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CBL Notes from foundation block B.
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05/11/2020CBL Foundation Block B-
Case 1: Infectious mononucleosis-
1. Which infections can cause a glandular fever-like syndrome?
Epstein-Barr Virus (EBV- highly contagious herpes virus), Cytomegalovirus
mononucleosis infection (CMV), Rubella (German measles), Toxoplasmosis (a
parasitic infection), Strep throat (Strep pyogenes pharyngitis), Adenovirus
Infection, Human herpes virus 6 (HHV-6), Acute retroviral syndrome due to HIV
infection, Primary Infection with herpes simplex virus type 1.
2. What is the route of primary infection by Epstein-Barr virus and which
human cells does it infect?
The primary mode of transmission is via the saliva (e.g. during kissing with an
infected individual or between siblings due to close contact by coughing, sneezing,
sharing cups and utensils, etc…).
So, the EBV is transmitted from the carrier through the saliva and enters the host
via the oropharynx region (this includes the soft palate, side and back wall of the
throat, tonsils and back 1/3 of the tongue).
The B-lymphocyte cells are the principle targets of the EBV infection mainly due to
their expression of CD21 which is the major receptor for the virus be able to bind
and enter through.
(The EBV can also infect epithelial cells through distinct processes including transfer
from infected B-cells as they are important sites of lytic infection which produces
viral offspring that amplify cell to cell spreading and enable transmission to new
hosts).
3. What is the cause of Jack’s abnormal albumin/globulin ratio?
His raised alkaline phosphatase and aspartate transaminase levels are the cause of
his abnormal albumin/globulin ratio which is because raised ALT and AST suggest a
leakage from damaged liver cells due to inflammation or cell death.
4. How does the monospot test work and what does it mean? What other
tests would you order?
The monotest looks for the presence of two antibodies that are typically form when
the Epstein-Barr virus are present in the body. Lab technicians will place a blood
sample on a microscope slide, mix it with other substances. If the blood begins to
clump, this test is considered a positive conformation of mononucleosis. This means
that the antibodies that are charged with attacking the Epstein-Barr virus were
detected in your blood and that you are most likely to be infected with the virus. I
would also order the EBV antibody test as this would allow me to see if certain
types of antibodies are present which may suggest that you were infected recently
or other antibodies that may suggest that you were infected in the past. I would
, 05/11/2020
also order other tests that look for infections such as a complete blood count
(and/or a blood smear) which checks for high levels of white blood cells, a sign of
infection and a throat culture, to check for strep throat, which has similar
symptoms to mononucleosis. Strep throat is a bacterial infection treated with
antibiotics. Antibiotics don’t work on viral infections such as mononucleosis.
5. What are the “atypical lymphocytes” mentioned in the haematology
report?
Atypical lymphocytes are lymphocytes that have been activated to respond to a
viral infection. In mononucleosis, a large number of atypical lymphocytes are found
which can be of clinical significance. These lymphocytes are atypical because they
are larger and contain more nucleoli in their nuclei. Jack’s haematology report
shows that over half of his lymphocytes were atypical suggesting that they were
reacting to an infection producing more antibodies against the EBV infection.
6. What is the expected outcome of Jack’s illness? Should he worry about
complications of his infection in the future?
The expected outcome is that Jack has infectious mononucleosis which there is no
cure for mono and it usually goes away on its own within a few weeks (2-4 weeks)
but he may feel fatigued for several weeks or even months. Jack should not really
worry about complications of his infection in the future as although after an EBV
infection the virus remains in your body cells it becomes inactive and it is very rare
for the virus to reactivate but if it does it is very unlikely he will experience any
symptoms unless he is immunocompromised (has a weakened immune system).
Case 2: Meningococcal Disease-
1. Which bacterial species may be associated with meningitis in children?
Which do you think is most likely to have caused Isabella’s illness and
why?
The Neisseria Meningitidis (meningococcus- of which there are several
different types called; A, B, C, W, X, Y and Z), Streptococcus
pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib)
are bacterial species that may be associated with meningitis in
children. I think that it is the Neisseria Meningitidis which has cause
Isabella’s illness because her gram stain shows ‘copious amounts of
gram negative cocci in pairs’ which is characteristic of Neisseria
Meningitidis as it produces gram-negative diplococci which is what is
observed on Isabella’s gram stain.
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