L25: Mono+Lyme Disease Flashcards
What’s Mono caused by?
Epstein-Barr virus
What else is EBV linked to and where?
Burkitt’s lymphoma if EBV early in life
parts of Africa
Mono incubates for ____ and replicates in ____
1-2 months
Oropharynx, then lymph nodes
B cells, causing polyclonal expansion of lymphocytes
cells disseminate through lymph system
Mono prodrome
3-5 days
HA, fever, malaise, fatigue
Mono presentation
Sore throat
Symmetrical LAD
Fever
+/- hepatomegaly, increased LFTs, jaundice
Throat of a mono patient
Palatal enanthem at junction of hard and soft palate with petechial lesions
Downey cells
Atypical lymphocytes, mostly T cells, seen in mono
T cell response controls and halts infection, but also generates most of the symptoms
EBV epidemiology
Person-to-person, found in saliva for 1 month
asymptomatic/mild infection frequent
**peak: ages 17-25*
Best way to diagnose EBV
patient age
+
heterophile antibodies
patient serum+ horse RBCs= agglutinate
Who might not have a strong enough heterophile antibody response?
Preteens
Confirmation of EBV infection if (+) heterophile Ab
Serology:
IgM anti-virus capsid antigen
anti-VCA
You think a case of mono is strep and treat it with PCN….
Penicillin Injection rash!
Unknown mechanism
Looks like measles
How is CMV different from EBV?
Doesn’t produce heterophile antibodies
In whom is CMV most problematic?
Transplants
Pregnant
Major source of CMV infection
Children with minor colds
Owl’s eye phenomenon
seen on histology CMV
inclusion bodies in (lung?) cells
CMV treatment
Ganciclovir
Immunoglobulin
How/Where was Lyme disease discovered?
Old Lyme, Connecticut
Cluster of juvenile arthritis cases
Lyme disease morphology
Spirochete
How does Lyme’s present
Similar to syphilis
Can mimic other conditions, complicating diagnosis
Lyme’s Stage 1
Acute localized disease
Erythema migrans: growing bull’s eye pattern
fades in a few weeks
+/- flu like symptoms
Lyme’s Stage 2
Subacute disseminated disease Flu-like symptoms *asymmetric arthritis attacks* (knees) annular skin lesions (1/2) Meningitis (15%): subacute, facial palsy Nonspecific follicular conjunctivitis (10% stage 1/2)
How many patients resolve spontaneously after Stage 1 of Lyme disease?
30%
70% get stage 2 weeks/months after infection
Lyme’s Stage 3
Chronic disease: years
Musculoskeletal
More persistant, longer arthritis attacks
10% have chronic arthritis: >1 year without remitting
