Microbiology Case 1 - Johns & Skildum Flashcards Preview

IHO Week 1 > Microbiology Case 1 - Johns & Skildum > Flashcards

Flashcards in Microbiology Case 1 - Johns & Skildum Deck (27):
1

What physical symptoms are seen in EBV?

-Mild tenderness of sternum
-Left costovertebral angle tenderness
-Tenderness to palpation in left upper and left mid quadrant
-Pain in chest, flanks, back
-Cloudy urine
-Abdominal pain - 8/10
-Fever
-Mild sore throat
-Nausea
-Malaise
-Spleen enlargement

2

What physical symptoms are seen in EBV?

-Mild tenderness of sternum
-Left costovertebral angle tenderness
-Tenderness to palpation in left upper and left mid quadrant
-Pain in chest, flanks, back
-Cloudy urine
-Abdominal pain - 8/10
-Fever
-Mild sore throat
-Nausea

3

What tests do you see abnormalities in for EBV?

Monospot - Positive
CBC - Abnormal granulocytes (low-20%) & lymphocytes (high-60%), high monocytes, low hemoglobin, MCV is high
-Sedimentation rate is normal
-CT of abdomen shows splenic & hepatic enlargement

4

What are the clinical symptoms of EBV?

-Fever
-Pharyngitis
-Adenopathy
-Malaise
-Atypical lymphcytosis

5

What are complications of EBV?

-Splenomegaly
-Hepatomegaly
-Jaundice
-Splenic rupture
-Splenic infarction

6

What is the incidence of EBV?

-Highest rates 10-19 years
-College students (48 cases/1,000 persons)
-Uncommon over age 30

7

What is the etiology of Eptein Barr Virus?

-EBV is a herpes virus that replicates in lymphocytes but may also replicate in the epithelial cells of pharynx and parotid duct
-Infection spread by saliva
-Incubation period 4-8 weeks

8

What HHV is EBV?

HHV-4

9

How do you diagnose EBV?

Hoagland Criteria:
-50% lymphocytes
-10% atypical lymphocytes
-Fever, pharyngitis, adenopathy

10

How do you diagnose EBV?

Hoagland Criteria:
-50% lymphocytes
-10% atypical lymphocytes
-Fever, pharyngitis, adenopathy
Monospot
-Heterophil antibody that agglutinates sheep erythrocytes

11

How do you diagnose EBV?

Hoagland Criteria:
-50% lymphocytes
-10% atypical lymphocytes
-Fever, pharyngitis, adenopathy
Monospot
-Heterophil antibody that agglutinates sheep erythrocytes

12

How do you diagnose EBV?

Hoagland Criteria:
-50% lymphocytes
-10% atypical lymphocytes (funky shaped nuclei and cytoplasm)
-Fever, pharyngitis, adenopathy
Monospot
-Heterophil antibody that agglutinates sheep erythrocytes
---You cell RBC agglutination on slides!!

13

What is the differential for EBV?

1. Acute human immunodeficiency virus infection
2. Cytomegalovirus infection
3. Streptococcal pharyngitis
4. Toxoplasmosis
5. Other viral pharyngitis

14

Key features of Acute human immunodeficiency virus infection:

-Mucocutaneous lesions, rash, diarrhea, weight loss, nausea, and vomiting

15

Key features of Cytomegalovirus infection:

Paired IgG serology shows a fourfold increase in antibody titers and a significant elevation in IgM (at least 30% of IgG value)

16

Key features of Streptococcal pharyngitis:

Absence of splenomegaly or hepatomegaly; fatigue is less prominent

17

Key features of Toxoplasmosis:

Paired IgG serology show s fourfold increase in antibodies titter sand a significant elevation in IgM (at least 30% of IgG value)

18

Other viral pharyngitis

Patient is less likely to have adenopathy, tonsillar exudates, fever, or absence of cough than patients with streptococcal pharyngitis or infectious mononucleosis

19

What is CMV?

-Cytomegalovirus
-Member of herpes virus family
-Prevalent pathogen - up to 80% of population has positive serology indicating prior exposure
-Primary infection is usually inapparent
-Infection of newborns & immunocompromised can result in severe illness

20

What HHV is CMV?

HHV-5

21

What is CMV induced mononucleosis?

-Symptoms indistinguishable from EBV mono
-Commonly causes elevation of liver enzymes
-Guillain-Barre related CMV has been documented

22

CMV and HIV

-CD4 T-lymphocyte count of less than 50
-Numerous skin disorders
-Retinitis most common end-organ damage

23

CMV in kidney transplant patients:

-CMV syndrome - fever, leukopenia, atypical lymphocytes, hepatomegaly, myalgia and arthralgia

24

How to treat EBV and CMV?

-Mononucleosis - supportive care, hydration, throat lozenges, or oral lidocaine
-Corticosteroids for patients with significant threat edema that affects breathing
-Up to 30% of patients also have group A beta hemolytic strep
-Avoid contact sports for 3-4 weeks
-Anti-CMV agents for HIV and transplant patients

25

How to treat uncomplicated mononucleosis?

-Supportive care
-Oral steroids
-Antiviral oral therapy
-Rest

26

What populations are CMV most dangerous in?

Transplant patients, HIV patients iwht CD4 counts of 100-200

27

What is an uncommon complication of mononucleosis syndrome?

Splenic infarction