glandular fever the kissing disease !!!!! why ???

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Glandular Fever Caused by infection with the Epstein-Barr virus very low infectivity rate because the virus is “environmentally fragile” in that it’s survival outside the human body is very poor

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Glandular FeverThe Kissing Disease !!!!!

Why ???

Glandular FeverCaused by infection with the Epstein-Barr virusvery low infectivity ratebecause the virus is “environmentally fragile” in that it’s survival outside the human body is very poor

Glandular FeverSpreads by:•Coughing•Sneezing•Kissing

Clinically:

Glandular Fever

Age of presentation: 15 - 40 (usually)

Symptoms: None (usually)(The infection is usually subclinical)

Occassionally….

Glandular FeverClinically:

In Symptomatic cases:

Bilateral cervical lymphadenopathy in 75% of symptomatic casesGeneralized lymphadenopathy in 50% of symptomatic cases

Sore throat >50% of symptomatic cases.

Fever of varying severity

Visual Problems - photophobia – conjuctivitis - peri-orbital oedema

Glandular FeverClinically:

More rarely:Spleno-hepatomegaly

• About 15% of symptomatic cases•About 5% of symptomatic cases are jaundiced

Haemato-pathology

•About 1% of symptomatic cases there is: •Severe anaemia (auto-immune)•Purpura due to thrombocytopenia

Glandular FeverLaboratory Findings:

Nothing abnormal…..

If the patient presents very early in the course of the disease, there will be no

abnormalities evident.

Glandular FeverLaboratory Findings:

An atypical lymphocytosis

•Lymphocyte count of 10 - 20 x10 9 cells/litre is usual in symptomatic cases.

•These cells appear reactive

•Usually evident after a week or so.

In most symptomatic cases of glandular fever there is circulating heterophile antibody.

These are absorbed by ox red cells but not by guinea pig kidney cells

and agglutinate formalized horse red cells

Who thinks this up ??????

Glandular FeverThe Paul – Bunnell Test: (historically)

The GF test

Two drops of plasma

The GF test

Two drops of plasma

Drop some minced guinea pig

in this one

The GF test

Two drops of plasma

Drop some minced guinea pig

in this one

And some minced ox in this one

The GF test

Two drops of plasma

Drop some minced guinea pig

in this one

And some minced ox in this one

The GF test

Two drops of plasma

Drop some minced guinea pig

in this one

And some minced ox in this one

The GF test

Two drops of plasma

Drop some minced guinea pig

in this one

And some minced ox in this one

Mix it in

The GF test

Two drops of plasma

Mix it in

The GF test

Two drops of plasma

Leave for thirty seconds

The GF test

Two drops of plasma

Leave for thirty seconds

The minced ox absorbs the heterophile

antibody

The GF test

Two drops of plasma

Leave for thirty seconds

The minced ox absorbs the heterophile

antibody

The minced guinea pig does

not

The GF test

Two drops of plasma

Add some formalized horse

cells

The GF test

Two drops of plasma

Add some formalized horse

cells

The GF test

Two drops of plasma

Add some formalized horse

cells

The GF test

Two drops of plasma

And mix for one minute

The GF test

Two drops of plasma

The GF test

Two drops of plasma

The heterophile antibody has not been absorbed by the minced guinea

pig

The GF test

Two drops of plasma

And so agglutinates the formalised horse

cells

The GF test

Two drops of plasma

And so agglutinates the formalised horse

cells

The heterophile antibody has been absorbed by the minced ox cells

The GF test

Two drops of plasma

And so agglutinates the formalised horse

cells

And so is no longer present to agglutinate the

formalised horse cells

The GF test - Nowadays

One drop of plasma – “one stage”

One drop of plasma

Add latex coated with purified Paul-Bunnell antigen and mix

Presence of IM heterophile antibody causes agglutination

The GF test - Nowadays

One drop of plasma – one stage

Is this test a good test for glandular fever ?

It doesn’t test for glandular fever

It tests for the body’s reaction to it

Therefore it has limitations

Glandular FeverClinical Chemistry Findings:

Liver function deranged in extreme cases

No treatment The majority of cases are sub clinical

Symptomatic cases have symptomatic treatmentThe condition is self limiting

The very few severe cases may be treated with corticosteroids.

Glandular FeverTreatment:

•Takes 4 - 6 weeks•convalescence is slow•severe malaise & lethargy•Wait for negative GF test….?

Glandular FeverRecovery:

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