DOCSLIB.ORG

Epstein-Barr Virus

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Epstein-Barr Virus CHAPTER 10 Epstein-Barr Virus Alfred S. Evans and James C. Niederman 1. Introduction 2. Historical Background Epstein-Barr virus (EBV), a member of the herpes In 1889, Emil Pfeiffer of Wiesbaden, Germany, group of viruses, is the cause of heterophile-positive described a condition called Driisenfieber (glandular infectious mononucleosis, of most heterophile-neg­ fever), characterized by fever, adenopathy, mild ative cases, and of occasional cases of tonsillitis and sore throat, and in severe cases enlargement of the pharyngitis in childhood. Rarely, it may involve the liver and spleen. (63, 126) Since Pfeiffer's original de­ liver or central nervous system as primary mani­ scription, as well as Filatov's, (53,54) a Russian, in festations. This virus is strongly implicated as hav­ 1892, antedated by some 30-50 years recognition of ing a causal relationship to African Burkitt lym­ the hematological changes and the heterophile an­ phoma and to nasopharyngeal cancer. High antibody tibody, it is uncertain whether these were true in­ titers are also present in 30-40% of cases of Hodg­ fectious mononucleosis. However, his description kin's disease, in some patients with sarcoidosis, and of this febrile syndrome in older children and young in systemic lupus erythematosus. adults seems best to fit this diagnosis. There is little This chapter will deal with the epidemiology of doubt about the classic description of the disease EBV infections and the epidemiology of infectious made by Sprunt and Evans, (139) from Johns Hop­ mononucleosis. Infectious mononucleosis can be kins, in 1920. They described the disorder in young defined as an acute febrile illness involving children adults as we now know it, named the disease "in­ and young adults characterized clinically by sore fectious mononucleosis," and reported in detail the throat and lymphadenopathy, hematologically by hematological changes. This description was fol­ lymphocytosis of 50% or more, of which 10% or lowed rapidly by similar reports from other work­ more are atypical, and serologically by an elevated ers.(12,14,22,96,108) A definitive presentation of hema- absorbed heterophile-antibody titer and the devel­ tological changes was made by Downey and opment of EBV immunoglobulin M (IgM) and other McKinlay(28) in 1923. The next major development EBV antibodies. This chapter also mentions the re­ was the discovery in 1932 of the heterophile anti­ lationship of high antibody titers to certain chronic body by John R. Paul and William W. Bunnell(121) and malignant diseases, but the major discussion of Yale University. Their report was based on an of Burkitt lymphoma and of nasopharyngeal cancer accidental observation while studying the occur­ will be found in later chapters of this book. rence of heterophile antibodies in rheumatic fever. Alfred S. Evans . WHO Serum Reference Bank, Section This search had been initiated because of the clinical of International Epidemiology, Department of Epidemiol­ similarity of rheumatic fever and serum sickness and ogy and Public Health, Yale University School of Medicine, because of the work of Davidsohn(24) describing the NewHaven,Connecticut. JamesC.Niederman . De­ partment of Epidemiology and Public Health, Yale Uni­ presence of heterophile antibodies in serum sick­ versity School of Medicine, New Haven, Connecticut. ness. Among the control subjects for rheumatic 253 A. S. Evans (ed.), Viral Infections of Humans © Plenum Publishing Corporation 1982 254 Chapter 10 • Epstein-Barr Virus fever patients was one who had infectious mono­ fectious agent from the throat or blood of patients nucleosis and was found to have a much higher with infectious mononucleosis using several tissue­ heterophile antibody titer than present in any other culture systems, long-term cultures of lymphocytes condition. Paul and Bunnell then continued these on a feeder layer, and fluorescent antibody tech­ observations in 3 additional cases of infectious niques to identify an agent were unsuccessful. (37) mononucleosis and utilized 275 controls for com­ EpidemiolOgically, the key events during this time parison. Their paper also describes what they be­ were the observations of Hoagland, who suggested lieved to be a false-positive heterophile antibody that the disease might be transmitted by kissing(79) occurring in a patient with aplastic leukemia. A re­ and that the incubation period was of the order of view of the details of this case(43) reveals that the 30-49 days. (81) heterophile antibody occurred about 20 days after Early in 1968, evidence first appeared that EBV the administration of several units of blood, and was the cause of infectious mononucleosis. (72,114) therefore this patient may represent