EBV
A HERPES FAMILY VIRUS
INFECTS B CELLS—–INCITES AN ABSOLUTE LYMPHOCYTOSIS
ACTIVATES ATYPICAL T-LYMPHOCYTES=DOWNEY CELLS
ABSOLUTE LYMPHOCYTOSIS (>50%) WITH > 10-50% ATYPICAL REACTIVE T-LYMPHOCYTES (DOWNEY CELLS)
ELEVATES LFT’S
LOW ESR
HETEROPHILE ANTIBODY = + SERUM AB TO HORSE RBC’S—-=MONOSPOT TEST
CHILDREN LESS THAN 10 USUALLY TEST –
15% DO NOT TURN + FOR WEEKS
FALSE + IS COMMON WITH CECLOR(SERUM SICKNESS), RA, HODGKINS, BRUCELLOSIS, HEPATITIS
PAUL-BUNNELL HETEROPHILE AB TEST = SERUM AB TO SHEEP RBC’S
IF NEGATIVE
GET EBV AB (IGG OR IGM), VCA (VIRAL CAPSID AG), EBNA (EBV NUCLEAR AG)
ONLY 60% OF PTS WILL HAVE A POSITIVE TEST WITHIN THE FIRST 2 WEEKS—90% TURN POSITIVE WITHIN 1 MONTH
MONONUCLEOSIS (EBV CAUSES 90%)—CAN ALSO BE CMV, TOXO, RUBELLA, HAV, ADENOVIRUS–ALSO CAUSES ATYPICAL LYMPHOCYTOSIS—-CMV–URINE CULTURE AFTER INNOCULATION IN HUMAN DIPLOID TISSUE CULTURE
FATIGUE, ODYNOPHAGIA, CHILLS, DYSPNEA, DEHYDRATION
EXUDATIVE TONSILLOPHARYNGITIS—-REFRACTORY TO ABX,  FEVER, FATIGUE, LAD, 50% H-S MEGALLY, POST TRIANGLE LAD, RARELY ASEPTIC MENINGITIS
LOW ESR, HEMOLYTIC ANEMIA, THROMBOCYTOPENIC PURPURA, JAUNDICE, NEURO ABNL, AIRWAY COMPROMISE
Dx: CBC WITH PBS, MONOSPOT, Hx, PE
Rx: 1 L NS WITH 10 MG DECADRON, 10 MG COMPAZINE, AND 1 G ROCEPHIN—–THEN SEND HOME ON MEDROL DOSE PACK AND T#3—STEROIDS (DECADRON 10 MG 1V Q 6 OR MEDROL DOSE PACK OR 16 MG P.O. QOD X 2), FLAGYL OR CLEOCIN HELPS WITH TONSILLOPHARYNGITIS INFLAMMATION OF SUPERINFXN AND OVERGROWTH OF ANAEROBES
IF REALLY BAD THINK OF A NASAL TRUMPET—POSSIBLE INTUBATION WITH IMMEDIATE TONSILLECTOMY
DO NOT USE AMINOPCN/AUGMENTIN/UNASYN—-50% MORBILLIFORM RASH (MAY FOLLOW IN DAYS OR WEEKS)
AFRICAN BURKITTS LYMPHOMA
A B-CELL LYMPHOMA
RESPONDS WELL TO CHEMO
STARRY SKY APPEARANCE ON PATH
NPCA
ETIOLOGY AND PX RELATED TO EBV TITERS?
ORAL HAIRY LEUKOPLAKIA
ASSOC IN PTS WITH AIDS
LESS CERTAIN ASSOC. WITH : CHRONIC FATIGUE SYNDROME, NHL (T-CELL), POLYCLONAL B-CELL LYMPHOMA, ATAXIA TELANGIECTASIA IN TRANSPLANT RECIPIENTS