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IHO Week 1 > Microbiology Case 1 - Johns & Skildum > Flashcards

Microbiology Case 1 - Johns & Skildum Flashcards

1
Q

What physical symptoms are seen in EBV?

A
  • Mild tenderness of sternum
  • Left costovertebral angle tenderness
  • Tenderness to palpation in left upper and left mid quadrant
  • Pain in chest, flanks, back
  • Cloudy urine
  • Abdominal pain - 8/10
  • Fever
  • Mild sore throat
  • Nausea
  • Malaise
  • Spleen enlargement
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2
Q

What physical symptoms are seen in EBV?

A
  • Mild tenderness of sternum
  • Left costovertebral angle tenderness
  • Tenderness to palpation in left upper and left mid quadrant
  • Pain in chest, flanks, back
  • Cloudy urine
  • Abdominal pain - 8/10
  • Fever
  • Mild sore throat
  • Nausea
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3
Q

What tests do you see abnormalities in for EBV?

A

Monospot - Positive
CBC - Abnormal granulocytes (low-20%) & lymphocytes (high-60%), high monocytes, low hemoglobin, MCV is high
-Sedimentation rate is normal
-CT of abdomen shows splenic & hepatic enlargement

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4
Q

What are the clinical symptoms of EBV?

A
  • Fever
  • Pharyngitis
  • Adenopathy
  • Malaise
  • Atypical lymphcytosis
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5
Q

What are complications of EBV?

A
  • Splenomegaly
  • Hepatomegaly
  • Jaundice
  • Splenic rupture
  • Splenic infarction
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6
Q

What is the incidence of EBV?

A
  • Highest rates 10-19 years
  • College students (48 cases/1,000 persons)
  • Uncommon over age 30
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7
Q

What is the etiology of Eptein Barr Virus?

A
  • EBV is a herpes virus that replicates in lymphocytes but may also replicate in the epithelial cells of pharynx and parotid duct
  • Infection spread by saliva
  • Incubation period 4-8 weeks
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8
Q

What HHV is EBV?

A

HHV-4

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9
Q

How do you diagnose EBV?

A

Hoagland Criteria:

  • 50% lymphocytes
  • 10% atypical lymphocytes
  • Fever, pharyngitis, adenopathy
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10
Q

How do you diagnose EBV?

A 
Hoagland Criteria:
-50% lymphocytes
-10% atypical lymphocytes
-Fever, pharyngitis, adenopathy
Monospot 
-Heterophil antibody that agglutinates sheep erythrocytes
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11
Q

How do you diagnose EBV?

A 
Hoagland Criteria:
-50% lymphocytes
-10% atypical lymphocytes
-Fever, pharyngitis, adenopathy
Monospot 
-Heterophil antibody that agglutinates sheep erythrocytes
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12
Q

How do you diagnose EBV?

A

Hoagland Criteria:
-50% lymphocytes
-10% atypical lymphocytes (funky shaped nuclei and cytoplasm)
-Fever, pharyngitis, adenopathy
Monospot
-Heterophil antibody that agglutinates sheep erythrocytes
—You cell RBC agglutination on slides!!

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13
Q

What is the differential for EBV?

A
  1. Acute human immunodeficiency virus infection
  2. Cytomegalovirus infection
  3. Streptococcal pharyngitis
  4. Toxoplasmosis
  5. Other viral pharyngitis
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14
Q

Key features of Acute human immunodeficiency virus infection:

A

-Mucocutaneous lesions, rash, diarrhea, weight loss, nausea, and vomiting

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15
Q

Key features of Cytomegalovirus infection:

A

Paired IgG serology shows a fourfold increase in antibody titers and a significant elevation in IgM (at least 30% of IgG value)

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16
Q

Key features of Streptococcal pharyngitis:

A

Absence of splenomegaly or hepatomegaly; fatigue is less prominent

17
Q

Key features of Toxoplasmosis:

A

Paired IgG serology show s fourfold increase in antibodies titter sand a significant elevation in IgM (at least 30% of IgG value)

18
Q

Other viral pharyngitis

A

Patient is less likely to have adenopathy, tonsillar exudates, fever, or absence of cough than patients with streptococcal pharyngitis or infectious mononucleosis

19
Q

What is CMV?

A
  • Cytomegalovirus
  • Member of herpes virus family
  • Prevalent pathogen - up to 80% of population has positive serology indicating prior exposure
  • Primary infection is usually inapparent
  • Infection of newborns & immunocompromised can result in severe illness
20
Q

What HHV is CMV?

A

HHV-5

21
Q

What is CMV induced mononucleosis?

A
  • Symptoms indistinguishable from EBV mono
  • Commonly causes elevation of liver enzymes
  • Guillain-Barre related CMV has been documented
22
Q

CMV and HIV

A
  • CD4 T-lymphocyte count of less than 50
  • Numerous skin disorders
  • Retinitis most common end-organ damage
23
Q

CMV in kidney transplant patients:

A

-CMV syndrome - fever, leukopenia, atypical lymphocytes, hepatomegaly, myalgia and arthralgia

24
Q

How to treat EBV and CMV?

A
  • Mononucleosis - supportive care, hydration, throat lozenges, or oral lidocaine
  • Corticosteroids for patients with significant threat edema that affects breathing
  • Up to 30% of patients also have group A beta hemolytic strep
  • Avoid contact sports for 3-4 weeks
  • Anti-CMV agents for HIV and transplant patients
25
Q

How to treat uncomplicated mononucleosis?

A
  • Supportive care
  • Oral steroids
  • Antiviral oral therapy
  • Rest
26
Q

What populations are CMV most dangerous in?

A

Transplant patients, HIV patients iwht CD4 counts of 100-200

27
Q

What is an uncommon complication of mononucleosis syndrome?

A

Splenic infarction

IHO Week 1 (10 decks)

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