SIMILAR CLINICAL ONSET - 1 Acula Infecllons - Prodromal stage of influenza at upper respiratory

5 to 10 percent of patients - (a) with the glandular enlargement. (b) as the first symptom followed by other features, (c) as the only symptom with slight or no fever. Raised SGPT levels.5. Other less common features -(a) Neurological - Lymphocytic meningitis. polyneuritis, mononeuritis and encephalopathy. (b) Segmental opacities on chest radiograph (c) Paratracheal,or mediastinal lymphadenopathy (d) Suppurative conditions such as peritonsallar abscess or acute sinusitis may coexist or complicate IM (e) Mscellaneous - very rarely hemophagocytic; syndrome, or polyarthropathy with antinuclear antibodes CAUSE OF DEATH - !M is rarely fatal: 1. Neurological complications 2 Airway obstrucation 3 Splenic rupture.4. Duncan's syndrome (linked lymphoprolifracativ syndrome) = Severe hematologic or immunologic sequaelae such as aplastic anemia, lymphocyte or agammaglobulnemia Investigaiions - 1 Hemaiology - WBC count usually increased Absolute (>4x<109)yitre)>5O% of total WBC), increase in monounclear celis of which upto 20% are atypcal lymphocytes. 2. Serology - Nonspecific haterophile antibodies - Patients with primary EBV infection develop IgM antibodes that bind antigens on RBCs of other species. panticulanry sheep and horses, but not gunieapig kidney cells Heterophile,antibodes also occur in normal sera and in some patients with lymphorra. but thesa normally also bind to guniapig kichey cells. These differences form the basis of tests for heterophile antibods; (a) Paul-Bunnell test - measures agglutination of sheep RBCs by patients serum; (b) Moditied Paul-Bunnell-Davidson test - The serum B pre-absorbed with gunieapig kidney cells. (c)Monospot test - measuras agglutnation of formalinlzed horse. RECs after absorption with gunieapig kidney cells Interpretation - Heierophile antibodles are present in 40% of patiants during first week of illness. 60% by 2nd waak and 80% by 3 rd week: a negative monoapot test hance does not exclude diagnosis of IM After classical IM. heierophile antibodies usually oersist for 3-6 months, and at limes up to one year Specific antibody responses - Pallents also develop specific antibodies against - (a) Viral capsid antigen Anti-VCA IgM & specific indicaor of recent infsction. Anti-VCA gG is usually preset at prsemation and persists for life. (b)EBVearly antigens (EA) [c] EBV nuclear antigens (EBNA) These tests may be help ful in dificult cases 3 Biochemistry - Mild derengement of liver function tests with elevated alanine transaminase and billtubin usual Differentia Diagnosis - A. DISEASES WITH SIMILAR CLINICAL ONSET - 1 Acula Infecllons - Prodromal stage of influenza at upper respiratory tract Infection Typnoid feuar and subacuta bacterial endocardits may simulats because of palpable spleen 2. Disorders causing membranoue pharyngitis - Acute tonsillitis. diphtheria. Vincent's angina, acute leukemia, agranulocytose, aplastic anemia Clinical and bacteriofogical siudies will help to distinguish. 3. Diseases with rash - Rubella may be simulated since posterior cervical glands are often palpable, and drug reactions because of rash, fever, joint pains, lymph node enlargement and lymphocytosis. 4. Infective hepatitia - Presence of Fever but no sore throat or rash Jaundice well developed and persistent Liver enlarged but not tender