Overview of Infectious Mononucleosis and Treatments

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Questions and Answers

Which virus causes infectious mononucleosis?

Infectious mononucleosis is caused by the Epstein-Barr virus (EBV).

What are two common transmission methods of EBV?

EBV is spread through saliva, often by kissing or sharing items like cups or toothbrushes.

Name a common symptom of infectious mononucleosis.

Fever.

What does a maculopapular rash during IM indicate?

It indicates an EBV reaction to taking amoxicillin or cephalosporins. Signup and view all the answers

What test is commonly used to detect heterophile antibodies in suspected IM cases?

The Monospot Test. Signup and view all the answers

What is a potential risk associated with splenomegaly in infectious mononucleosis?

There is a risk of spleen rupture in severe cases. Signup and view all the answers

What is the most common cause of blood loss in adults?

Blood loss from the gastrointestinal (GI) tract. Signup and view all the answers

Identify two common sources of GI bleeding.

Stomach cancer and peptic ulcers. Signup and view all the answers

How does stomach acid affect iron absorption?

Stomach acid helps maintain iron in the soluble ferrous (Fe2+) form, which is essential for absorption. Signup and view all the answers

What is the significance of low ferritin levels?

Low ferritin levels are highly indicative of iron deficiency. Signup and view all the answers

What change occurs in transferrin levels during iron deficiency?

Transferrin levels increase. Signup and view all the answers

What is the formula for calculating transferrin saturation?

Transferrin saturation = serum iron / total iron-binding capacity. Signup and view all the answers

Describe one sign of iron deficiency in children.

Pica, which is the craving for non-food items like soil. Signup and view all the answers

What does high ferritin levels indicate?

High ferritin levels could indicate inflammation, liver disease, iron supplements, or haemochromatosis. Signup and view all the answers

What is the primary aim of palliative chemotherapy?

To improve quality of life and survival in advanced cases. Signup and view all the answers

Which treatments are primarily used for Small Cell Lung Cancer (SCLC)?

Chemotherapy and radiotherapy. Signup and view all the answers

Define exudative pleural effusion.

An exudative pleural effusion is characterized by a high protein content (greater than 30 g/L) due to inflammatory processes. Signup and view all the answers

What is Light’s Criteria used for in relation to pleural effusions?

To determine if a pleural effusion is exudative. Signup and view all the answers

Name two causes of transudative pleural effusion.

Congestive cardiac failure and hypoalbuminaemia. Signup and view all the answers

What is the primary symptom of pleural effusion?

Shortness of breath. Signup and view all the answers

What happens to the chest drain's water level during respiration?

It swings due to pressure changes in the chest. Signup and view all the answers

List one exudative cause of pleural effusion.

Cancer, such as lung cancer or mesothelioma. Signup and view all the answers

What is the genetic inheritance pattern of sickle cell anaemia, and how does it differ from sickle cell trait?

Sickle cell anaemia is inherited in an autosomal recessive manner, where two abnormal copies of the gene are present, whereas sickle cell trait occurs with just one abnormal copy, making the individual asymptomatic. Signup and view all the answers

Explain the role of haemoglobin S (HbS) in sickle cell anaemia.

Haemoglobin S (HbS) replaces normal adult haemoglobin (HbA) in individuals with sickle cell anaemia, causing the red blood cells to deform into a sickle shape. Signup and view all the answers

Identify two surgical interventions that may be necessary in managing complications of sickle cell anaemia.

Splenectomy for severe splenomegaly and cholecystectomy for gallstones are two surgical interventions that may be needed. Signup and view all the answers

What are some common triggers of sickle cell crises?

Common triggers of sickle cell crises include dehydration, infection, stress, and exposure to cold weather. Signup and view all the answers

How does sickle cell trait provide a selective advantage in malaria-endemic regions?

Individuals with sickle cell trait have increased resistance to malaria, which explains the higher prevalence of the gene in malaria-affected areas. Signup and view all the answers

Describe the typical management strategies employed during a sickle cell crisis.

Management during a sickle cell crisis typically includes supportive care such as hospital admission, hydration through IV fluids, warmth, and pain management. Signup and view all the answers

What screening methods are used for early detection of sickle cell disease?

Newborn screening involves a blood spot test around 5 days of age, while antenatal screening is offered to pregnant women at high risk of carrying the sickle cell gene. Signup and view all the answers

List two potential complications arising from sickle cell anaemia.

Two potential complications include anaemia and increased risk of infection. Signup and view all the answers

What are the key characteristics seen on a chest X-ray for primary TB?

Patchy consolidation, pleural effusions, and hilar lymphadenopathy. Signup and view all the answers

What does a positive result in an Interferon-Gamma Release Assay (IGRA) indicate?

It indicates prior contact with Mycobacterium tuberculosis. Signup and view all the answers

Why is it important to collect sputum cultures before initiating TB treatment?

To assess for drug resistance and confirm the presence of TB bacteria. Signup and view all the answers

What is a distinguishing feature of miliary TB on a chest X-ray?

