Infectious diseases in literaturePart 1.

Pavlov State Medical University, Department of Infectious diseases

and Epidemiology,St-Petersburg, Russia

Dr. Andrey DyachkovE-mail: cd4@inbox.ru

17.09.2012

In this quiz you have to find out:

1.From which book we took a description of disease?

2.Which infectious disease is described?

Then you can learn a little bit about it

Here comes a description of a disease from a book:

She coughed deeply and I heard phlegm rattling in her lungs.

“Um, yeah, actually. God, I can’t believe this is happening to me!”

“What? What’s happening?”

“I can’t go to Europe with Miranda. I have .......................”

“What?”

“You heard me, I can’t go. The doctor called today with the blood results, and as of right now, I’m not allowed to leave my apartment for the next three weeks.”

Three weeks! She had to be kidding. There wasn’t time to feel badly for her—she’d just told me she wasn’t going to Europe, and it was that thought alone—the idea that both Miranda and Emily would be out of my life—that had sustained me through the past couple months.

This hint can help you to figure out a name of a book.

Lauren Weisberger «The Devil Wears Prada» Weisberger was born in Scranton,

Pennsylvania, she attended Cornell University, New York. Graduating in 1999 she traveled as a backpacker through Europe, Middle East and Asia.

Returning home she was hired as assistant of Anna Wintour an editor of Vogue. She was there for ten months and in 2003 she wrote «The Devil Wears Prada» which is a semi-fictional but highly critical view of the Manhattan elite, it also highlights the presumed insanity of the fashion world. This book spent six months on the New York Times Best Sellers List.

A Movie of the same name, based on the novel, was released by 20th Century Fox in June 2006, starring Meryl Streep and Anne Hathaway.

Now we ready to figure out a disease whish was described in a book. To do that we have to go back to 1938

A few people can expect that a young men who had lost his eye in boys fight will become a fellow of Edinburgh's Royal College of Surgeons in 1938. He was born in Nothen Ireland at 15 Feb 1911 and decided to live engeneer college to take a degree in medicine.

Growing in a religious protestant family he was dedicated to work in one of a Britain colony but all his application was rejected since one-eyed surgeon didnt look practical.

It was a second world war which helped him - he became an army physician and in 1943-1945 was posted in Kenya, Somalia and Uganda, obtaining the rank of major.

After war he had been working as a surgeon in educational hospital near Lake Victoria where in 1957 he was asked to

examine a 5 year old boy in the paediatric ward.

A few weeks later he saw a girl with the same symptoms. What was a name of a surgeon?

This surgeon was Denis Parsons Burkitt

He suggested that symptoms he observed in his small patients are related to a new undiscribed type of a tumor. Together with his collegues he took one of the first field geografical survey, he visited more then 60 hospitals in East and South Africa to examine a incidence of a disease and found it to be correlated with the same temperature and rainfall zones as malaria.

Burkitt's lymphoma survey is regarded as one of the pioneering studies of geographical pathology.

His first reports and lectures was met with little interest but In 1961 he published a new compilation on malign lymphoma in African children in the journal Cancer.

… and he was able to find a willing earsAttending one of Denis Burkitt's lectures

in England in 1961 was Sir Michael Anthony Epstein. Born in 18 May 1921 he was educated in St. Paul's School (London), Cambridge and Middlesex Hospital Medical School. He was knighet in 1991.

Epstein suggested viral etiology of Burkitt's lymphoma. Epstein and Burkitt had decided to cooperate and Burkitt provided Epstein with a sample tissue of this new tumor.

In 1964 Epstein together with his assistant british virologist Yvonne Barr and specialist in electronic microscopy Bert Geoffrey Achong examined a sample of a tumor and described a new herpes virus which was named Epstein-Barr Virus (EBV).

Facts about EBV- EBV is also called human herpesvirus 4

- Globally 95-98% of adults are infected if EBV.

- Virus affect a B-lymphocites and epithelial cells (mostly tonsils), it can persist for years after primary infection and reactivate in case of severe immunideficiency (transplanted patients)

- In developing countries EBV mostly affect small children, vise versa in developed counties this is a infection of young adults

- Virus is shed with saliva in a small amount so mutual mucous contact are needed for acquaring infection. This why infectious mononucleosis is also called «kissing disease».

Epstein-Barr virus can cause Infectious mononucleosis («Mono»)

Hairy leucoplacky of tongue in HIV-infected patients (Resnick L. et al.,1988) (photo)

Burkitt's lymphoma

Nasopharengeal cancer — is relativly rare cancer of epitelial cells (less then 1 in 100000) except in southern China (20 in 100000) and northen population such is Inuit and Greenlanders

Primary infection with EBV results in a particularly severe disease in patients with X-linked lymphoproliferative disease (XLPD), survivors are also at high risk of developing B-cell lymphoma.

Transplanted patients can develope severe infection or tumor

Rarely cause: Encephalitis, Aplastic anemia, Idiopathic trombocytopenic purpura, spleen rupture, asphixia

Clinical symptoms of Mono:- Exudative pharingitis with a moderate hyperemia

- Petecheal hemmorhagges on soft palate (left picture)

- Polylymphoadenopathy (usually more then 2 groups incl. cervical)

- Moderate hepato- and slenomegaly

- Hemisynthetic pennicilin's induced rush (usually pruritic maculopapular)

- Patients might experienced respiratory symptoms couple of weeks before pharingitis outset.

Please note an absence in hyperemia and hemmorrages on soft palate

in Mono (left) VS Strep. A (right) pharingitis:

Clinically Mono is difficult to diffentiate from Toxoplasmosis, Acute HIV and Cytomegalovirus so Lab tests has particular importance

In a CBC you should find leucocytosis, accompanied by neutropenia and more then 10% of atypical mononuclears (young T-supressors)

Moderate increase of liver enzyme ALT is common

The ability of serum of patients with Mono to agglutinate sheep and horse erytrocites lead to development of Heterofilic antibodies tests (named Paul-Bunnel (test suggested in 1935) and Goff-Bauer (in 1965) respectivly).

Modern test are based on assesment of antibody response toward different EBV antigens

Lab tests

Each patient on this diagnostic plate have a 3 holes - Patient with acute Mono having holes E2, E6 and E10.

Please note that almost all tested patients are positive for anti-EBNA JgG. This fact demontrate a high incidence of past infection among population.

Unrecognised MonoTreatment is usually supportive

Interestingly that despite a fact that in a book «The Devil Wears Prado» girls whom I quotated in the begining of this presentation discussed Mono, but in a movie they decided not to mentioned a Mono but make girls discussing foot fracture as a result of car accident.

May be Mono was to compicated for Holywood but it certanly isnt for you if had reach the end of this presentation.

Please visit our Facebook group «Infectious diseases for doctors» to find photous and new clinical cases from infectious diseases hospital.http://www.facebook.com/groups/414509858598674/

Here is me working on this quiz =)