Glandular Fever The Kissing Disease !!!!! Why ???

Glandular Fever Caused by infection with the Epstein-Barr virus very low infectivity rate because the virus is “environmentally fragile” in that it’s survival outside the human body is very poor

Glandular Fever Spreads by: Coughing Sneezing Kissing

Glandular Fever Clinically: Age of presentation: 15 - 40 (usually) Symptoms: None (usually) (The infection is usually subclinical) Occassionally….

Glandular Fever Clinically: In Symptomatic cases: Bilateral cervical lymphadenopathy in 75% of symptomatic cases Generalized lymphadenopathy in 50% of symptomatic cases Sore throat >50% of symptomatic cases. Fever of varying severity Visual Problems - photophobia – conjuctivitis - peri-orbital oedema

Glandular Fever Clinically: More rarely: Spleno-hepatomegaly About 15% of symptomatic cases About 5% of symptomatic cases are jaundiced Haemato-pathology About 1% of symptomatic cases there is: Severe anaemia (auto-immune) Purpura due to thrombocytopenia

Glandular Fever Nothing abnormal….. Laboratory Findings: If the patient presents very early in the course of the disease, there will be no abnormalities evident.

An atypical lymphocytosis Glandular Fever Laboratory Findings: An atypical lymphocytosis Lymphocyte count of 10 - 20 x10 9 cells/litre is usual in symptomatic cases. These cells appear reactive Usually evident after a week or so.

Glandular Fever The Paul – Bunnell Test: (historically) In most symptomatic cases of glandular fever there is circulating heterophile antibody. These are absorbed by ox red cells but not by guinea pig kidney cells and agglutinate formalized horse red cells Who thinks this up ??????

The GF test Two drops of plasma

Drop some minced guinea pig in this one The GF test Two drops of plasma Drop some minced guinea pig in this one

Drop some minced guinea pig in this one And some minced ox in this one The GF test Two drops of plasma Drop some minced guinea pig in this one And some minced ox in this one

Drop some minced guinea pig in this one And some minced ox in this one The GF test Two drops of plasma Drop some minced guinea pig in this one And some minced ox in this one

Drop some minced guinea pig in this one And some minced ox in this one The GF test Two drops of plasma Drop some minced guinea pig in this one And some minced ox in this one

Drop some minced guinea pig in this one And some minced ox in this one The GF test Two drops of plasma Drop some minced guinea pig in this one And some minced ox in this one Mix it in

The GF test Two drops of plasma Mix it in

Leave for thirty seconds The GF test Two drops of plasma Leave for thirty seconds

The GF test Two drops of plasma The minced ox absorbs the heterophile antibody Leave for thirty seconds

The GF test Two drops of plasma The minced guinea pig does not The minced ox absorbs the heterophile antibody Leave for thirty seconds

Add some formalized horse cells The GF test Two drops of plasma Add some formalized horse cells

Add some formalized horse cells The GF test Two drops of plasma Add some formalized horse cells

Add some formalized horse cells The GF test Two drops of plasma Add some formalized horse cells

The GF test Two drops of plasma And mix for one minute

The GF test Two drops of plasma

The GF test Two drops of plasma The heterophile antibody has not been absorbed by the minced guinea pig

And so agglutinates the formalised horse cells The GF test Two drops of plasma And so agglutinates the formalised horse cells

The GF test Two drops of plasma And so agglutinates the formalised horse cells The heterophile antibody has been absorbed by the minced ox cells

The GF test Two drops of plasma And so agglutinates the formalised horse cells And so is no longer present to agglutinate the formalised horse cells

The GF test - Nowadays One drop of plasma – “one stage” Add latex coated with purified Paul-Bunnell antigen and mix Presence of IM heterophile antibody causes agglutination

One drop of plasma – one stage The GF test - Nowadays One drop of plasma – one stage

It doesn’t test for glandular fever Is this test a good test for glandular fever ? It doesn’t test for glandular fever It tests for the body’s reaction to it Therefore it has limitations

Glandular Fever Clinical Chemistry Findings: Liver function deranged in extreme cases

Glandular Fever Treatment: No treatment The majority of cases are sub clinical Symptomatic cases have symptomatic treatment The condition is self limiting The very few severe cases may be treated with corticosteroids.

Glandular Fever Takes 4 - 6 weeks convalescence is slow Recovery: Takes 4 - 6 weeks convalescence is slow severe malaise & lethargy Wait for negative GF test….?