It presents with a 'millet seed' appearance—small, uniformly distributed nodules. Signup and view all the answers

What is the treatment regimen for Isoniazid and Rifampicin in latent TB?

It is taken for 3 months. Signup and view all the answers

What role do Nucleic Acid Amplification Tests (NAAT) play in TB diagnosis?

They detect TB DNA for quicker diagnosis than traditional culture. Signup and view all the answers

Study Notes

Nasal Cautery

Silver nitrate sticks are used to cauterize bleeding vessels.

Post-Treatment Care

Naseptin Nasal Cream contains chlorhexidine and neomycin.
Apply Naseptin Nasal Cream four times daily for 10 days.
It is used to reduce crusting, inflammation, and potential infection.
Do not use Naseptin Nasal Cream if the patient has a peanut or soya allergy.

Overview of Infectious Mononucleosis (IM)

Infectious mononucleosis (IM) is caused by the Epstein-Barr virus (EBV).
IM is commonly known as “glandular fever” or “mono.”
The virus is spread through saliva, often by kissing or sharing items like cups or toothbrushes.
EBV can be infectious weeks before symptoms appear and intermittently for the patient's lifetime.
Most people contract EBV in childhood with few symptoms.
When infection occurs in adolescents or young adults, it results in more symptomatic disease (IM).

Key Features of Infectious Mononucleosis (IM)

Common symptoms include fever, sore throat, fatigue, swollen lymph nodes, red and swollen tonsils with white or yellow coating, and enlarged spleen.
A distinctive itchy rash can develop in patients who take amoxicillin or cephalosporins during IM.
This rash is an EBV reaction to the antibiotics.

Diagnosis of Infectious Mononucleosis (IM)

Heterophile antibodies are non-specific but help confirm IM when EBV-specific tests are unavailable.
The Monospot Test uses horse red blood cells that react with heterophile antibodies in the patient's blood.
The Paul-Bunnell Test uses sheep red blood cells.
Both tests have high specificity for IM (almost 100%).

Blood Loss

The most common cause of blood loss in adults is bleeding from the gastrointestinal (GI) tract.
In menstruating women, heavy periods (menorrhagia) are a common cause.
In non-menstruating women and men, GI tract bleeding is often the source.
Potential sources of GI bleeding include cancer of the stomach or bowel, oesophagitis, gastritis, peptic ulcers, inflammatory bowel disease, and angiodysplasia.

Dietary Insufficiency in Children

High growth demands in children often exceed dietary iron intake.
Pica (eating non-food items like soil) can be a sign of iron deficiency in children.

Absorption Mechanism

Iron is absorbed primarily in the duodenum and jejunum.
Iron is absorbed in its soluble ferrous (Fe2+) form.
Stomach acid helps maintain the ferrous form.
Low stomach acid can hinder iron absorption by converting it to insoluble ferric (Fe3+) form.
Conditions like coeliac disease or Crohn’s disease in the duodenum or jejunum impair iron absorption.

Testing for Iron Levels

Transferrin is a protein that binds and transports iron in the blood.
Total Iron-Binding Capacity (TIBC) is a measure of the amount of transferrin available to bind iron.
Transferrin Saturation is the percentage of transferrin bound with iron.
Ferritin is a protein that stores iron within cells and acts as an acute-phase protein.
Low Ferritin is highly indicative of iron deficiency.
High Ferritin could indicate inflammation, liver disease, iron supplements, or haemochromatosis.
Serum Iron levels fluctuate throughout the day and rise after meals rich in iron.

Interpretation of Iron Markers

Iron Deficiency is indicated by increased TIBC and transferrin levels, and decreased transferrin saturation.
Iron Overload is indicated by high serum iron, transferrin saturation, and ferritin, with low TIBC.

Iron Chelation

Iron chelation is essential to prevent complications from iron overload.

Surgical Interventions for Infectious Mononucleosis

Splenectomy may be needed for severe splenomegaly.
Cholecystectomy may be needed for gallstones.

Curative Option for Infectious Mononucleosis

Bone marrow transplant is a curative option in severe cases, particularly for thalassaemia major.

Overview of Sickle Cell Anaemia

Sickle cell anaemia is an autosomal recessive genetic disorder.
The disorder causes red blood cells (RBCs) to become sickle or crescent-shaped due to abnormal haemoglobin S (HbS).
The sickle shape makes RBCs more fragile, leading to haemolytic anaemia and sickle cell crises.

Pathophysiology of Sickle Cell Anaemia

Haemoglobin S (HbS) replaces normal adult haemoglobin (HbA) in affected individuals.
The mutation affects the beta-globin gene on chromosome 11.
Sickle Cell Trait occurs when an individual carries one abnormal copy of the gene (asymptomatic).
Sickle Cell Disease occurs when an individual carries two abnormal copies of the gene (symptomatic).

Relation to Malaria

Individuals with sickle cell trait are more resistant to malaria.
This selective advantage explains the higher prevalence of the gene in regions with a history of malaria.

Screening for Sickle Cell Anaemia

Newborn screening is conducted using a blood spot test at around 5 days of age.
Antenatal screening is offered to pregnant women at high risk of carrying the sickle cell gene.