the first case This virus, isolated by Epstein et al. (33) from a culture of transfusion infectious mononucleosis. Soon after of African Burkitt tumor tissue, (128) was found to be the discovery of the presence of heterophile anti­ a new member of the herpes group of viruses. While bodies, Davidsohn and Walker<23) reported on the working with this agent, a technician in the Henles' use of guinea pig kidney and of beef cells to absorb laboratory in Philadelphia developed infectious serum prior to heterophile testing in order to in­ mononucleosis. Her serum, which lacked antibody crease the specificity of the test. Both these proce­ several months prior to disease, developed EBV an­ dures have withstood the test of time well and still tibody during illness, and her lymphocytes, which constitute one of the major criteria of diagnosis. had previously failed to be cultivated successfully, Regular alterations in various liver-function tests now grew well in tissue culture and were shown to during acute infectious mononucleosis were rec­ contain EBV antigen. (72) This serendipitous obser­ ognized in several laboratories in the late 1940s and vation was rapidly confirmed and extended at that 1950s, (13,35,86) even though only 5% of patients had time by the Henles in conjunction with Niederman clinical jaundice. This was followed by the discovery and McCollum(114) of Yale and later in several other of alterations in serum glutamic oxalacetic trans­ prospective studies carried out by the Yale aminase (SCOT) and other hepatic enzymes during team(SO,113,132) and in one English study. (148) Subse- the course of disease. (6,131,158) quent investigations established the presence and Search for the etiological agent of infectious mono­ persistence of EBV in the throat during and after nucleosis began in the 1920s, but met with little acute infectious mononucleosis,<t9,59,103) the occur­ success until 1942, when Wising(156) reported the rence of EBV-specific IgM, (3,66,114b,133) and the re­ successful transmission of classic infectious mono­ production of some features of mononucleosis by nucleosis to a female medical student volunteer inoculation of EBV into monkeys.(135,154) Fuller de­ who received 250 ml of blood from a patient ill with tails of the history of infectious mononucleosis have the acute disease. This successful experiment was been published elsewhere. (16,43) not reproducible by Wising in several other at­ tempts, nor by Bang, (4) who carried out a similar set of volunteer experiments. In 1947 and again in 1950, additional efforts of this sort were carried out at Yale 3. Methodology University using whole blood, serum, or throat washings. The results provided suggestive but in­ 3.1. Mortality Data conclusive evidence of transmission. (34,36) A third effort without success was reported from Yale Uni­ Infectious mononucleosis is rarely a fatal disease; versity in 1965. (112) Subsequent EBV antibody tests only about 50 fatalities have been reported. (39) Ex­ on the sera from these last experiments in 1968 re­ amination of autopsy records or of international in­ vealed that all volunteers had actually been immune dexes of causes of death would therefore give little to infection prior to the experiment as indicated by indication of the occurrence of the disease even the presence of antibody. (111) though its pathological features are quite character­ Repeated attempts in the 1950s to isolate an in- istic. Chapter 10 • Epstein-Barr Virus 255 3.2. Morbidity Data way, an elevated titer quite accurately reflects the occurrence of infectious mononucleosis even in the Infectious mononucleosis is not a reportable dis­ absence of clinical and hematological data and has ease in most states and in most countries. Excep­ been utilized as an indicator of infectious mononu­ tions are the state of Connecticut, where it has been cleosis in sera sent to hospitals and state labora­ reportable since 1948}21) and the United States tories. (38) The major limitation of this approach is armed forces, which collect hospitalization data on the extent to which physicians have sent sera from all diseases. (41) Unless strong emphasis is placed on suspected cases to the diagnostic laboratory for the need for fulfilling clinical, hematological, and analysis. The increasing use of simple laboratory serological criteria for diagnosis before reporting, kits for identifying heterophile-antibody elevations the reliability of morbidity data from these sources in the physician's office probably results in much must be seriously questioned. This requirement is less utilization of state and hospital laboratories, so emphasized by the fact that even for the 15-25 age that morbidity data from these sources may greatly group-in which the disease has its highest inci­ underestimate the occurrence of the disease.
