Serological Conditions Flashcards
Infectious mononucleosis pathophysiology
Epstein Barr virus spread through salvia to tonsils and pharynx; can have it without knowing
Epidemiology & incidence of mono
Ages 10-30 (esp. 15-25)
Clinical findings for infectious mono
Fatigue, high fever, sore throat, generalized lymphadenopathy
CBC findings in infectious mono
RBC: NL
Leukocytosis with lymphocytosis (>50%), large amts of reactive lymphocytes
Thrombocytopenia possible
Special tests for infectious mono
Heterophile antibody tests (monospot), specific Epstein Barr virus titers (anti-VCA antibody & anti-EBNA antibody)
Heterophile antibody tests
Inexpensive, rapid, less sensitive, less specific, less reliable in 1st week of infection, not reliable in patients under 5 yoa
Anti-VCA antibody test
IgM: early, disappear in 4-6 weeks
IgG: peaks at 2-4 weeks, persists for life
Anti-EBNA antibody test
Elevates after acute phase ~2-4 months after onset of s/s, then persists for life
Management of infectious mono
No specific treatment, saline gargles, tea w/ honey can be supportive
Contraindications for infectious mono
Avoid strenuous exercise, contact sports, heavy lifting for ~4 weeks; avoid side posture and thoracic adjustments
Aspirin/acetylsalicyclic acid (associated with Reye syndrome)
Acute rheumatic fever
Inflammatory disease (autoimmune) (heart, joints, skin, CNS), untreated group A streptococcal infections, recurrence common without prophylactic antibiotic treatment
ARF epidemiology
Most common in children 5-15 yoa, once patient has it, it may come back
Clinical findings for ARF
Arthritis, carditis, subcutaneous nodules on skin, erythema merginatum, Sydenham chorea (late finding)
Carditis findings for ARF
Tachycardia common, high fever, chest pain, valvulitis, murmurs, damage may be permanent
Erythema marginatum
Flat, painless rash on trunk and proximal extremities seen with ARF
ARF lab findings
Elevated CRP and ESR, leukocytosis, neutrophilia
Additions test for ARF
Throat culture for GABHS (often negative by time ARF develops), ASO titer (elevated), DNase B (elevated)
Major criteria for ARF diagnosis
Carditis, arthritis, chorea, erythema marginatum, subcutaneous nodules
Minor criteria for diagnosis of ARF
Fever, arthralgia, previous rheumatic fever, acute phase reactant labs, prolonged P-R interval on ECG
Management of ARF
Limit activities with symptoms of arthritis, chorea, or carditis
Treatment aimed at eliminating streptococcal infection, prophylactic prevention, pain reduction, anti-inflammatory
Systemic lupus erythematosus (SLE)
Multi-system, autoimmune inflammatory condition of the connective tissue, fluctuating, chronic course, may be mild to severe
SLE epidemiology/risk factors
Female > male (10:1)
Possible in all ages, 15-45 most common
Clinical findings in SLE
Variable onset, variable system involvement, exacerbations
Joint involvement in SLE
Metacarpophalangeal, interphalangeal, wrist, and knee most impacted; commonly the first symptom to appear, may looks like RA, arthritis is non-erosive
Dermatologic clinical findings in SLE
Malar erythema (butterfly rash), photosensitivity, alopecia, mottled erythema on side of palm into fingers
Other clinical findings in SLE
Vascular: Reynauds
GI: ulcers on mucus membranes
Cardiac
Obstetrics: higher prevalence of miscarriage
CNS: seizures, hyperthyroidism
Renal: lupus nephritis
UA findings in SLE
Proteinuria, hematuria (if kidney involvement)
CBC findings for SLE
Hypochromic microcytic anemia, leukopenia with lymphocytopenia, thrombocytopenia
Immunologic tests for SLE diagnosis
Antinuclear antibody test & anti-double-stranded DNA test
Antinuclear antibody test (ANA)
More sensitive, less specific
Screening test
Will be elevated
Anti-ds-DNA test
Less sensitive, more specific
Diagnostic test
What is needed for diagnosis of SLE
4 of 11 manifestations
Management of SLE
Avoidance of UV light, stress avoidance/management, activity as tolerated
Prognosis of SLE
Remission and exacerbation