Complications of Sickle Cell Anaemia

Anaemia
Increased infection risk
Chronic kidney disease
Sickle cell crises
Acute chest syndrome
Stroke
Avascular necrosis
Pulmonary hypertension
Gallstones
Priapism

Sickle Cell Crisis

Sickle cell crises are acute exacerbations of the disease, which can range from mild to life-threatening.
Triggers for crises include dehydration, infection, stress, or cold weather.

Management of Sickle Cell Crisis

Supportive care includes hospital admission, hydration (IV fluids), warmth, and pain management.
Avoid NSAIDs in patients with renal impairment.

Types of Sickle Cell Crisis

Vaso-occlusive Crisis (VOC): Sickle cells obstruct capillaries, causing distal ischaemia.
Aplastic Crisis: Temporary decrease in RBC production.
Splenic Sequestration Crisis: Excessive pooling of blood in the spleen.
Hyperhemolytic Crisis: Increased rate of RBC destruction.

Small Cell Lung Cancer (SCLC)

SCLC is primarily treated with chemotherapy and radiotherapy.
It has a poorer prognosis than Non-Small Cell Lung Cancer (NSCLC).

Endobronchial Treatments

Stents or debulking can provide palliative relief for airway obstruction.

Chest Drains

Chest drains are used post-thoracic surgery to remove air and fluid, allowing lung expansion.
The drain is placed underwater to prevent air reentry; bubbles allow air to escape while preventing backflow.
The water in the chest drain swings with respiration due to pressure changes in the chest.

Overview of Pleural Effusion

A pleural effusion is a collection of fluid in the pleural space between the lungs and chest wall.
Exudative Effusion has high protein content (> 30 g/L) due to inflammatory processes.
Transudative Effusion has low protein content (< 30 g/L) due to non-inflammatory processes.

Light’s Criteria for Exudative Effusions

These criteria are used to determine if an effusion is exudative:
- Pleural fluid protein / serum protein > 0.5
- Pleural fluid LDH / serum LDH > 0.6
- Pleural fluid LDH > 2/3 of the upper limit of normal for serum LDH

Causes of Pleural Effusion

Exudative Causes:
- Cancer (e.g., lung cancer, mesothelioma)
- Infection (e.g., pneumonia, tuberculosis)
- Rheumatoid Arthritis
Transudative Causes:
- Congestive Cardiac Failure
- Hypoalbuminaemia
- Hypothyroidism
- Meigs Syndrome (a triad of a benign ovarian tumour, pleural effusion, and ascites)

Presentation of Pleural Effusion

The primary symptom is shortness of breath.
Examination findings include:
- Dullness to percussion over the effusion area
- Reduced breath sounds
- Tracheal deviation away from the effusion in cases of large effusions

Investigations for Pleural Effusion

Tests for immune response (to detect exposure, latent, or active TB) include:
- Mantoux Test (skin test using purified protein derivative (PPD))
- Interferon-Gamma Release Assay (IGRA) (blood test to detect immune response to TB antigens)
Tests for active disease include:
- Chest X-ray
- Sputum Cultures

Diagnostic testing for Tuberculosis

Mantoux Test:
- A small amount of tuberculin (TB proteins) is injected into the forearm, creating a small raised bleb.
- After 72 hours, the induration (firm swelling) at the injection site is measured.
- An induration of ≥5mm is considered positive, indicating TB exposure or infection.
Interferon-Gamma Release Assays (IGRA):
- Blood is mixed with TB antigens.
- Sensitized white blood cells from prior TB exposure release interferon-gamma.
- A positive result indicates prior contact with M. tuberculosis.
Chest X-Ray Findings:
- Primary TB: Patchy consolidation, pleural effusions, and hilar lymphadenopathy.
- Reactivated TB: Patchy or nodular consolidation with cavitation, usually in the upper lung zones.
- Miliary TB: Characterized by "millet seed" appearance—small, uniformly distributed nodules (1-3mm) across lung fields
Cultures:
- Ideally collected before initiating treatment to assess drug resistance.
- Collection methods include:
  - Sputum Cultures (three separate samples required)
  - Blood Cultures (special bottles for Mycobacterium blood cultures)
  - Lymph Node Biopsy or Aspiration
- Special techniques for collecting sputum include:
  - Sputum induction (nebulized saline)
  - Bronchoscopy with lavage (if sputum production is low)
Nucleic Acid Amplification Tests (NAAT):
- Detects TB DNA for quicker diagnosis than traditional culture.
- Employed in high-risk patients (e.g., HIV positive, children under 16) and suspected drug-resistant cases.

Treatment of Tuberculosis

Latent TB:
- Options include:
  - Isoniazid and Rifampicin: Taken for 3 months.
  - Isoniazid: Taken alone for 6 months.

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Description

This quiz covers key points about infectious mononucleosis, including its causes, common symptoms, and transmission methods. It also discusses treatment options such as nasal cautery and the use of Naseptin Nasal Cream for post-treatment care. Test your knowledge on this viral infection and its management.