Load more

Recommended publications
  • Download (739Kb)
    VIEWS & REVIEWS Arterial ischemic stroke in HIV Defining and classifying etiology for research studies Laura A. Benjamin, ABSTRACT MRCP, PhD HIV infection, and potentially its treatment, increases the risk of an arterial ischemic stroke. Mul- Alan Bryer, FCN (SA), tiple etiologies and lack of clear case definitions inhibit progress in this field. Several etiologies, PhD many treatable, are relevant to HIV-related stroke. To fully understand the mechanisms and the Sebastian Lucas, FRCP, terminology used, a robust classification algorithm to help ascribe the various etiologies is FRCPath needed. This consensus paper considers the strengths and limitations of current case definitions Alan Stanley, FCN (SA) in the context of HIV infection. The case definitions for the major etiologies in HIV-related strokes Theresa J. Allain, FRCP, were refined (e.g., varicella zoster vasculopathy and antiphospholipid syndrome) and in some in- PhD stances new case definitions were described (e.g., HIV-associated vasculopathy). These case def- Elizabeth Joekes, FRCR initions provided a framework for an algorithm to help assign a final diagnosis, and help classify Hedley Emsley, FRCP, the subtypes of HIV etiology in ischemic stroke. Neurol Neuroimmunol Neuroinflamm 2016;3:e254; PhD doi: 10.1212/NXI.0000000000000254 Ian Turnbull, FRCR Colin Downey, MIBMS GLOSSARY Cheng-Hock Toh, FRCP, ACL 5 anticardiolipin antibodies; anti-b2GP1 5 anti–b2-glycoprotein I; APS 5 antiphospholipid syndrome; HSV 5 herpes PhD simplex virus; IgG 5 immunoglobulin G; LA 5 lupus anticoagulant; RPR 5 rapid plasma reagin; SVD 5 small vessel disease; 5 5 5 Kevin Brown, FRCPath, TB tuberculosis; TOAST Trial of Org 10172 in Acute Stroke Treatment; TTP thrombotic thrombocytopenic purpura; VDRL 5 Venereal Disease Research Laboratory; VZV 5 varicella zoster virus.
    [Show full text]
  • Herpesviruses
    J Clin Pathol: first published as 10.1136/jcp.32.9.859 on 1 September 1979. Downloaded from Journal of Clinical Pathology, 1979, 32, 859-881 Herpesviruses MORAG C. TIMBURY' AND ELIZABETH EDMOND2 From the 'Department of Bacteriology, Royal Infirmary, Glasgow and the 2Regional Virus Laboratory, City Hospital, Greenbank Drive, Edinburgh, UK Herpesviruses are ubiquitous in both human and tion (Plummer et al., 1970) or microneutralisation animal populations (Plummer, 1967). The four tests (Pauls and Dowdle, 1967) are often used for human herpesviruses are herpes simplex (HSV), this, but differentiating the two types of virus today varicella-zoster (VZ), cytomegalovirus (CMV), and can probably be done more easily by biochemical Epstein-Barr (EBV) viruses, and all exhibit the prop- methods. Thus the DNA of the viruses can be dis- erty, rare among human pathogenic viruses, of tinguished by restriction enzyme analysis (Skare et remaining latent within the body after primary infec- al., 1975). Similarly, many of the virus polypeptides tion. Latent virus persists for many years-probably produced in infected cells by the two types of virus throughout life-and in some patients reactivates to can be distinguished by polyacrylamide gel electro- cause secondary or recurrent infections. Human phoresis (Courtney and Powell, 1975). herpesviruses can almost be regarded as part of the commensal flora, and certainly HSV is present in LABORATORY DIAGNOSIS the saliva of healthy people from time to time HSV-1 infections are most rapidly diagnosed by (Douglas and Couch, 1970). The viruses exhibit a isolation of the virus in cell cultures such as BHK21 remarkably successful parasitism since the upset to or RK1 3 cells (Grist et al., 1979).
