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Glandular Fever

Glandular Fever. The Kissing Disease !!!!!. Why ???. Glandular Fever. Caused by infection with the Epstein-Barr virus very low infectivity rate because the virus is “ environmentally fragile ” in that it’s survival outside the human body is very poor. Glandular Fever. Spreads by:

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Glandular Fever

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  1. Glandular Fever The Kissing Disease !!!!! Why ???

  2. Glandular Fever Caused by infection with the Epstein-Barr virus very low infectivity rate because the virus is “environmentally fragile” in that it’s survival outside the human body is very poor

  3. Glandular Fever • Spreads by: • Coughing • Sneezing • Kissing

  4. Glandular Fever Clinically: Age of presentation: 15 - 40 (usually) Symptoms: None (usually) (The infection is usually subclinical) Occassionally….

  5. Glandular Fever Clinically: In Symptomatic cases: Bilateral cervical lymphadenopathy in 75% of symptomatic cases Generalized lymphadenopathy in 50% of symptomatic cases Sore throat >50% of symptomatic cases. Fever of varying severity Visual Problems - photophobia – conjuctivitis - peri-orbital oedema

  6. Glandular Fever Clinically: • More rarely: • Spleno-hepatomegaly • About 15% of symptomatic cases • About 5% of symptomatic cases are jaundiced • Haemato-pathology • About 1% of symptomatic cases there is: • Severe anaemia (auto-immune) • Purpura due to thrombocytopenia

  7. Glandular Fever Laboratory Findings: Nothing abnormal….. If the patient presents very early in the course of the disease, there will be no abnormalities evident.

  8. Glandular Fever Laboratory Findings: • An atypical lymphocytosis • Lymphocyte count of 10 - 20 x10 9 cells/litre is usual in symptomatic cases. • These cells appear reactive • Usually evident after a week or so.

  9. Glandular Fever The Paul – Bunnell Test: (historically) In most symptomatic cases of glandular fever there is circulating heterophile antibody. These are absorbed by ox red cells but not by guinea pig kidney cells and agglutinate formalized horse red cells Who thinks this up ??????

  10. The GF test Two drops of plasma

  11. The GF test Two drops of plasma Drop some minced guinea pig in this one

  12. The GF test Two drops of plasma Drop some minced guinea pig in this one And some minced ox in this one

  13. The GF test Two drops of plasma Drop some minced guinea pig in this one And some minced ox in this one

  14. The GF test Two drops of plasma Drop some minced guinea pig in this one And some minced ox in this one

  15. The GF test Two drops of plasma Drop some minced guinea pig in this one And some minced ox in this one Mix it in

  16. The GF test Two drops of plasma Mix it in

  17. The GF test Two drops of plasma Leave for thirty seconds

  18. The GF test Two drops of plasma The minced ox absorbs the heterophile antibody Leave for thirty seconds

  19. The GF test Two drops of plasma The minced guinea pig does not The minced ox absorbs the heterophile antibody Leave for thirty seconds

  20. The GF test Two drops of plasma Add some formalized horse cells

  21. The GF test Two drops of plasma Add some formalized horse cells

  22. The GF test Two drops of plasma Add some formalized horse cells

  23. The GF test Two drops of plasma And mix for one minute

  24. The GF test Two drops of plasma

  25. The GF test Two drops of plasma The heterophile antibody has not been absorbed by the minced guinea pig

  26. The GF test Two drops of plasma And so agglutinates the formalised horse cells

  27. The GF test Two drops of plasma And so agglutinates the formalised horse cells The heterophile antibody has been absorbed by the minced ox cells

  28. The GF test Two drops of plasma And so agglutinates the formalised horse cells And so is no longer present to agglutinate the formalised horse cells

  29. The GF test - Nowadays One drop of plasma – “one stage” One drop of plasma Add latex coated with purified Paul-Bunnell antigen and mix Presence of IM heterophile antibody causes agglutination

  30. The GF test - Nowadays One drop of plasma – one stage

  31. Is this test a good test for glandular fever ? It doesn’t test for glandular fever It tests for the body’s reaction to it Therefore it has limitations

  32. Glandular Fever Clinical Chemistry Findings: Liver function deranged in extreme cases

  33. Glandular Fever Treatment: No treatment The majority of cases are sub clinical Symptomatic cases have symptomatic treatment The condition is self limiting The very few severe cases may be treated with corticosteroids.

  34. Glandular Fever Recovery: • Takes 4 - 6 weeks • convalescence is slow • severe malaise & lethargy • Wait for negative GF test….?

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