Infectious Mononucleosis: A Case Report With Unusual Features and Abnormal Laboratory Findings

Despite the widespread Epstein-Barr virus (EBV) infections, we continue to see new reports with strange and unusual manifestations of the infection, which raises the question of how well we understand this pathogen. The age of contracting the infection is increasing in developed countries, which is changing the clinical presentation of those who get infected during their adolescence or early adulthood. In these stages, liver involvement is more prominent, and other physical symptoms are less apparent. Therefore, an update on infectious mononucleosis (IM) variable manifestation is required to make healthcare providers aware of this shift. This case stands as an example of the new shift as a patient scheduled for elective surgery suddenly presented with subclinical hepatitis caused by primary EBV infection. Our patient presented with few physical symptoms but had a classical picture of EBV-induced hepatitis on blood analysis. The diagnosis was missed by many physicians due to the varied presentations of IM. This case corresponds to the new evidence that suggests that hepatic involvement is one of the most prominent manifestation in the adult population with primary EBV infection

Molecular identification and prevalence of Mycobacterium tuberculosis complex amongst people living with HIV in Osun state, Nigeria.

Human immunodeficiency virus (HIV) infection has created a special niche for Mycobacterium tuberculosis complex in humans as a result of the defect/reduction in cell mediated immunity. M. tuberculosis still responsible for most cases of death due to infectious diseases after HIV. In this study, prevalence of M. tuberculosis was determined in people living with HIV in Osun state of Nigeria with identification of culture positive isolates by polymerase chain reaction. A total of 160 samples were collected from people living with HIV with mean age of 36.8 years old of age (Median -34; age range 16 – 68; 95% confidence interval – 2.49) after seeking ethical approval from the Ministry of Health, Osun State. The result of the microscopy by ZN stain showed that 40 (25%) of the 160 samples were positive for acid fast bacilli while culture on Lowenstein-Jensen (LJ) medium revealed that 30 (18.75%) of the samples processed, grew organism that conformed to the characteristics of M. tuberculosis complex. Polymerase chain reaction for IS6110 was used to confirm the identity of the colonies on LJ slope as M. tuberculosis complex while the PCR for 260 bp of Rv1255c was used in identifying M. tuberculosis. M. tuberculosis represented 92% of the M. tuberculosis complex. The prevalence of M. tuberculosis among people living with HIV was found to be 15% after PCR identification. The effects of socio-demographic factors on the prevalence of TB were analysed. Occupation was found to be associated with the proportional distribution of TB in people living with HIV (X2 = 14.85; p < 0.05). The study concluded that PCR should be integrated into the schema for identification of tuberculosis in reference laboratories in developing countries.Key words: Molecular identification, Polymerase chain reaction, Mycobacterium tuberculosis complex; Mycobacterium tuberculosis, Prevalence, HIV, Nigeri

Thalassaemia (part 2): Management

The management of thalassaemia with a severe phenotype includes blood transfusion, iron chelation, bone marrow transplantation, prenatal diagnosis and national programmes to co-ordinate these in countries with a high prevalence. If blood transfusion and iron chelation therapy are not administered regularly, as was the case historically and as is still the case in many poorer regions, progressive deterioration occurs, viz. impaired growth and development, hepatosplenomegaly, bony abnormalities, cardiac failure, increased susceptibility to infections and premature mortality. Remarkable progress has been made in the past few decades, which has led to much-improved survival rates. Transfusion therapy has evolved to a hyper-transfusion regimen designed to maintain a physiological haemoglobin level and achieve a post-transfusion haemoglobin of 14 g/dL, which, as a matter of course, necessitated intensification of iron chelation. The development of effective oral iron chelators has led to improved compliance. Exploration of novel therapeutic approaches continues, with several agents under study. The prospect of gene therapy is particularly exciting as it has potential to provide cure on a large scale. Currently, regular blood transfusion and iron chelation therapy remain the cornerstone of management of thalassaemia major