Wednesday, March 23, 2016

sore throat.-DrSudeepKC

A 22-year-old woman complains of a sore throat. On examination she has mild jaundice and an enlarged liver and spleen.
Examination of Throat

a. Anaerobic bacteria
b. Chlamydia psittaci
c. Corynebacterium diphtheriae
d. Epstein–Barr virus

D.Epstein–Barr virus right answer

EBV infects B cells of the immune system and epithelial cells. Once EBV's initial lytic infection is brought under control, EBV latency persists in the individual's B cells for the rest of the individual's life.

It is best known as the cause of infectious mononucleosis (glandular fever). It is also associated with particular forms of cancer, such as Hodgkin's lymphomaBurkitt's lymphomagastric cancer,nasopharyngeal carcinoma, and conditions associated with human immunodeficiency virus (HIV), such as hairy leukoplakia and central nervous system lymphomas.There is evidence that infection with EBV is associated with a higher risk of certain autoimmune diseases,especiallydermatomyositissystemic lupus erythematosusrheumatoid arthritisSjögren's syndrome,and multiple sclerosis.Some 200,000 cancer cases per year are thought to be attributable to EBV.

The infection develops slowly with such mild symptoms that it may initially be indistinguishable from a cold or the flu. As the condition progresses the symptoms may include:
  • sore throat that lasts two weeks or more
  • Swollen lymph nodes in the neck, armpits, and groin
  • A persistent fever (usually about 102 degrees F)
  • fatigue
  • malaise (a vague feeling of discomfort)
These symptoms can be mild or so severe that throat pain impedes swallowing and fever reaches 105 degrees F. Some people also experience a rash, eye painphotophobia (discomfort with bright light), a swollen spleen or liver infection.
Although the symptoms of infectious mononucleosis usually resolve in one or two months, the EBV remains dormant in cells in the throat and blood for the rest of the person's life. Periodically, the virus can reactivate and can be found in the saliva of infected persons. This reactivation usually occurs without symptoms of illness. EBV also establishes a lifelong dormant infection in some cells of the body's immune system.
Diagnosis is suggested on the basis of the clinical symptoms of fever, sore throat, swollen lymph glands and the age of the patient. A physical examination may reveal an enlarged liver and/or enlarged spleen. The liver and spleen may also be tender. Laboratory tests may be needed for confirmation.
Blood findings with infectious mononucleosis may include an elevated white blood cell count, an increased percentage of certain white blood cells and a positive reaction to a "monospot test." The monospot test relies on clumping of horse red blood cells by mononucleosis antibodies presumed to be in a person's serum.
antibody tests for EBV measure the presence and/or the concentration of specific EBV antibodies. Different laboratory tests can measure specific EBV antibodies. Some of these tests can be performed on a single sample of blood, while others compare different samples of blood over a period of time.
In most cases of mononucleosis, no specific treatment is necessary. The illness is usually self-limited. Since it is a viral infection and viruses do not respond to antibiotics, they are ineffective against mono. Doctors will recommend bedrest and drinking plenty of fluids.
When the patient's temperature returns to normal, he or she may gradually resume normal activities as strength returns. However, mono can be accompanied by a streptococcal infection of the throat, in which case an antibiotic will be prescribed to treat that condition.
In severe cases, corticosteroid drugs that reduce swelling are prescribed. If the spleen is swollen, the doctor may recommend avoiding strenuous activities, such as lifting and pushing, as well as any contact sports, which may cause sudden rupture of the spleen. Hospitalization is necessary if there is a serious complication, such as rupture of the spleen.


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