    [Show full text]
  • New York Chapter American College of Physicians Annual
    New York Chapter American College of Physicians Annual Scientific Meeting Poster Presentations Saturday, October 12, 2019 Westchester Hilton Hotel 699 Westchester Avenue Rye Brook, NY New York Chapter American College of Physicians Annual Scientific Meeting Medical Student Clinical Vignette 1 Medical Student Clinical Vignette Adina Amin Medical Student Jessy Epstein, Miguel Lacayo, Emmanuel Morakinyo Touro College of Osteopathic Medicine A Series of Unfortunate Events - A Rare Presentation of Thoracic Outlet Syndrome Venous thoracic outlet syndrome, formerly known as Paget-Schroetter Syndrome, is a condition characterized by spontaneous deep vein thrombosis of the upper extremity. It is a very rare syndrome resulting from anatomical abnormalities of the thoracic outlet, causing thrombosis of the deep veins draining the upper extremity. This disease is also called “effort thrombosis― because of increased association with vigorous and repetitive upper extremity activities. Symptoms include severe upper extremity pain and swelling after strenuous activity. A 31-year-old female with a history of vascular thoracic outlet syndrome, two prior thrombectomies, and right first rib resection presented with symptoms of loss of blood sensation, dull pain in the area, and sharp pain when coughing/sneezing. When the patient had her first blood clot, physical exam was notable for swelling, venous distension, and skin discoloration. The patient had her first thrombectomy in her right upper extremity a couple weeks after the first clot was discovered. Thrombolysis with TPA was initiated, and percutaneous mechanical thrombectomy with angioplasty of the axillary and subclavian veins was performed. Almost immediately after the thrombectomy, the patient had a rethrombosis which was confirmed by ultrasound.
    [Show full text]
  • Antibiotic Use for Sepsis in Neonates and Children: 2016 Evidence Update
    Antibiotic Use for Sepsis in Neonates and Children: 2016 Evidence Update Aline Fuchsa, Julia Bielickia,b, Shrey Mathurb, Mike Sharlandb, Johannes N. Van Den Ankera,c a Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, Basel, Switzerland b Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom c Division of Clinical Pharmacology, Children’s National Health System, Washington, DC, USA WHO-Reviews 1 TABLE OF CONTENTS 1. INTRODUCTION ............................................................................................................................... 3 1.1. Aims ......................................................................................................................................... 3 1.2. Background ............................................................................................................................. 3 1.2.1. Definition and diagnosis ................................................................................................. 3 Neonatal Sepsis ............................................................................................................................... 3 Paediatric Sepsis ............................................................................................................................. 4 Community versus hospital acquired sepsis .................................................................................. 5 1.2.2. Microbiology ..................................................................................................................
