Viral Infectious diseases (Glandular fever, HPV, CMV)

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Viral Infectious diseases (Glandular fever, HPV,
CMV)

• Done by Hisham Al-Hammadi

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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 worlds population

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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.

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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.

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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.

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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.

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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).

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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.

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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.

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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.

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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

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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.