The epidemiology of infectious mononucleosis in Northern Scotland : a decreasing incidence and winter peak

Peer reviewedPublisher PD

Case of the month

A 25 year old previously healthy female presented with a sore throat of three days duration. Associated symptoms included dysphagia and odynophagia but no drooling was reported. Her pain progressed to the point that she refused all solid foods and liquids. She also complained of neck pain and swelling that limited the range of motion in her neck. Fever had ranged from 102-104 degrees F. She had a "raspy" voice but did not complain of respiratory difficulty, stridor or wheezing

The frequency of epstein-barr virus infection and associated lymphoproliferative syndrome after transplantation and its manifestations in children

Twenty cases of Epstein-Barr virus (EBV)-associated lymphoproliferative syndrome (LPS), defined by the presence of EBV nuclear antigen and/or EBV DNA in tissues, were diagnosed in 1467 transplant recipients in Pittsburgh from 1981—1985. The frequency of occurrence in pediatric transplant recipients was 4% (10/ 253), while in adults it was 0.8% (10/1214) (P < .0005). The frequency of LPS in adults declined after 1983 coincidental with the introduction of cyclosporine monitoring. However there was no apparent decline of LPS in children. We describe these ten pediatric cases and one additional case of LPS in a child who received her transplant before 1981. The frequency of EBV infection in 92 pediatric liver recipients was 63%. Of these subjects, 49% were sero-negative and 77% of those acquired primary infection. Of 11 cases of pediatric EBV-associated LPS, 10 were in children who had primary infection shortly before or after transplantation. These results reinforce the impor-tance of primary EBV infection in producing LPS, which was previously shown in adults. Children are at greater risk because they are more likely to be seronegative for EBV and to acquire primary infection. Three clinical types of LPS were recognized in children. The first (5 cases) was a self-limited mononucleo-sislike syndrome. The second syndrome (4 cases) began similarly, but then progressed over the next two months to widespread lymphoproliferation in internal organs and death. The third type (2 cases) was an extranodal intestinal monoclonal B cell lymphoma, occurring late after primary infection. © 1988 by The Williams and Wilkins Co

A 45-year-old Female with an Atypical Presentation of Pharyngitis

Introduction: Emergency physicians are trained to treat a variety of ailments in the emergency department (ED), some of which are emergent, while others are not. A common complaint seen in the ED is a sore throat. While most sore throats are easily diagnosed and treated, less common causes are often not considered in the differential diagnoses. Therefore, the purpose of this case study was to present an atypical case of sore throat and discuss differential diagnoses.Case Presentation: The patient was a 45-year-old female who presented to the ED with a three-day history of sore throat that was exacerbated by eating and drinking. The patient was not on any prescription medications, but tried over-the-counter medications for the sore throat without any improvement in symptoms. Review of systems was positive for sore throat, fevers, and chills. Physical examination of her oropharynx revealed mildly dry mucous membranes with confluent plaques and white patchy ulcerative appearance involving the tongue, tonsils, hard palate, and soft palate. Rapid streptococcal antigen, mononucleosis spot test, and KOH test were performed and found to be negative.Discussion: After initial testing was negative, a follow-up complete blood count with differential and complete metabolic profile were ordered. The patient was found to have decreased lymphocytes and platelets. Based upon those results, a diagnosis was made in the ED, the patient was started on medication, and further laboratory workup was ordered to confirm the diagnosis. ED providers should consider non-infectious as well as infectious causes for a sore throat, as this might lead to a diagnosis of an underlying condition

PhD

dissertationTwo standard tests for infectious mononucleosis (the Davidsohn differential and the ox cell hemolysin test) and ten slide tests Monotest (Wampole), Monospot (Ortho), Monosticon (Organon), Diagluto I. M. (Beckman), I. M. Kit (Micro. Res. Corp.), Mono-Diff (Wampole), Bacto-Hetrol (Difco), Monosticon Dri-Dot (Organon), Monophile (BDS) and Rythrotex (BMC) were evaluated as they were used in 50 laboratories within the state of Utah plus two referee laboratories outside the state. The state proficiency testing program for infectious mononucleosis was modified so that the desired evaluation survey data could be obtained. The sensitivity, specificity, reproducibility (within and between shipments) and percent agreement with target results were determined for each test. Factors which might have affected the test results were evaluated to determine which were correlated with good performance. These factors included: formal education of the technologist performing the test, professional affiliation of the technologist, technologist's experience, technologist's area of major interest, type of laboratory, size of laboratory, number of tests performed, use of the test (screen, confirm or both), technologist's experience with the test and procedural differences. Since there is a critical need for evaluation survey data in almost every area of clinical laboratory testing and since there are in existence numerous proficiency testing programs in these areas, it is felt that an enormous amount of valuable information could be relatively easily obtained by similar modifications of existing proficiency testing programs

Çocuklarda Epstein-Barr virüsüyle ilişkili akut enfeksiyöz mononükleozun klinik ve laboratuvar özelliklerinin değerlendirilmesi