    [Show full text]
  • The Pangenome Diversity, Dynamics and Evolution of Genomes the Pangenome Hervé Tettelin • Duccio Medini Editors
    Hervé Tettelin Duccio Medini Editors The Pangenome Diversity, Dynamics and Evolution of Genomes The Pangenome Hervé Tettelin • Duccio Medini Editors The Pangenome Diversity, Dynamics and Evolution of Genomes Editors Hervé Tettelin Duccio Medini Department of Microbiology and GSK Vaccines R&D Immunology, Institute for Genome Siena, Italy Sciences University of Maryland School of Medicine Baltimore, Maryland, USA ISBN 978-3-030-38280-3 ISBN 978-3-030-38281-0 (eBook) https://doi.org/10.1007/978-3-030-38281-0 This book is an open access publication. © The Editor(s) (if applicable) and The Author(s) 2020. Open Access This book is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence and indicate if changes were made. The images or other third party material in this book are included in the book’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the book’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
    [Show full text]
  • A Compendium of Transfusion Practice Guidelines Edition 4.0 January 2021
    A Compendium of Transfusion Practice Guidelines Edition 4.0 January 2021 Table of Contents Introduction Red Blood Cells Platelets Low Titer Group O Whole Blood Plasma Cryoprecipitated AHF Testing Serices Therapeutic Apheresis Blood Component Modifications Hospital Transfusion Committee Patient Blood Management Appendices Introduction Transfusion of blood products is one of the most common medical procedures, used for patients with a wide range of medical conditions to improve tissue oxygenation, achieve hemostasis, and/or fight infections. Moreover, transfusion therapy enables many complex procedures, such as organ transplantation, cardiac and other surgeries, and stem cell transplantation. Yet the curriculum of academic medical and nursing programs provide limited exposure and training towards helping providers to understand the attributes of the different types of blood products, appreciate the risks of transfusion, and raise awareness of the accumulating body of evidence that is helping to refine our understanding of clinical indications for each type of transfusion. While the approach to transfusion medicine has historically been based on personal experience, local practice, expert opinion, and consensus conference recommendations, the availability of hemovigilance data that document the adverse effects of transfusion, randomized controlled trials (RCTs) demonstrating both the benefits and risks of transfusion, and growing debates regarding alternate therapies provide a good foundation to develop evidence-based resources to aid in transfusion care of today and the future. There is a growing belief that transfusion therapy, like many other types of drug therapies, can be tailored or personalized to address specific patient and disease contexts. One example is in the care of the actively hemorrhaging patient, particularly in the prehospital time frame.
    [Show full text]
  • Prospects for Effective and Scalable Community-Based Approaches to Improve Reproductive, Maternal, Newborn and Child Health (RMNCH)
    Prospects for Effective and Scalable Community-Based Approaches to Improve Reproductive, Maternal, Newborn and Child Health (RMNCH) A Summary of Experiences from the Maternal and Child Health Integrated Program (MCHIP) and the Child Survival and Health Grants Program (CSHGP) and a Review of the Evidence June 2014 Authors: Henry B. Perry Jim Ricca Karen LeBan Melanie Morrow Copyright © 2014 by Jhpiego Corporation. All rights reserved. Suggested citation: Perry HB, Ricca J, LeBan K. and Morrow M. 2014. Prospects for Effective and Scalable Community-Based Approaches to Improve Reproductive, Maternal, Newborn and Child Health (RMNCH): A Summary of Experiences from the Maternal and Child Health Integrated Program (MCHIP) and the Child Survival and Health Grants Program (CSHGP) and a Review of the Evidence. Jhpiego. Baltimore, MD. The Maternal and Child Health Integrated Program (MCHIP) is the USAID Bureau for Global Health’s flagship maternal, neonatal and child health (MNCH) program. MCHIP supports programming in maternal, newborn and child health, immunization, family planning, malaria, nutrition, and HIV/AIDS, and strongly encourages opportunities for integration. Cross-cutting technical areas include water, sanitation, hygiene, urban health and health systems strengthening. This report was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Leader with Associates Cooperative Agreement GHS-A-00-08-00002-00. The contents are the responsibility of the Maternal and Child Health Integrated Program (MCHIP) and do not necessarily reflect the views of USAID or the United States Government. Table of Contents Table of Contents .................................................................................................................................... i Abbreviations .........................................................................................................................................
