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

2. 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

3. Glandular Fever
Spreads by:
Coughing
Sneezing
Kissing

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

5. 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

6. 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

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

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

9. 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 ??????

10. The GF test
Two drops of plasma

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

12. 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

13. 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

14. 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

15. 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

16. The GF test
Two drops of plasma
Mix it in

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

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

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

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

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

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

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

24. The GF test
Two drops of plasma

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

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

27. 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

28. 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

29. 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

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

31. 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

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

33. 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.

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