Infectious mononucleosis 3 Essay, Research Paper

Infectious glandular fever & # 8212 ; known popularly as & # 8220 ; mono & # 8221 ; or & # 8220 ; the caressing disease & # 8221 ; & # 8212 ; has been recognized for more than a century. An estimated 90 per centum of glandular fever instances are caused by the Epstein-Barr virus ( EBV ) , a member of the herpes virus group. Most of the staying instances are caused by certain other herpes viruses, peculiarly cytomegalo virus. This fact sheet focuses on glandular fever caused by EBV. EBV is a common virus that scientists estimate has infected over 90 per centum of people aged 40 or older sometime during their lives. These infections can happen with no symptoms of disease. Like all herpes viruses, EBV remains in the organic structure for life after infection, normally kept under control by a healthy immune system. Almost anyone at any age can acquire glandular fever. Seventy to 80 per centum of all documented instances, nevertheless, involve individuals between the ages of 15 and 30. Both work forces and adult females are affected, but surveies suggest that the disease occurs somewhat more frequently in work forces than in adult females. Doctors estimate that each twelvemonth 50 out of every 100,000 Americans have mononucleosis symptoms. Among college pupils, the rate is several times higher. Infectious mononucleosis does non happen in any peculiar & # 8220 ; season, & # 8221 ; although governments in colleges and schools, where the disease has been good studied, report that they see most patients in the autumn and early spring. Epidemics do non happen, but physicians have reported bunch of instances. Transmission: EBV, the virus that causes most instances of glandular fever, infects and reproduces in the salivary secretory organs. It besides infects white blood cells called B cells. Direct contact with virus-infected spit, such as through caressing, can convey the virus and consequence in glandular fever. Person with glandular fever, nevertheless, does non necessitate to be isolated. Household members or college roomies have merely a little hazard of being infected unless they come into direct contact with the patient & # 8217 ; s spit. A individual is infective several yearss before symptoms appear and for some clip after acute infection. No 1 knows how long this period of infectiousness stopping points, although the virus can be found routinely in the spit of most people with glandular fever for at least six months after the acute infection has subsided. It can be detected in the spit of about 15 per centum of people for old ages after first infection. Symptoms: Symptoms may take between two and seven hebdomads to develop after exposure to the virus and can last a few yearss or every bit long as several months. In most instances, nevertheless, they disappear in one to three hebdomads. In fact, glandular fever symptoms may be nonexistent or so mild that most people are non even cognizant of their unwellness. In striplings and immature grownups, the unwellness normally develops easy and early symptoms are obscure. Symptoms may include a general ailment of & # 8220 ; non experiencing good, & # 8221 ; concern, weariness, coolness, bouffant palpebras, and loss of appetency. Subsequently, the familiar three of symptoms appears: febrility, sore pharynx, and conceited lymph secretory organs, particularly at the side and dorsum of the cervix, but besides under the arm and in the inguen. A febrility of 101.F to 105.F stopping points for a few yearss and sometimes continues intermittently for one to three hebdomads. ( High febrility tardily in the unwellness suggests bacterial complications. ) The conceited lymph secretory organs, changing in size from that of a bean to a little egg, are stamp and house. Swelling bit by bit disappears over a few yearss or hebdomads. The lien is enlarged in 50 per centum of glandular fever patients, and the liver is enlarged in 20 per centum. Tonsillitis, trouble in get downing, and shed blooding gums may attach to these symptoms. Rarely, icterus or a roseola that lasts one or two yearss is present. In immature kids and older grownups ( more than 35 old ages old ) , glandular fever may be hard to name because the typical glandular fever symptoms are non present. A physician may surmise glandular fever in older grownups, nevertheless, if the patient has had a high febrility for at least a hebdomad, has an enlarged liver, has unnatural liver map surveies, or has neurological symptoms. In kids, EBV infection can bring forth a different image. A kid may hold a mild sore pharynx or tonsillitis or have no symptoms at all, and the unwellness frequently goes unrecognized by the parent or instructor. Diagnosis: As glandular fever symptoms appear, the organic structure reacts to the virus in certain typical ways that can be detected through research lab trials. White blood cells called lymph cells addition in figure ( a procedure known as lymph cells ) , and atypical-looking ( activated ) lymphocytes involved in contending the virus infection are normally seen in blood samples. The organic structure produces antibodies, or specific proteins, that protect against EBV. Blood trials that step lymphocytes and antibodies assistance in the diagnosing of glandular fever. In EBV infection, the organic structure & # 8217 ; s immune system besides produces more of substances called heterophil antibodies ( Paul-Bunnell antibodies ) . These antibodies indicate that an EBV infection is present in the organic structure, but they are non directed against the virus itself and make non function a protective map. Because other types of infections and immunologic reactions besides induce heterophil antibodies, their presence suggests, but does non bespeak specifically, an EBV infection. Symptoms play an of import function in the diagnosing of glandular fever. But because this disease can masquerade as other diseases, symptoms can be misdirecting. They may resemble, for case, the sore pharynx of a & # 8220 ; strep & # 8221 ; infection, the painful stiff cervix of meningitis, the abdominal strivings of acute appendicitis, the cough and pharynx lesions of diphtheria, the roseola of German measles or rubeolas, or the conceited lymph secretory organs seen in certain signifiers of malignant neoplastic disease. Rapid and cheap blood trials can observe heterophil antibodies in approximately 80 per centum of individuals with a current or recent infection. These antibodies can look in sufficient strength to give a positive diagnosing every bit early as the 4th twenty-four hours and by and large by the 21st twenty-four hours of unwellness. Heterophil antibodies can prevail for months, nevertheless, so their visual aspect does non turn out current infection. Furthermore,

