Module 9 Part 2 Patho Mononucleosis

Question 1

Question

Answer 1

Answer

Question 2

What is infectious mononucleosis (IM)?

Answer 2

IM is an acute, self-limiting clinical syndrome characterized by B lymphocyte infection.

Question 3

What is the most common cause of IM?

Answer 3

Epstein-Barr virus (EBV) is the most common cause of IM, accounting for approximately 85% of cases.

Question 4

Name other viruses that can cause symptoms resembling IM.

Answer 4

Other viruses include cytomegalovirus (CMV), adenovirus, HIV, hepatitis A, influenza A and B, and rubella.

Question 5

Which bacteria can cause symptoms similar to IM?

Answer 5

Bacteria like Toxoplasma gondii, Corynebacterium diphtheriae, and Coxiella burnetii can cause similar symptoms.

Question 6

What are the classic symptoms of IM?

Answer 6

The classic symptoms include pharyngitis (sore throat), lymphadenopathy (swollen lymph nodes), and fever.

Question 7

When do most people become infected with EBV, and what happens during early infections?

Answer 7

Most people are infected with EBV during childhood. Early infections are usually asymptomatic and provide immunity to EBV.

Question 8

When does symptomatic IM typically occur, and who does it affect?

Answer 8

Symptomatic IM usually occurs when the first EBV infection happens in adolescence or later. It often affects young adults between ages 15 and 35.

Question 9

When is the peak incidence of IM, and what is the overall incidence rate in the affected age group?

Answer 9

The peak incidence occurs between ages 1-6 and 14-20 years. The overall incidence rate is about 2 to 3 cases per 1,000 persons per year.

Question 10

Who is particularly susceptible to EBV infections?

Answer 10

Children from low socioeconomic environments are particularly susceptible to EBV infections.

Question 11

Is IM common in individuals older than age 40, and what might cause it in older individuals?

Answer 11

IM is uncommon in individuals over age 40. If it occurs, it is commonly caused by cytomegalovirus (CMV).

Question 12

How is Epstein-Barr virus (EBV) typically transmitted?

Answer 12

EBV is usually transmitted through saliva from close personal contact, such as kissing, which is why it’s sometimes called the “kissing disease.”

Question 13

Besides saliva, where else can EBV be found in bodily secretions?

Answer 13

EBV may also be present in genital, rectal, and respiratory secretions, as well as in blood.

Question 14

How does EBV infection begin in the body?

Answer 14

EBV infection starts with the widespread invasion of B cells, which have specific receptors for EBV.

Question 15

In which parts of the body does the initial EBV infection occur?

Answer 15

The initial EBV infection takes place in the mouth and throat, particularly in the oropharynx, nasopharynx, and salivary epithelial cells.

Question 16

Where does EBV infection spread in the body after the initial site of infection?

Answer 16

EBV later spreads to lymphoid tissues and B cells in the body.

Question 17

What happens in the immune response against EBV in immunocompetent individuals?

Answer 17

In immunocompetent individuals, unaffected B cells produce antibodies (immunoglobulins IgG, IgA, IgM) against the virus. There’s also a significant proliferation of T-cytotoxic cells (CD8) directed against EBV-infected cells.

Question 18

What is responsible for the cellular proliferation in lymphoid tissues (e.g., lymph nodes, spleen, tonsils) during an EBV infection?

Answer 18

The immune response against EBV-infected cells plays a significant role in cellular proliferation within lymphoid tissues.

Question 19

How does EBV infection spread throughout the body once it enters the bloodstream?

Answer 19

Once EBV enters the bloodstream, the infection spreads throughout the body.

Question 20

What symptoms are associated with the inflammation at the site of the first viral entry in the mouth and throat during an EBV infection?

Answer 20

Inflammation at the site of first viral entry (the mouth and throat) can cause sore throat and fever.

Question 21

What is the typical incubation period for Infectious Mononucleosis (IM)?

Answer 21

The incubation period for IM is usually about 30 to 50 days.

Question 22

What are some early symptoms of IM that can appear during the first 3 to 5 days after infection?

Answer 22

Early symptoms can include headache, malaise, joint pain, and fatigue. However, some individuals may not experience any symptoms.

Question 23

What are the classic symptoms individuals commonly present with at the time of IM diagnosis?

Answer 23

At the time of diagnosis, individuals with IM typically have fever, sore throat (pharyngitis), cervical lymph node enlargement, and fatigue.

Question 24

How does pharyngitis typically appear in IM?

Answer 24

Pharyngitis in IM is usually diffuse with a whitish or greyish-green, thick exudate. It can be painful, leading individuals to seek treatment.

Question 25

What can be observed as IM progresses?

Answer 25

As IM progresses, individuals may develop generalized lymphadenopathy, an enlarged spleen, and the appearance of atypical activated T lymphocytes in the blood.

Question 26

Is IM a self-limiting condition, and if so, how long does recovery typically take?

Answer 26

Yes, IM is usually self-limiting, and recovery occurs within a few weeks.

Question 27

What is a common lingering symptom after the resolution of IM?

Answer 27

Fatigue may persist for 1 to 2 months after the resolution of the infection.

Question 28

How common are severe clinical complications in Infectious Mononucleosis (IM)?