Amaç: Epstein-Barr virüsünden kaynaklanan enfeksiyöz mononukleozun değişik semptomları, ayırıcı tanıda hekimlerin aklını karıştırabilir. Bu çalışmanın amacı semptomatik çocuklarda bu hastalışın klinik ve laboratuvar bulgularının değerlendirilmesidir. Hastalar ve Yöntemler: Bu çalışma akut Epstein- Barr virüs eneksiyonu olan 52 olgu (31 erkek, 21 kız; ort. yaş 5.4±3.4; dağılım 1-13) üzerinde retrospektif olarak yürütüldü. Klinik ve laboratuvar bulgular, şikayetler başladıktan sonraki başvuru zamanı (?5/>5 gün) ve yaş gruplarına (?2/>2 yıl) göre değerlendirildi. Bulgular: Major semptomlar klasik triadda yer alan ateş, lenfadenopati, tonsillofarenjit idi. Ayrıca asit, artrit ve şiddetli abdominal ağrıyla başvuran atipik olgular da tanımlandı. Hiçbir olguda kötü bir prognoz gözlenmedi. En sık rastlanan laboratuvar bulgu lenfositozdu. Major semptomlar başvuru zamanı ?5 gün olan grupta daha sık iken, atipik lenfositler başvuru zamanı >5 gün olan grupta daha yüksek bulundu. Bu tür farklılıklar yaş grupları arasında saptanmadı. Sonuç: Epstein-Barr virüsüne bağlı enfeksiyöz mononükleoz, çocuklarda iyi prognozlu bir hastalıktır. Hastalık özellikleri başvuru gününe göre değişkenlik gösterebilir, tanıda bu durum göz önüne alınmalıdır.Objectives: The various symptoms of infectious mononucleosis associated with Epstein-Barr virus may confuse physicians in differential diagnosis. The aim of this study is to evaluate the clinical and laboratory findings of this disease in symptomatic children. Patients and Methods: This study was retrospectively performed on 52 cases (31 boys, 21 girls; mean age 5.4&plusmn;3.4 years; range 1 to 13 years) with acute Epstein-Barr virus infection. The clinical and laboratory findings were evaluated according to admission time after initial complaints (&amp;#8804;5/&gt;5 days) and the age groups of the cases (&amp;#8804;2/&gt;2 years). Results: The major symptoms were fever, lymphadenopathy and tonsillopharyngitis in the classical triad. Moreover, atypical cases who had ascites, arthritis and severe abdominal pain were defined. No case had a poor prognosis. The most frequent laboratory finding was lymphocytosis. While the major symptoms were more frequent in the group &amp;#8220;admission time &amp;#8804; 5 days&amp;#8221;, the count of atypical lymphocyte were higher in the group &amp;#8220;admission time &gt; 5 days&amp;#8221;. However, these differences could not be defined between age groups. Conclusion: Infectious mononucleosis due to&lt; Epstein-Barr virus is a disease with good prognosis in children. The features of the disease may vary according to admission time, and this fact should be taken into consideration in the diagnosis

Nanoscale molecular reorganization of the inhibitory postsynaptic density is a determinant of gabaergic synaptic potentiation

Gephyrin is a key scaffold protein mediating the anchoring of GABAA receptors at inhibitory synapses. Here, we exploited superresolution techniques combined with proximity-based clustering analysis and model simulations to investigate the single-molecule gephyrin reorganization during plasticity of inhibitory synapses in mouse hippocampal cultured neurons. This approach revealed that, during the expression of inhibitory LTP, the increase of gephyrin density at postsynaptic sites is associated with the promoted formation of gephyrin nanodomains. We demonstrate that the gephyrin rearrangement in nanodomains stabilizes the amplitude of postsynaptic currents, indicating that, in addition to the number of synaptic GABAA receptors, the nanoscale distribution of GABAA receptors in the postsynaptic area is a crucial determinant for the expression of inhibitory synaptic plasticity. In addition, the methodology implemented here clears the way to the application of the graph-based theory to single-molecule data for the description and quantification of the spatial organization of the synapse at the single-molecule level

Cytomegalovirus-associated pulmonary exacerbation in patients with cystic fibrosis.

CMV is an unusual cause of pulmonary exacerbation in immunocompetent individuals with CF http://ow.ly/Rdds30hlnjV

Severe Acute Pharyngitis Caused by Group C Streptococcus

INTRODUCTION: Adult group C beta-hemolytic streptococcal pharyngitis has a prevalence of approximately 5%. It can present with a broad spectrum of severity. CASE REPORT: We report a 30-year-old woman who presented with severe Group C streptococcal pharyngitis. DISCUSSION: She presented with a 9-day history of progressive symptoms, including fever, sore throat, neck swelling, and recent onset of hoarseness. In the 9 days before the emergency room (ER) presentation, the patient had visited the ER twice complaining of a sore throat. At both visits, the physicians performed rapid antigen strep testing. Each time her test was negative and the physicians recommended symptomatic therapy. Her symptoms continued to worsen leading to her repeat presentation. At this time she had severe pharyngitis with markedly enlarged tonsils. Neck CT excluded peritonsillar abscess. Rapid strep testing was again negative, but her throat culture grew group C beta-hemolytic streptococcus. CONCLUSION: This presentation illustrates the importance of a systematic approach to evaluating patients with negative rapid strep tests and worsening pharyngitis