Case study

The nineteen-year-old girl is likely to be diagnosed with an Epstein-Barr virus (EBV) infection. Epstein-Barr virus (EBV) is a virus with double strands belonging to the herpes virus family that mainly attacks the lymphocytes. The student case eliminates other diseases due to sore throat, fatigue, rashes, headache, and high fever. Epstein-Barr virus (EBV) infection caused by infectious mononucleosis elevates white blood cells’ concentration as a responsive measure to fight the virus (Sufang et al., 2019). The spleen plays a significant immune role, and therefore it may enlarge to increase the percentage of white blood cells.  The phenomenon explains why the patient had a spleen that is 3cm below the rib margin. EBV affects B-lymphocytes and epithelial cells and may result in swelling and lymphadenopathy. Even though the patient denies personal contact with sick people, there is evidence of salivary transfer through her boyfriend. According to Sufang et al. (2019), EBV in adolescents can be transmitted through sexual intercourse by infected epithelial cells in semen or uterine cervixes or saliva.

Epstein-Barr virus infection is best diagnosed through molecular assays. The DNA of EBV can easily be identified by molecular techniques and follow up treatment accordingly implemented. The diagnosis suits molecular assays since the viral load of EBV remains in the saliva for almost six months instead of viral clearance in the blood. The methods of the molecular technique include protein-based assays, quantitative real-time chain reaction, and immunoblotting techniques. The quantitative real-time approach (qPCR) is the most reliable, simple, silent reactive, sensitive, and fastest way of diagnosing EBV. Additionally, the method can be used with patients with a compromised immune system or monitoring those likely to acquire EBV related illness (Haleem et al., 2020). Moreover, Heterophile Antibody Test can be applied by testing sheep red blood cells’ agglutination in response to infectious mononucleosis virus.

 The patient’s worsening sore throat can be managed by administering saltwater gargles, nonsteroidal anti-inflammatory drugs, and acetaminophen to relieve the sore throat. The patient should also rest to reduce the unexplainable fatigue she experiences due to the disease. Nucleoside-analog medications like acyclovir, ganciclovir, and famciclovir also hamper the multiplication of EBV virus when taken in large quantities by acting as a DNA polymerase. The student should also refrain from activities such as sports that may rupture the spleen if she overstretches. In the case of airway obstructions, bleeding thrombocytopenia, meningitis, seizures, or hemolytic anemia, corticosteroids may be administered. The patient should also take a lot of fluids to keep her body dehydrated due to fever and inability to swallow solid food. Furthermore, the patient should avoid the intake of rash stimulant drugs such as ampicillin.

EBV weakens the immunity of patients; therefore, the patient may feel exhausted for a while or get exposed to other diseases. If the spleen is not adequately monitored, it may rupture and put the patient’s life at stake due to blood loss. Increased swelling of the throat could also constrict the flow of air into the lungs. Although it rarely happens, the patient stands a chance to experience liver failures. Other complications include lymphoproliferative cancers, arthritis, sclerosis, and meningitis (Fugl & Andersen, 2019). However, if the Epstein-Barr virus (EBV) infection is appropriately managed, the symptoms can last for about 2 to 4 weeks as the patient gradually recovers.

References

Fugl, A., & Andersen, C. L. (2019, May 14). Epstein-Barr virus and its association with disease – a review of relevance to general practice. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518816/

Haleem, M. A., Gan, S. H., Al-Hatamleh, M. A., Irekeola, A. A., Shueb, R. H., & Yean, C. Y. (2020, March 18). Recent advances in diagnostic approaches for Epstein–Barr virus. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7157745/

Smatti, M. K., Al-Sadeq, D. W., Ali, N. H., Pintus, G., Abou-saleh, h., & Nasrallah, G. K. (2018, June 13). Epstein–Barr virus epidemiology, serology, and genetic variability of LMP-1 oncogene among healthy population: An update. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6008310/

Sufang, T., Lindsey, W., Shu-Yuan, X., Yanlin, Z., Yan, H., & Hanlin, W. (2019, September). The morphologic features of primary Epstein-Barr virus… : The American Journal of surgical pathology. LWW. https://journals.lww.com/ajsp/fulltext/2019/09000/the_morphologic_features_of_primary_epstein_barr.11.aspx

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