Answer 28

Severe clinical complications are rare in IM.

Question 29

What complications may develop with the progression of IM?

Answer 29

As IM progresses, it can lead to general lymph node enlargement and splenomegaly (enlarged spleen).

Question 30

Why is it challenging to detect splenomegaly in IM through physical examination?

Answer 30

Splenomegaly is observed radiologically in all cases, but it may not be clinically evident due to the difficulty of physical examination.

Question 31

What is splenic rupture, and how common is it as a complication of IM?

Answer 31

Splenic rupture is a rare but serious complication of IM. It primarily affects men under 25 years old and occurs between days 4 and 21 after symptom onset. It is the most common cause of death related to IM.

Question 32

Besides splenic rupture, what are other potential causes of fatalities related to IM?

Answer 32

Other causes of fatalities in IM include hepatic failure, extensive bacterial infection, and viral myocarditis.

Question 33

What are some organ systems that can rarely be involved in IM, leading to characteristic manifestations?

Answer 33

Other organ systems may include manifestations such as hepatitis with jaundice and anemia, encephalitis, meningitis, Guillain-Barré syndrome, Bell’s palsy, and eye manifestations.

Question 34

What is Reye syndrome, and when does it develop in the context of EBV infection?

Answer 34

Reye syndrome can develop in children with EBV infection.

Question 35

Who is more likely to experience pulmonary and respiratory failure in IM, and under what circumstances?

Answer 35

Pulmonary and respiratory failure is more likely to occur in immunocompromised individuals.

Question 36

What percentage of adults older than 40 years who have not been previously infected with EBV are susceptible to IM later in life?

Answer 36

Approximately 3 to 10% of adults older than 40 who have not been previously infected with EBV remain susceptible to IM later in life.

Question 37

What makes the diagnosis of IM more challenging in these individuals?

Answer 37

In individuals who have not been previously infected with EBV and develop IM later in life, the classic symptoms are not generally present, making diagnosis more difficult.

Question 38

What is the basis for diagnosing Infectious Mononucleosis (IM)?

Answer 38

Diagnosis of IM is based on specific findings in blood tests.

Question 39

What specific criteria are used in diagnosing IM based on blood tests?

Answer 39

Diagnostic criteria include an increase in the number of lymphocytes, with at least 50% of the cells being lymphocytes and at least 10% being atypical lymphocytes in the blood.

Question 40

What is the monospot test, and why is it commonly used for diagnosing IM?

Answer 40

The monospot test is a positive heterophile antibody reaction, and it is commonly used for diagnosing IM.

Question 41

How does the monospot test detect IM?

Answer 41

The monospot test detects heterophilic antibodies, which are a group of IgM antibodies against nonhuman red blood cells (e.g., horse, sheep).

Question 42

What are the limitations of the monospot test in diagnosing IM?

Answer 42

The monospot test may lead to false-positive results (5 to 15%) because other infections, like CMV, adenovirus, and toxoplasmosis, can also produce similar heterophilic antibodies.

Question 43

How do heterophilic antibodies in the blood change as IM progresses?

Answer 43

Heterophilic antibodies in the blood increase as the condition progresses.

Question 44

Are heterophilic antibodies produced in all individuals with IM, including children?

Answer 44

No, some individuals and children younger than 4 years old do not produce these antibodies.

Question 45

Besides the monospot test, how can the diagnosis of EBV infection be enhanced?

Answer 45

Newer viral-specific tests that detect EBV-specific antibodies can enhance the diagnosis of EBV infection.

Question 46

What is the primary approach to treating Infectious Mononucleosis (IM)?

Answer 46

Treatment for IM is primarily supportive and aims to relieve symptoms.

Question 47

What are the key components of supportive treatment for IM?

Answer 47

Supportive treatment includes rest and symptom relief using analgesics and antipyretics.

Question 48

Why is aspirin avoided in the treatment of IM, especially in children?

Answer 48

Aspirin is avoided because it is associated with Reye syndrome, a severe condition.

Question 49

How is streptococcal pharyngitis, which occurs in a significant number of IM cases, treated?

Answer 49

Streptococcal pharyngitis is treated with penicillin or erythromycin.

Question 50

Why is the use of ampicillin or amoxicillin avoided in IM treatment?

Answer 50

These antibiotics are avoided because they can cause a rash.

Question 51

Besides medication, what lifestyle recommendations are made for individuals with IM?

Answer 51

Patients are advised to get bed rest, avoid strenuous activities, and refrain from contact sports.

Question 52

When are steroids considered in the treatment of IM?

Answer 52

Steroids are considered when severe complications like impending airway obstruction or other organ involvement (e.g., central nervous system manifestations, thrombocytopenic purpura, myocarditis, pericarditis) are present.

Question 53

What is the role of Acyclovir in IM treatment, and when is it used?

Answer 53

Acyclovir has been used in immunocompromised individuals with IM, but it is not considered standard therapy.

Question 54

What is the standard treatment for splenic rupture, a rare complication of IM?

Answer 54

The standard treatment for splenic rupture is the removal of the spleen.

Question 55

. What emerging approach to splenic rupture treatment is suggested by current research?

Answer 55

Current research suggests that repairing the spleen may be a better option to avoid overwhelmingpostsplenectomyinfection.