    [Show full text]
  • UNIVERSITY of CALIFORNIA Los Angeles Improving the Detection
    UNIVERSITY OF CALIFORNIA Los Angeles Improving the Detection and Surveillance of Sexually Transmitted Infections in Public Health Laboratories A dissertation in partial satisfaction of the requirements for the Doctor of Philosophy in Environmental Health Sciences by Sean A. Buono 2017 © Copyright by Sean A. Buono 2017 ABSTRACT OF THE DISSERTATION Improving the Detection and Surveillance of Sexually Transmitted Infections in Public Health Laboratories by Sean A. Buono Doctor of Philosophy in Environmental Health Sciences University of California, Los Angeles, 2017 Professor Hilary Godwin, Co-Chair Richard J. Jackson, Co-Chair The overarching goal of the work described herein is to investigate strategies for improving the detection and surveillance of multidrug-resistant Neisseria gonorrhoeae (MDRNG) and syphilis, two important sexually transmitted infections. First, we conducted a critical review of the literature to ascertain whether improvements could be made in the way that Neisseria gonorrhoeae is screened and treated. We reviewed the existing literature on the global distribution of MDRNG, current public health surveillance practices, and new methods for detection and molecular characterization of N. gonorrhoeae. Based on a synthesis of this information, we recommended that clinical samples should be screened using rapid molecular testing for known antimicrobial susceptibility markers to enable the treatment paradigm for N. gonorrhoeae to be shifted towards individualized treatment. Next, we conducted studies to provide guidance to public health laboratories to enable them to choose Syphilis screening assays and algorithms that are both cost effective and meet public health goals. First, we compared the performance, cost, and ease of use ii for three automated treponemal assays: Phoenix Biotech Trep-Sure Syphilis Total Antibody EIA, Siemens Advia Centaur Syphilis, and the DiaSorin Liaison Treponema assay.
    [Show full text]
  • Consultation Document for Case Definitions
    Consultation Document for Case Definitions Adverse Events of Special Interest and Adverse Events Following Immunization during COVID-19 Vaccine Introduction 0 Consultation Document for Case Definitions Adverse Events of Special Interest and Adverse Events Following Immunization during COVID-19 Vaccine Introduction Washington, D.C., 2021 Consultation Document for Case Definitions: Adverse Events of Special Interest and Adverse Events Following Immunization during COVID-19 Vaccine Introduction PAHO/HSS/MT/COVID-19/21-0006 © Pan American Health Organization, 2021 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO license (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this license, this work may be copied, redistributed, and adapted for non-commercial purposes, provided the new work is issued using the same or equivalent Creative Commons license and it is appropriately cited. In any use of this work, there should be no suggestion that the Pan American Health Organization (PAHO) endorses any specific organization, product, or service. Use of the PAHO logo is not permitted. All reasonable precautions have been taken by PAHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall PAHO be liable for damages arising from its use. Disclaimer. This document was prepared with support from the European Union through the project “Working Together to Fight Antimicrobial Resistance”.
    [Show full text]
  • Volume - Ix Issue - L Mar / Apr 2012
    VOLUME - IX ISSUE - L MAR / APR 2012 The Disease Diagnosis segment of this issue comprehends for you a disease that has many synonyms - it is simply known as infectious mononucleosis or as EBV infectious mononucleosis, Pfeiffer's disease, Filatov's disease and sometimes colloquially as the kissing disease from its oral transmission or simply as mono in North America and as glandular fever in other English-speaking countries) is an infectious, widespread viral disease caused by the Epstein–Barr virus (EBV), one type of herpes virus, to which more than 90% of adults have been exposed. Occasionally, the symptoms can recur at a later period. Most people are 1 Editorial exposed to the virus as children, when the disease produces no noticeable or only flu-like Disease symptoms. In developing countries, people are exposed to the virus in early childhood more 2 often than in developed countries. As a result, the disease in its observable form is more Diagnosis common in developed countries. It is most common among adolescents and young adults. The Trouble disease is omnipresent the world over. 5 Shooting Especially in adolescents and young adults, the disease is characterized by fever, sore throat and fatigue, along with several other possible signs and symptoms. It is primarily diagnosed by 6 Bouquet observation of symptoms, but suspicion can be confirmed by several diagnostic tests. The syndrome was described as an infectious process by Nil Filatov in 1887 and 7 Interpretation independently by Emil Pfeiffer in 1889. It evokes a very strong reaction from the reticuloendothelial system and the body throws up what are known as Downey & McKinley cells (atypical lymphocytes) that are not of neoplastic 8 Tulip News but as bad looking and can be mistaken for neoplastic cells.
