Microbiology Case 1 - Johns & Skildum Flashcards
What physical symptoms are seen in EBV?
- 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
What physical symptoms are seen in EBV?
- 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
What tests do you see abnormalities in for EBV?
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
What are the clinical symptoms of EBV?
- Fever
- Pharyngitis
- Adenopathy
- Malaise
- Atypical lymphcytosis
What are complications of EBV?
- Splenomegaly
- Hepatomegaly
- Jaundice
- Splenic rupture
- Splenic infarction
What is the incidence of EBV?
- Highest rates 10-19 years
- College students (48 cases/1,000 persons)
- Uncommon over age 30
What is the etiology of Eptein Barr Virus?
- 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
What HHV is EBV?
HHV-4
How do you diagnose EBV?
Hoagland Criteria:
- 50% lymphocytes
- 10% atypical lymphocytes
- Fever, pharyngitis, adenopathy
How do you diagnose EBV?
Hoagland Criteria: -50% lymphocytes -10% atypical lymphocytes -Fever, pharyngitis, adenopathy Monospot -Heterophil antibody that agglutinates sheep erythrocytes
How do you diagnose EBV?
Hoagland Criteria: -50% lymphocytes -10% atypical lymphocytes -Fever, pharyngitis, adenopathy Monospot -Heterophil antibody that agglutinates sheep erythrocytes
How do you diagnose EBV?
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!!
What is the differential for EBV?
- Acute human immunodeficiency virus infection
- Cytomegalovirus infection
- Streptococcal pharyngitis
- Toxoplasmosis
- Other viral pharyngitis
Key features of Acute human immunodeficiency virus infection:
-Mucocutaneous lesions, rash, diarrhea, weight loss, nausea, and vomiting
Key features of Cytomegalovirus infection:
Paired IgG serology shows a fourfold increase in antibody titers and a significant elevation in IgM (at least 30% of IgG value)
Key features of Streptococcal pharyngitis:
Absence of splenomegaly or hepatomegaly; fatigue is less prominent
Key features of Toxoplasmosis:
Paired IgG serology show s fourfold increase in antibodies titter sand a significant elevation in IgM (at least 30% of IgG value)
Other viral pharyngitis
Patient is less likely to have adenopathy, tonsillar exudates, fever, or absence of cough than patients with streptococcal pharyngitis or infectious mononucleosis
What is CMV?
- 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
What HHV is CMV?
HHV-5
What is CMV induced mononucleosis?
- Symptoms indistinguishable from EBV mono
- Commonly causes elevation of liver enzymes
- Guillain-Barre related CMV has been documented
CMV and HIV
- CD4 T-lymphocyte count of less than 50
- Numerous skin disorders
- Retinitis most common end-organ damage
CMV in kidney transplant patients:
-CMV syndrome - fever, leukopenia, atypical lymphocytes, hepatomegaly, myalgia and arthralgia
How to treat EBV and CMV?
- 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
