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Mononuleosis

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  • Mononuleosis




    Infectious mononucleosis

    Infectious mononucleosis,

    (also known as the kissing disease, or Pfeiffer's disease,
    in North America as mono and more commonly known as glandular fever in other English-speaking countries
    ) is seen most commonly in adolescents and young adults,

    characterized in teenagers by fever, sore throat, muscle soreness, and fatigue
    . Mononucleosis is usually caused by the Epstein-Barr virus (EBV), which infects B cells (B-lymphocytes), producing a reactive lymphocytosis and atypical T cells (T-lymphocytes) known as Downey bodies.

    Mononucleosis is typically transmitted from asymptomatic individuals through saliva, earning it the name "the kissing disease", or by sharing a drink, or sharing eating utensils.

    It may also be transmitted through blood. The disease is far less contagious than is commonly thought.
    Mono is not spread through the air. It is even possible to live in the same house with a person and never acquire the virus. In rare cases a person may have a high resistance to infection.[citation needed] The disease is so-named because the count of mononuclear leukocytes (white blood cells with a one-lobed nucleus) rises significantly.

    There are two main types of mononuclear leukocytes: monocytes and lymphocytes. They normally account for about 35% of all white blood cells.

    With infectious mononucleosis, this can rise to 50-70%. Also, the total white blood count may increase to 10,000-20,000 per cubic millimeter.

    Symptoms

    Symptoms usually appear 4-6 weeks after exposure to infected other, and may resemble strep throat, or other bacterial or viral respiratory infections. The typical symptoms and signs of mononucleosis are:

    Fever—this varies from mild to severe, but is seen in nearly all cases.

    Tender and enlarged/swollen lymph nodes—particularly the posterior cervical lymph nodes, on both sides of the neck.
    Sore throat—White patches on the tonsils and back of the throat are often seen
    Fatigue (sometimes extreme fatigue)
    Some patients also display:
    Enlarged spleen (splenomegaly, which may lead to rupture) and/or liver (hepatomegaly)
    Petechial hemorrhage
    Abdominal pain - a possible symptom of a potentially fatal rupture of the spleen.[1]
    Aching muscles
    Headache
    Loss of appetite
    Depression
    Weakness
    Skin rash
    Dizziness or disorientation
    Uncontrolled shaking at times
    Dry cough

    Supra-orbital oedema—the eyes become puffy and swollen—may occur in the early stages of infection

    After an initial prodrome of 1-2 weeks, the fatigue of infectious mononucleosis often lasts from 1-2 months. The virus can remain dormant in the B cells indefinitely after symptoms have disappeared, and resurface at a later date.

    Many people exposed to the Epstein-Barr virus do not show symptoms of the disease, but carry the virus. This is especially true in children, in whom infection seldom causes more than a very mild cold which often goes undiagnosed. Children are typically just carriers of the disease. This feature, along with mono's long (4 to 6 week) incubation period, makes epidemiological control of the disease impractical. About 6% of people who have had infectious mononucleosis will relapse.

    Mononucleosis can cause the spleen to swell. Rupture may occur without trauma, but impact to the spleen is also a factor. Other complications include hepatitis (inflammation of the liver) causing elevation of serum bilirubin (in approximately 40% of patients), jaundice (approximately 5% of cases), and anemia (a deficiency of red blood cells). In rare cases, death may result from severe hepatitis or splenic rupture.

    Usually, the longer the infected person experiences the symptoms the more the infection weakens the person's immune system and the longer he/she will need to recover.[citation needed] Cyclical reactivation of the virus, although rare in healthy people, is often a sign of immunological abnormalities in the small subset of organic disease patients in which the virus is active or reactivated.

    Although all cases of mononucleosis are caused by the E.B. virus, cytomegalovirus can produce a similar illness, usually with less throat pain. Due to the presence of the atypical lymphocytes on the blood smear in both conditions, some physicians confusingly used to include both infections under the diagnosis of "mononucleosis," though EBV is by definition the infection that must be present for this illness.

    Symptoms similar to those of mononucleosis can be caused by adenovirus, acute HIV infection and the protozoan Toxoplasma gondii.

    Atypical presentations of mononucleosis/EBV infection
    In small children, the course of the disease is frequently asymptomatic. Some adult patients suffer fever, tiredness, lassitude (abnormal fatigue), depression, lethargy, and chronic lymph node swelling, for months or years.

    This variant of mononucleosis has been referred to as chronic EBV syndrome or chronic fatigue syndrome, although the most recent medical studies have discounted the link between chronic EBV infection and chronic fatigue syndrome (CFS)[ In case of a weakening of the immune system, a reactivation of the Epstein-Barr Virus is possible; in CFS there is evidence of immune activation also.