    [Show full text]
  • Digestive System and Abdomen
    DIGESTIVE SYSTEM AND ABDOMEN DIGESTIVE SYSTEM Goodsall's Rule Softening of the vaginal part of the cervix during the first trimester Rare condition when pain occurs due to transposition of a loop of large intestine (usually Chilaiditi transverse colon) in between the diaphragm and the liver, visible on plain abdominal X-ray or chest Syndrome X-ray INTUSSUSCEPTION Dance's Sign Empty RLQ (retracted right iliac fossa) APPENDICITIS Aaron's Sign Epigastric pain with pressure on McBurney's point GI TRACT Dunphy Sign Increase in abdominal pain on coughing Markle Sign RLQ pain on dropping from standing on toes to heels 2/3 of the way lateral on a line from umbilicus to anterior superior iliac spine (corresponds to Mc Burney’s Point junction of vermiform appendix and cecum) Tenderness in the right lower quadrant increases when the patient moves from the supine position Rosenstein's Sign to a recumbent posture on the left side Rovsing's Sign Palpation of LLQ elicits pain in RLQ Sherren's Triangle Area of hyperaesthesia over the right lower abdomen Hampton's Line Line on barium meal indicating mucosal oedema associated with ulcer LIVER Councilman Body eosinophilic globules in liver An inclusion found in the cytoplasm of liver cells. Mallory bodies are damaged intermediate Mallory Body filaments within the hepatocytes BILIARY Boas' Sign Dermal hyperaesthesia at inferior angle of R scapula Courvoisier's Law Palpable gall bladder w/ painless jaundice unlikely to be cholelithiasis ACCESSORY Charcot's Jaundice, fever and chills, RUQ pain Cholangitis
    [Show full text]
  • Diagnostic Role of Procalcitonin in Neonatal Sepsis In
    DIAGNOSTIC ROLE OF PROCALCITONIN IN NEONATAL SEPSIS IN TERTIARY CARE HOSPITAL DISSERTATION SUBMITTED TO In partial fulfillment of the requirement for the degree of DOCTOR OF MEDICINE IN MICROBIOLOGY (Branch IV) M. D. (MICROBIOLOGY) of THE TAMIL NADU DR. M. G. R MEDICAL UNIVERSITY CHENNAI- 600032 DEPARTMENT OF MICROBIOLOGY TIRUNELVELI MEDICAL COLLEGE TIRUNELVELI- 11 MAY 2018 BONAFIDE CERTIFICATE This is to certify that the dissertation entitled “Diagnostic role of Procalcitonin in neonatal sepsis in tertiary care hospital” submitted by Dr.D.Jeyaganguli to the Tamilnadu Dr. M.G.R Medical University, Chennai, in partial fulfillment of the requirement for the award of M.D. Degree Branch – IV (Microbiology) is a bonafide research work carried out by her under direct supervision & guidance. Head of the Department, Department of Microbiology Tirunelveli Medical College, Tirunelveli. CERTIFICATE This is to certify that the Dissertation “Diagnostic role of procalcitonin in neonatal sepsis in tertiary care hospital” presented here in by Dr.D.Jeyaganguli is an original work done in the Department of Microbiology, Tirunelveli Medical College Hospital,Tirunelveli for the award of Degree of M.D. (Branch IV) Microbiology under my guidance and supervision during the academic period of 2015 -2018. The DEAN Tirunelveli Medical College, Tirunelveli - 627011. DECLARATION I solemnly declare that the dissertation titled“Diagnostic role of procalcitonin in neonatal sepsis in tertiary care hospital” is done by me at Tirunelveli Medical College hospital, Tirunelveli. I also declare that this bonafide work or a part of this work was not submitted by me or any others for any award, degree, or diploma to any other University, Board, either in or abroad.
    [Show full text]