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Welcome Applicants!

Welcome Applicants!. January 13, 2011. Epstein-Barr Virus. Identified in 1964 in Burkitt lymphoma Lab technician became ill with mononucleosis EBV seroconversion Ubiquitous Harbored by nearly all adults No seasonal variation or clustering of cases. Epstein-Barr Virus.

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Welcome Applicants!

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  1. Welcome Applicants! January 13, 2011

  2. Epstein-Barr Virus • Identified in 1964 in Burkitt lymphoma • Lab technician • became ill with mononucleosis • EBV seroconversion • Ubiquitous • Harbored by nearly all adults • No seasonal variation or clustering of cases

  3. Epstein-Barr Virus • Most infected by oral route • “kissing disease” • Other modes of transmission • Blood transfusions • Bone Marrow transplants • Sexually transmitted

  4. Epstein-Barr Virus • Incubation period 30-50 days • Age at infection varies with living conditions • Age 2 to 3 • 20% to 80% infected • Industrialized countries: • More common primary EBV in adolescents • IM in 30% to 50% of these cases

  5. Infectious Mononucleosis

  6. Illness Script Infectious Mononucleosis Fever Sore Throat (exudativepharyngitis) Malaise Lymphadenitis (Cervical) +/- Hepatosplenomegaly Atypical Lymphocytosis

  7. Infectious Mononucleosis • Highly suggestive findings • Palatal petechiae • Splenomegaly • Posterior cervical adenopathy • Absence of cervical lymphadenopathy and fatigue make the diagnosis much less likely.

  8. Clinical Manifestations • Rash • 4% of older patients • With antibiotic (ampicillin) administration • Nonallergicmorbilliform rash • Seen in nearly 100%. • Benzyl-penicilloyl-specific IgM

  9. Rare Clinical Manifestations • CNS (5%) • Aseptic meningitis • Encephalitis • Optic neuritis • CN palsies • Transverse myelitis • Guillian-Barre

  10. Rare Clinical Manifestations • Hematologic • Splenic rupture • Thrombocytopenia • Neutropenia • Hemolytic anemia • Others • Respiratory Compromise • Pneumonia • Orchitis • Myocarditis

  11. Diagnostic Tests • Viral culture is difficult • Diagnosis implicated by: • Characteristic clinical signs • Lymphocytosis (>50%) • Absolute (> 4500/mL) • Atypical Lymphocytosis (>10%) • Confirmed by: • Criteria above + positive heterophile

  12. Heterophile Test (Monospot) • Heterophile antibodies react to antigens from unrelated species • Monospot- Latex agglutination assay using horse erythrocytes and patient serum. • Peak levels at 2-6 weeks • May remain elevated for up to 1 year • Sensitivity 85% • Less sensitive in children < age 3. • Specificity 100%

  13. Diagnostic Testing • Other antibody Testing (useful if heterophile negative) • anti-VCA IgM • Some evidence for active/recent infection • anti-EBNA • Excludes active primary infection

  14. Treatment • “Take it easy” • No contact sports until spleen no longer palpable • Avoid ampicillin and amoxicillin • Steroids reserved for most severe of cases

  15. Associated Conditions • X-linked Lymphoproliferative Disease (XLP) • Defect in signaling lymphocytic activation molecule-associated protein • Characterized by • Nodular B-cell lymphomas +/- CNS involvement • Profound hypogammaglogulinemia • Aplastic anemia • Severe infectious mono early in life • 4% survival

  16. Associated Conditions • EBV associated B-Cell Lymphoproliferative Disease • 10% of transplant recipients • Donor organ is common vehicle of EBV infection • Occurs early after transplant • Time of most severe immunosuppression

  17. Other Associated Conditions • HemophagocyticLymphohistiocytosis • Chronic Active EBV Infection • Malignancies • Burkitt Lymphoma • Nasopharyngeal Carcinoma • Hodgkin Disease • T-Cell Lymphoma • Gastric carcinoma

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