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Viral Infectious diseases (Glandular fever, HPV, CMV)

Viral Infectious diseases (Glandular fever, HPV, CMV). Done by: Hisham Al-Hammadi. Glandular fever (Infectious Mononucleosis). Caused by EBV (90% of cases). Associated with the presence of atypical mononuclear cells in the blood.

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Viral Infectious diseases (Glandular fever, HPV, CMV)

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  1. Viral Infectious diseases (Glandular fever, HPV, CMV) Done by: Hisham Al-Hammadi

  2. Glandular fever (Infectious Mononucleosis) • Caused by EBV (90% of cases). • Associated with the presence of atypical mononuclear cells in the blood. • Is not uncommon in young children but is often asymtomatic or atypical. • EBV infects up to 95% of the world’s population

  3. Clinical features: • Incubation period in adolescent is 30-50 days, shorter in children. • Infection is usually asymptomatic in infants and young children. • Early symptoms consist of malaise, fatigue, fever, headache, sore throat and nausea. • Hepatosplenomegaly and enlarged L.N are usually present. • Sore throat is accompanied by pharyngitis with tonsillar enlargement. • Petechial hemorrhage in the soft plate. • Maculopapular skin rashes (3- 15%). • 80% develop rashes if treated with ampicillin or amoxicillin. • The course of the illness is variable but in most cases symptoms subside within 2-4 weeks.

  4. Diagnosis: • Lymphocytosis with atypical lymphocytes. • EBV-specific antibodies. • Monospot test to detect presence of heterophile antibodies (false negative common in children. • Differential diagnosis: • CMV infection, toxoplasmosis, hepatitis A, lymphoma, and leukemia.

  5. Complications: • The most feared complication is splenic rupture. • Swelling of the tonsils & oropharyngeal lymphoid tissue may cause airway impairment. • Hepatitis with clinical jundice. • Aseptic meningitis or encephalitis.

  6. Treatment: • There is no specific treatment. • Supporting & bed rest are indicated. • Avoid contact sports for one month (risk of splenic rupture) • Acyclovir may have some beneficial effects in life threatening EBV infection. • Corticosteroids can be used for respiratory distress resulting from tonsillar hypertrophy.

  7. Human Papillomavirus (HPV) • Over 50 different types have been identified. • The different HPV types typically cause disease in different anatomic sites (about half of HPV types have been identified in genital tract). • Mode of transmission: • Sexual contact (genital, oral warts). • Skin to skin contact (plantar, hand warts).

  8. Clinical features: • Lesions of the skin are proliferative, popular, and hyperkeratotic. • They may be single or multiple and are usually localized to a limited anatomic area. • Common warts: genital warts, laryngeal warts (recurrence common) • Dysplastic changes of the utrine cervix (usually without symptoms). • Respiratory papillomatosis may present with hoarseness, dyspnea, stridor, or cough. • Diagnosis: • Clinical • PAP smear • ELISA, PCR • Application of 3% acetic acid to infected epithelium may show whitening (acetowhite change) • Genital warts can be distinguished from condyloma lata of secondary syphilis by syphilis serology.

  9. Treatment: • Most cutaneous warts will resolve spontaneously and may not require treatment. • Treatment usually involves surgical removel or physical or chemical destruction of abnormal tissue using cryotherapy, laser vaporization, trichloroacetic acid, podophyllotoxin. • Interferon has been used in some cases of genital and respiratory papillomas. • Recurrence rate is high.

  10. Cytomegalovirus (CMV) • Is the most common congenital viral infection. • Mode of transmission: • Sources of CMV include saliva, milk, cervical & vaginal secretions, urine, semen, stools, and blood. • The spread of CMV requires very close contact because it is very labile. • Transmission occurs by direct person to person contact, but indirect transmission is possible via contaminated fomites. • Vertical transmission. • Organ/ blood donation.

  11. Clinical features: • Infection acquired early and usually asymptomatic. • Congenital disease (severity ranging from rash and hearing loss to microcephaly and mental retardation). • CMV “mononucleosis” syndrome: fever splenomegaly, abnormal LFTs, lymphocytosis • Can affect a number of organs causing retinitis, hepatitis, pneumonitis, esophagitis etc • Diagnosis: • culture • cytology • serology • antigen detection, PCR

  12. Treatment: • No vaccine or antiviral therapy is available for prevention or treatment of congenital CMV infection • ganciclovir has been used to treat life-threatening CMV infections in immunocompromised hosts.

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