7 Infectious Mono And Lyme

Question 1

____________ infection causes infectious mononucleosis

Answer 1

Epstein-Barr Virus (EBV)

Question 2

Burkitt’s Lymphoma is linked to _______ infection in some regions of the world

Answer 2

EBV

Really just in certain parts of Africa -

One of the strongest virus-cancer links

Question 3

Incubation period for mono is …

Answer 3

1-2 months

Primary virus replication occurs in the oropharynx, virus eventually reaches lymph nodes

Question 4

Mono is a ___ cell infection

Answer 4

B cell infection, inducing polyclonal expansion of lymphocytes

BUT Sx are from T-cell reaction

Question 5

Dissemination of mono infection is …

Answer 5

Through lymphoreticular system of infected cells

Prodromal period of 3-5 days (HA, fever, malaise, fatigue)

Question 6

Typical mono presentation

Answer 6

Sore throat, symmetrical LAD, fever

Sometimes hepatomegaly with increased liver enzymes and jaundice

More commonly, splenomegaly

Question 7

What does the throat look like in mono patients?

Answer 7

Palatal enanthem at junction of hard and soft palate with petechial lesions

Question 8

Mono is characterized by presence of _______ cells in circulation

Answer 8

Atypical lymphocytes (“Downey cells”)

These are mostly T cells and responsible for a lot of the Sx

Question 9

How is EBV spread?

Answer 9

Worldwide distribution
Person-to-person transmission
Asymptomatic infection (or mild infection) of children frequent

Question 10

Peak incidence of mono is in ages…

Answer 10

17-25

Question 11

EBV virus can be found in saliva for …

Answer 11

About 1 month or more (makes it easier to spread)

Question 12

Diagnosis of mono is difficult because…

Answer 12

It mimics other diseases (CMV, rubella, hepatitis, strep)

Question 13

Key factors in the diagnosis of mono

Answer 13

Patient age (TEEN) and the presence of HETEROPHILE ANTIBODIES

Agglutination of horse RBCs in Monospot test

Question 14

What is the downside of the Monospot test?

Answer 14

AGE-SPECIFIC REACTIVITY

Pre-teen patients may not have strong heterophile antibody response**

For younger patients, confirmation by serology (IgM anti-virus capsid antigen, anti-VCA)

Question 15

Treatment for Mono?

Answer 15

Symptomatic relief

Question 16

What happens if you mistake mono for strep and treat with penicillin?

Answer 16

A rash that they will forever mistake for a penicillin allergy

Question 17

Which virus is considered the “troll” of transplantation?

Answer 17

Cytomegalovirus (CMV)

Question 18

Virus similar to EBV but does not produce heterophile antibodies

Answer 18

CMV

Question 19

CMV infection is most problematic for…

Answer 19

Transplant patients

Immune suppressed patients

Infections occurring during pregnancy

Question 20

What is the major source of CMV infections?

Answer 20

Children with minor colds (snotty nosed kids)

Question 21

How do you treat CMV?

Answer 21

Ganciclovir and immunoglobulin (Cytogam) - esp helpful for transplant patients

Question 22

How is Mumps treated and prevented?

Answer 22

Symptomatic relief (no antivirals available)

Vaccination is the main method of control

MMR used in US contains the Jeryl Lynn attenuated virus strain

Question 23

Do you end up with lifelong immunity from Mumps with the MMR?

Answer 23

Not if you have an egg or neomycin sensitivity

Question 24

The Great 2006 Mumps outbreak in Iowa was mostly due to…

Answer 24

Breakthrough cases in already MMR vaccinated persons

Calls in to question the typical MMR protocol (may need to add a third booster?)

Question 25

Lyme Disease is named for...

Answer 25

Location of definitive description (Old Lyme, CT)

Question 26

What lead to the initial discovery of the etiology of Lyme disease?

Answer 26

Unusual cluster of juvenile arthritis

Question 27

Lyme disease progresses through several stages in a pattern similar to...

Answer 27

Syphilis Like syphilis, this disease can mimic other conditions complicating the diagnosis

Question 28

Stage 1 of Lyme disease is characterized by...

Answer 28

Acute localized disease Erythema migrants at the site of the tick bite in 70-80% • Bulls eye pattern • Expanding • Fades in less than a month but can be hidden • Patients may have flu-like symptoms

Question 29

Stage 2 of Lyme disease is the _______ disease

Answer 29

Subacute, disseminated 70% of untreated patients go to stage 2 weeks to months after infection Flu like symptoms ***ASYMMETRIC ARTHRITIS ATTACKS*** with swelling and pain of large joints (60%) MULTIPLE SECONDARY ANNULAR SKIN LESIONS days to weeks after infection (50%) 20% of untreated pt show hepatitis MENINGITIS in 15% of untreated patients (subacute but FACIAL PALSY) Nonspecific follicular conjunctivitis in 10% of stage 1 or 2 patients

Question 30

Stage 3 of Lyme disease is ...

Answer 30

Chronic disease Primarily musculoskeletal manifestations Arthritis attacks become more persistent, longer duration in second and third year after infection In 10% arthritis is chronic (at least one year of unremitting joint inflammation)

Question 31

What is the organism that causes Lyme disease in North America and Europe

Answer 31

Borreliella burgdorferi In Eurasia - B. garinii and B. afzelii

Question 32

90% of cases of Lyme disease in the US occur in ...

Answer 32

Upper Midwest and east coast CT, RI, NY, NJ, PA, DE, MD, Wi

Question 33

What is the vector for Lyme disease?

Answer 33

Tick - specifically the deer tick or black-legged tick Ixodes sp.***

Question 34

What is the reservoir for Lyme disease?

Answer 34

Small mammal reservoirs (rodents, rats, MICE) and birds Tick transmission is essential to maintain cycle (no trans-ovarian tick transmission)

Question 35

Lyme disease is associated with what type of location?

Answer 35

Forest edge Think MOUSE HABITAT - humans contact ticks in fields with tall grass and brush

Question 36

How is Lyme diagnosed?

Answer 36

Clinical findings - SSx and exposure in endemic area Serology • EIA plus Western blot if EIA is positive**** • Patients typically positive by 4th week

Question 37

What can cause false positives for Lyme?

Answer 37

``` Syphilis Mono SLE RA Oral infection with spirochete ```

Question 38

What is the best way to prevent Lyme disease?

Answer 38

Control and avoidance of vector • Repellents with DEET • Careful checks for attached ticks after outdoor activities • Control tick sources such as mice

Question 39

What happened to the Lyme vaccine?

Answer 39

Taken off the market b/c it induced symptoms There’s now a promising new anti-Lyme mouse vaccine though...

Question 40

What is the treatment for Lyme disease?

Answer 40

For patients with Symptoms - amoxicillin or doxycycline for 10-21 days Prophylactic treatment is not generally done (risk doesn’t justify it)

Question 41

Post Treatment Lyme Disease Syndrome resembles what?

Answer 41

Reiter’s syndrome 10-20% of abx treated patients have lingering Sx of fatigue, pain, and joint problems May reflect residual tissue damage and auto-immune responses Most improve with time