Mucocutaneous Manifestations of Viral Diseases: An Illustrated Guide to Diagnosis and Management

Mucocutaneous Manifestations of Viral Diseases
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Infectious mononucleosis mainly affects younger adults.

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The exact length of time between infection and symptoms is unclear. A review of the literature made an estimate of 33—49 days. It is one of the most commonly found viruses throughout the world. Contrary to common belief, the Epstein—Barr virus is not highly contagious. It can only be contracted through direct contact with an infected person's saliva , such as through kissing or sharing toothbrushes. A minority of cases of infectious mononucleosis is caused by human cytomegalovirus CMV , another type of herpes virus. This virus is found in body fluids including saliva , urine , blood , and tears. Cytomegalovirus is most commonly transmitted through kissing and sexual intercourse.

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It can also be transferred from an infected mother to her unborn child. This virus is often "silent" because the signs and symptoms cannot be felt by the person infected. For those with weak immune systems, cytomegalovirus can cause more serious illnesses such as pneumonia and inflammations of the retina , esophagus , liver , large intestine , and brain. Epstein—Barr virus infection is spread via saliva , and has an incubation period of four to seven weeks. Some studies indicate that a person can spread the infection for many months, possibly up to a year and a half.

The virus replicates first within epithelial cells in the pharynx which causes pharyngitis , or sore throat , and later primarily within B cells which are invaded via their CD The host immune response involves cytotoxic CD8-positive T cells against infected B lymphocytes, resulting in enlarged, atypical lymphocytes Downey cells. When the infection is acute recent onset, instead of chronic , heterophile antibodies are produced.

Cytomegalovirus , adenovirus and Toxoplasma gondii toxoplasmosis infections can cause symptoms similar to infectious mononucleosis, but a heterophile antibody test will test negative and differentiate those infections from infectious mononucleosis. Mononucleosis is sometimes accompanied by secondary cold agglutinin disease , an autoimmune disease in which abnormal circulating antibodies directed against red blood cells can lead to a form of autoimmune hemolytic anemia.

The cold agglutinin detected is of anti-i specificity. The presence of an enlarged spleen , and swollen posterior cervical , axillary , and inguinal lymph nodes are the most useful to suspect a diagnosis of infectious mononucleosis. On the other hand, the absence of swollen cervical lymph nodes and fatigue are the most useful to dismiss the idea of infectious mononucleosis as the correct diagnosis. The insensitivity of the physical examination in detecting an enlarged spleen means it should not be used as evidence against infectious mononucleosis. The heterophile antibody test works by agglutination of red blood cells from guinea pig, sheep and horse.

The antibodies involved in the test do not interact with the Epstein—Barr virus or any of its antigens. The monospot test is not recommended for general use by the CDC due to its poor accuracy. Serologic tests detect antibodies directed against the Epstein—Barr virus.

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Immunoglobulin G IgG , when positive, mainly reflects a past infection, whereas immunoglobulin M IgM mainly reflects a current infection. EBV-targeting antibodies can also be classified according to which part of the virus they bind to:. When negative, these tests are more accurate than the heterophile antibody test in ruling out infectious mononucleosis. When positive, they feature similar specificity to the heterophile antibody test. Therefore, these tests are useful for diagnosing infectious mononucleosis in people with highly suggestive symptoms and a negative heterophile antibody test.

Because their management is much the same, it is not always helpful, or possible, to distinguish between Epstein—Barr-virus mononucleosis and cytomegalovirus infection. However, in pregnant women, differentiation of mononucleosis from toxoplasmosis is important, since it is associated with significant consequences for the fetus. Acute HIV infection can mimic signs similar to those of infectious mononucleosis, and tests should be performed for pregnant women for the same reason as toxoplasmosis.

People with infectious mononucleosis are sometimes misdiagnosed with a streptococcal pharyngitis because of the symptoms of fever, pharyngitis and adenopathy and are given antibiotics such as ampicillin or amoxicillin as treatment.

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Other conditions from which to distinguish infectious mononucleosis include leukemia , tonsillitis , diphtheria , common cold and influenza flu. Infectious mononucleosis is generally self-limiting , so only symptomatic or supportive treatments are used. Prednisone , a corticosteroid , while used to try to reduce throat pain or enlarged tonsils , remains controversial due to the lack of evidence that it is effective and the potential for side effects. There is little evidence to support the use of antivirals such as aciclovir and valacyclovir although they may reduce initial viral shedding.

Although antibiotics exert no antiviral action they may be indicated to treat bacterial secondary infections of the throat, [50] such as with streptococcus strep throat. However, ampicillin and amoxicillin are not recommended during acute Epstein—Barr virus infection as a diffuse rash may develop. Splenomegaly is a common symptom of infectious mononucleosis and health care providers may consider using abdominal ultrasonography to get insight into the enlargement of a person's spleen.

Once the acute symptoms of an initial infection disappear, they often do not return.

Mucocutaneous Manifestations of Viral Diseases: An Illustrated Guide to Diagnosis and Management

But once infected, the person carries the virus for the rest of their life. The virus typically lives dormantly in B lymphocytes. Independent infections of mononucleosis may be contracted multiple times, regardless of whether the person is already carrying the virus dormantly. Periodically, the virus can reactivate, during which time the person is again infectious, but usually without any symptoms of illness.

However, in susceptible hosts under the appropriate environmental stressors, the virus can reactivate and cause vague physical symptoms or may be subclinical , and during this phase the virus can spread to others. The characteristic symptomatology of infectious mononucleosis does not appear to have been reported until the late nineteenth century. The word mononucleosis has several senses.

The term "infectious mononucleosis" was coined in by Thomas Peck Sprunt and Frank Alexander Evans in a classic clinical description of the disease published in the Bulletin of the Johns Hopkins Hospital , entitled "Mononuclear leukocytosis in reaction to acute infection infectious mononucleosis ". The link with infectious mononucleosis was uncovered in by Werner and Gertrude Henle at the Children's Hospital of Philadelphia , after a laboratory technician handling the virus contracted the disease: comparison of serum samples collected from the technician before and after the onset revealed development of antibodies to the virus.

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Evans confirmed through testing that mononucleosis was transmitted mainly through kissing leading to it being referred to colloquially as "the kissing disease". From Wikipedia, the free encyclopedia.

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