the level of heterophil antibodies in the blood does not correlate with the severity of symptoms. The slide agglutination mono “spot test,” which is widely used to screen for heterophil antibodies, is inexpensive, requires less than three minutes, and can be performed in a physician’s office. Spot tests are generally accurate, but they can give false positive or false negative results. Sometimes, appearance of heterophil antibodies is delayed, and a repeat test may be necessary to establish a diagnosis. Moreover, young children, older adults, and individuals with EBV infections that do not resemble classic mononucleosis are less likely to develop heterophil antibodies. If a patient with negative spot test results is seriously ill or has unusual symptoms, the doctor should conduct additional tests to rule out other illnesses or infections (such as HIV infection, toxoplasmosis or rubella). An EBV serologic profile is a series of blood tests that, if done and interpreted correctly, will provide a definite diagnosis of mononucleosis that is caused by EBV. Appearance of the antibodies specific for EBV proteins correlates with the stages of infection. The profile is highly accurate, but it is expensive. All physicians have access to laboratories that can perform these tests if they are necessary. The single most meaningful test result to confirm a recent EBV infection is the demonstration of immunoglobulin M (IgM) antibodies to an EBV protein called the viral capsid antigen (VCA). This assay can be done several ways, but unfortunately some of the commercial test kits are overly sensitive and give false positive results. Another way to prove recent EBV infection is to have blood collected at two separate time points, preferably at the first sign of symptoms and again three to four weeks later. The doctor will send both blood samples together to a lab for testing. A more than four-fold increase in immunoglobulin G (IgG) antibodies to several of the EBV-VCA proteins indicates recent infection. Treatment and Recovery: Usually, mononucleosis is an acute, self-limited infection for which there is no specific therapy. For years, standard treatment was bed rest for four to six weeks, with limited activity for three months after all symptoms had disappeared. Today, doctors usually only recommend avoiding strenuous exercise. One real hazard of uncomplicated mononucleosis is the possibility of damaging one’s enlarged spleen. Therefore, the patient should avoid lifting, straining, and competitive sports until recovery is complete. A person should limit other activity according to symptoms and how he or she feels. Treatment of the acute phase of the illness is symptomatic and nonspecific because there is no specific drug treatment for mononucleosis. Rest, plenty of fluids to guard against dehydration, and a well-balanced diet are recommended. Doctors usually recommend acetaminophen or ibuprofen for headache, muscle pains, and chills, and salt gargles for sore throats. (Children and adolescents with a fever should not take aspirin because it can increase the risk of Reye syndrome.) Oral steroid drugs such as prednisone can help lessen some of the symptoms of mononucleosis, but because of their potential toxicity, these drugs are best reserved for treating severe complications. Antibiotics are ineffective against viruses, and they should not be prescribed for mononucleosis itself. Some patients with mononucleosis also develop streptococcal (bacterial) throat infections, which should be treated with penicillin or erythromycin. Ampicillin (a form of penicillin) should not be used. When mononucleosis patients take ampicillin, 70 to 80 percent develop a rash for unknown reasons. Although not a true allergic reaction, the rash may be diagnosed as such, and the patient may be instructed unnecessarily to avoid penicillin in the future. More than 90 percent of mononucleosis infections are benign and uncomplicated, but fatigue and weakness that continue for a month or more are not uncommon. The illness may be more severe and last longer in adults over the age of 30. Airway obstruction, rupture of the spleen, inflammation of the heart or tissues surrounding the heart, and severe bone marrow or central nervous system involvement are rare, life-threatening complications that are treated with steroid drugs. If the spleen should rupture, a doctor will immediately have to remove it surgically and start transfusions and other therapy for shock. Although EBV remains in the body indefinitely following a bout of mononucleosis, the disease rarely recurs. Nearly all individuals who have repeated mono-like illnesses either have a seriously impaired immune system, such as transplant recipients, or are actually experiencing sequential infections with different viruses that can provoke similar symptoms. In addition, several scientific studies now have confirmed that EBV does not cause chronic fatigue syndrome. Further Research: Scientists believe that increased knowledge of normal and abnormal immune responses will lead to an understanding of how EBV can cause a relatively benign illness, like mononucleosis, and also play a role in much more serious, sometimes fatal, diseases. Epstein and Barr, two British scientists after whom EBV is named, first found evidence of the virus in B-lymphocytes of patients with a rare form of cancer of the lymph system. This cancer, known as Burkett s lymphoma, occurs primarily in Africa. Scientists have learned a lot about how EBV affects the body’s cells in mononucleosis. EBV is known to increase the number of B-lymphocytes, which have receptors for the virus on their surfaces. The normal response of the body to this increase in B cells is a corresponding increase in T lymphocytes, another component of the immune system, which change in appearance to become atypical cells. Some of these T cells apparently limit the spread of the virus from cell to cell; others suppress the production of the B cells. This suppression is what seems to eliminate the infection. Normally, the T cell response subsides as the patient recovers from mononucleosis.