Welcome Applicants!

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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. - PowerPoint PPT Presentation

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Welcome Applicants!January 13, 2011

Epstein-Barr VirusIdentified in 1964 in Burkitt lymphomaLab technician became ill with mononucleosisEBV seroconversion UbiquitousHarbored by nearly all adultsNo seasonal variation or clustering of casesEpstein-Barr VirusMost infected by oral routekissing diseaseOther modes of transmissionBlood transfusionsBone Marrow transplantsSexually transmitted

Epstein-Barr VirusIncubation period 30-50 daysAge at infection varies with living conditionsAge 2 to 320% to 80% infectedIndustrialized countries: More common primary EBV in adolescentsIM in 30% to 50% of these casesInfectious MononucleosisIllness Script

Infectious MononucleosisFeverSore Throat (exudative pharyngitis)MalaiseLymphadenitis (Cervical)+/- HepatosplenomegalyAtypical LymphocytosisInfectious MononucleosisHighly suggestive findingsPalatal petechiaeSplenomegalyPosterior cervical adenopathyAbsence of cervical lymphadenopathy and fatigue make the diagnosis much less likely.

Clinical ManifestationsRash4% of older patientsWith antibiotic (ampicillin) administrationNonallergic morbilliform rashSeen in nearly 100%.Benzyl-penicilloyl-specific IgM

Rare Clinical ManifestationsCNS (5%)Aseptic meningitisEncephalitisOptic neuritisCN palsiesTransverse myelitisGuillian-BarreRare Clinical ManifestationsHematologicSplenic ruptureThrombocytopeniaNeutropeniaHemolytic anemiaOthersRespiratory CompromisePneumoniaOrchitisMyocarditis

Diagnostic TestsViral culture is difficultDiagnosis implicated by:Characteristic clinical signsLymphocytosis (>50%)Absolute (> 4500/mL)Atypical Lymphocytosis (>10%)Confirmed by:Criteria above + positive heterophile

VCA viral capsid antigenEBNA EBV nuclear antigen13Heterophile Test (Monospot)Heterophile antibodies react to antigens from unrelated speciesMonospot- Latex agglutination assay using horse erythrocytes and patient serum.Peak levels at 2-6 weeksMay remain elevated for up to 1 yearSensitivity 85%Less sensitive in children < age 3.Specificity 100%

Diagnostic TestingOther antibody Testing (useful if heterophile negative)anti-VCA IgMSome evidence for active/recent infectionanti-EBNAExcludes active primary infection

TreatmentTake it easyNo contact sports until spleen no longer palpableAvoid ampicillin and amoxicillinSteroids reserved for most severe of cases

Steroids in impending airway obstruction or severe thrombocytopenia.16Associated ConditionsX-linked Lymphoproliferative Disease (XLP)Defect in signaling lymphocytic activation molecule-associated proteinCharacterized byNodular B-cell lymphomas +/- CNS involvementProfound hypogammaglogulinemiaAplastic anemiaSevere infectious mono early in life4% survival

Associated ConditionsEBV associated B-Cell Lymphoproliferative Disease10% of transplant recipientsDonor organ is common vehicle of EBV infectionOccurs early after transplantTime of most severe immunosuppression

Other Associated ConditionsHemophagocytic LymphohistiocytosisChronic Active EBV InfectionMalignanciesBurkitt LymphomaNasopharyngeal CarcinomaHodgkin DiseaseT-Cell LymphomaGastric carcinoma