Blood And Lymph- Ebv & Cmv By Blue

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Blood and Lymph- EBV & CMV by Blue

Back 1

Blood and Lymph- EBV & CMV by Blue

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Triad of mononucleosis

Back 2

1. lymphadenopathy
2. pharyngitis (exudative)
3. fever

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When do you see heterophile antibodies, and what are they?

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when you make Abs to sheep, horse, etc RBCs. not sure why this happens. seen in mono from epstein-barr, but not CMV mono.

Front 4

what is a common misdiagnosis for mono?

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strep pharyngitis, where you also see a rash. but it's a different rash.

in mono, there's a transient allergic response to penicillins, so if you give ampicillin to treat strep, and you see a rash, you can suspect mono.

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difference between ebv mono and cmv

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both have the same clinical presentations, but cmv can give you fetal infections. also, im cmv, there are NO heterophile antibodies.

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Write out the pathogenesis.

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oral-> easy into epithelial cells causes productive virus; pharyngitis (may see oral hairy cell leukoplakia, can't be scraped off tongue)

infection of B cells can't fully support EBV replication, doesnt lead to virus production/cell destruction. migration to lymph nodes (causes lymphadenopathy). within the nucleus, the virus stays as extrachromosomal DNA and is latent (but may activate later). this partial expression can block apoptosis and stimulate telomerase (immortality) leading to massive proliferation and symptoms.

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who fights these crazy B-cells?

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T-cells vs B-cells (with expressed antigen).
These activated T-cells (also called Downey cells or atypical lymphocytosis) eventually kill enough infected B-cells so the symptoms subside, but there still can be B-cells with the virus that may reactivate and replicate and spread to someone else.

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epidemiology. how is this mono spread? when is the infection most common? what percent of the world's adult population has been infected by ebv?

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B. Epidemiology: over 90% of world’s adult population has been infected with EBV (retained latently).
1. Infection most common ages 1-5. Usually asymptomatic.
2. Mono most common among adolescents and young adults, esp. teens, 10-19 yrs. Overall incidence 8/1000; College students, 48/1000; >30, less than 1/1000. Considered endemic in educational institutions.
3.Transmission via saliva, especially by kissing. Incubation period 30-50 days. Infectious for many months after recovery. Intermittent spread thereafter. Fomites, blood transfer.
4.Sporadic asymptomatic reactivation, likely for life. Rare cases of recurrent/chronic symptomatic illness (prolonged fatigue). Not linked to Chronic Fatigue Syndrome.

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Burkitt's Lymphoma.

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c-myc, 8:14

Anti-herpesviral drugs inhibit EBV, but not indicated (a disease of gene expression.)

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Can cytomegalovirus be spread from mother to fetus?

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yes. especially if pregnant female is infected for the first time during pregnancy (before an immune response is generated).

Cytomegalic Inclusion Disease is the most common infectious cause of fetal disabilities.

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Cytomegalic Inclusion Disease

what are temporary and permanent symptoms?

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(CID) prenatal, neonatal, or postnatal. Mother to fetus or newborn. Multi-organ system.

temp:
liver dysfunction (jaundice)
enlarged spleen
seizures

permanent:
hearing loss
vision loss
mental disability/retardation

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What can you see if you have a reactivation of CMV in the immunosuppressed (HIV, transplant)

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*retinitis, esophagitis

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Histologically, what can you see in CMV?

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OWL-EYE CELLS (Reed Sternberg cells)
-related to hodgkins

treat with gancyclovir