intervals)

29
Q

What is the management for Hepatitis B?

A

A low threshold for screening patients at risk of hepatitis B
Screen for other viral infections (e.g., HIV, hepatitis A, C and D)
Referral to gastroenterology, hepatology or infectious diseases for specialist management
Avoid alcohol
Education about reducing transmission
Contact tracing and informing potential at-risk contacts
Testing for complications (e.g., FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma)
Antiviral medication can be used to slow the progression of the disease and reduce infectivity
Liver transplantation for liver failure (fulminant hepatitis)

30
Q

What type of virus is Hep C and is there a vaccine for it?

A

It is an RNA virus and there is no vaccine against it currently.

31
Q

How is Hep C transmitted?

A

Is spread through blood and body fluids like semen

32
Q

What is the treatment for Hep C?

A

With direct-acting antiviral medications like sofosbuvir and daclatasvir

33
Q

What is the test to look for Hep C

A

Hep C antibody

34
Q

What does the Hep C RNA testing do?

A

It is used to confirm the diagnosis of Hep C , calculate the viral load and identify the genotype

35
Q

How do you manage hepatitis C?

A

Use anti-viral treatment with direct-acting antivirals (DAAs) which is tailored to the specific viral genotype.

36
Q

What is the treatment duration for Hep C?

A

8-12 weeks

37
Q

In what type of patient would you see who has Hep D?

A

A patient who has Hep B (as Hep D can ONLY survive in patients who also have a Hep B infection)

38
Q

What type of virus is Hep D?

A

RNA

39
Q

What does Hep D virus need to atatch to in order to survive?

A

HBsAg (the Hep B surface antigen)
That is why it is associated with Hep B infection

40
Q

How is Hep D treated?

A

With pegylated interferon alpha for over AT LEAST 48 weeks

41
Q

In which hepatitis is no treatment required?

A

Hep E (it is also very rare in the UK)

42
Q

For which Hepatitis’ is there no vaccine?

A

Hep C,D and E

43
Q

How is Hep E transmitted?

A

By faecal-oral route

44
Q

What type of virus is Hep E?

A

RNA virus

45
Q

How do patients with hepatitis usually present?

A

Viral hepatitis may be asymptomatic or present with non-specific symptoms of:

Abdominal pain
Fatigue
Flu-like illness
Pruritus (itching)
Muscle and joint aches
Nausea and vomiting
Jaundice

46
Q
A

Infectious diseases (6 decks)

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