    Laboratory tests


    An atypical lymphocyte.
    The laboratory hallmark of the disease is the presence of so-called atypical lymphocytes (a type of mononuclear cell, see image) on the peripheral blood smear. In addition, the overall white blood cell count is almost invariably increased, particularly the number of lymphocytes.
    The Paul Bunell test is an agglutination test usable to detect non-EBV heterophile antibodies that are present in infectious mononucleosis.
    Specific EBV antibody detection tests are available.


    Treatment

    Infectious mononucleosis is generally self-limiting and only symptomatic and/or supportive treatments are used.[3] Rest is recommended during the acute phase of the infection, but activity should be resumed once acute symptoms have resolved. Nevertheless heavy physical activity and contact sports should be avoided to abrogate the risk of splenic rupture, for at least one month following initial infection and until splenomegaly has resolved, as determined by ultrasound scan.[3]
    In terms of pharmacotherapies, acetaminophen/paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce fever and pain – aspirin is not used due to the risk of Reye's syndrome in children and young adults. Intravenous corticosteroids, usually hydrocortisone or dexamethasone, are not recommended for routine use[4] but may be useful if there is a risk of airway obstruction, severe thrombocytopenia, or hemolytic anemia.[5][6]
    There is little evidence to support the use of aciclovir, although it may reduce initial viral shedding.[7] However, the antiviral drug valacyclovir has recently been shown to lower or eliminate the presence of the Epstein-Barr virus in subjects afflicted with acute mononucleosis, leading to a significant decrease in the severity of symptoms.[8][9][10] Antibiotics are not used as they are ineffective against viral infections. The antibiotics amoxicillin and ampicillin are contraindicated in the case of any coinciding bacterial infections during mononucleosis because their use can frequently precipitate a non-allergic rash. In a small percentage of cases, mononucleosis infection is complicated by co-infection with streptococcal infection in the throat and tonsils (strep throat). Penicillin or other antibiotics (with the exception of the two mentioned above) should be administered to treat the strep throat. Opioid analgesics are also contraindicated due to risk of respiratory depression.[5]
    الملفات المرفقة
    التعديل الأخير تم بواسطة soma; الساعة 29-12-2007, 09:53 PM.
    ان عشت فعش حرا أومت كالاشجار وقوفا


    sigpic

  • #2
    يعطيكي العافية .... وانا بقرا تزكرت بايام الجامعة....الله يرحم هديك الايام
    معلومات شاملة كتيير عن كل اشي بيخص هلمرض


    والله يعافينا يارب
    Life is different than a teacher, A teacher teaches u a lesson & then keeps the exam..
    But the LIFE keeps the exam first & then teachs u the lesson
    ..

    :sm198:

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    • #3
      hehehe
      gd allah yer7amha

      kanat ayam wala arw3

      thank u for nice passing

      god bless u
      ان عشت فعش حرا أومت كالاشجار وقوفا


      sigpic

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      • #4
        good work soma as usual i hope you can writte more in details about the laboratory diiagnosis
        :extra77:

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        • #5
          sorry for late

          hiiiiii


          this file contain

          Describtion of the etiology and clinical significance of heterophile antibodies.



          Discuss the difference between the Presumptive and Differential heterophile antibody tests.
          Describe the significance of antibody titer with respect to heterophile antibody.

          Describe the principles of the Paul Bunnell, Davidsohn, and Card tests for IM heterophile antibody.
          Identify the etiologic agent of Infectious Mononucleosis
          .


          i hope it's easy and useful
          الملفات المرفقة
          التعديل الأخير تم بواسطة soma; الساعة 09-02-2008, 11:04 PM.
          ان عشت فعش حرا أومت كالاشجار وقوفا


          sigpic

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          • #6
            thank you so much my dear on this useful file

            my greet for you
            الحياة مليئة بالحجارة..فلا تتعثر بها بل اجمعها وابن بها سّلما تصعد به نحو النجاح

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            • #7
              u r welcome

              and thnx 4 ur nice passing
              ان عشت فعش حرا أومت كالاشجار وقوفا


              sigpic

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              • #8
                thank you so much my dear on this useful file

                my greet for you

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                • #9
                  موضوع رائع يعطيك العافية
                  ألف شكر
                  قال رسول الله صلى الله عليه وسلم :

                  من سلك طريقاً يلتمس فيه علماً .. سهل الله له به طريقاً
                  إلى
                  الجنه

                  لا خير في كاتم علم

                  يا حي يا قيوم برحمتك أستغيث أصلح لي شأني كله و لا تكلني إلى نفسي طرفة عين


                  مع أطيب التمنيات
                  CAESAR22

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                  • #10
                    شكرا على الموضوع

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