Question

A 17 yr old female is brought to the office for evaluation of a sore throat and fever. Her symptoms started about 1 week ago and have been worsening. She has been extremely fatigued and has spent most of the last 3 days in bed. She denies any ill contacts. She has no significant medical history, takes no medications, and has no allergies. On examination of her pharynx shows her tonsils to be markedly enlarged, almost touching in the midline. They are erythematous and covered with white exudates. She has prominent cervical adenopathy, which is mildly tender. A cardiovascular examination is normal, and her abdomen is soft, nontender, without organomegaly. A rapid streptococcal antigen test is negative. Depite the use of amoxicillin to combat streptococcal infection the patient is not getting better and now complains of a red rash (likely an allergic response) from head to toe.

1. What specific viruses may be involved in this infection?

2. What specific tests can be performed to help confirm a diagnosis (think serology and another type of specimen).

3. If you were to culture this patient for a virus what types of cells would you need to use to assure it will grow.

4. How was this viral infection likely acquired?

5. What are the basic characteristics of this virus? (example: DNA or RNA, single or double stranded, enveloped or naked, helical or icosahedral)

Answer 1

The symptoms mentioned in the question are very much similar to the Acute tonsillitis

1) A series of viruses may be involved such as adenovirus, EBV, CMV, HSV, rhinovirus, coronavirus, influenza and parainfluenza viruses, HIV

2) Diagnosis test involve –

• Primary testing - throat culture, rapid streptococcal antigen test

• Secondary tests - serologic testing for streptococci, WBC count and differential, heterophile antibodies, vaginal and cervical, or penile, and rectal cultures

3) Cells from the fluid of the tonsils and the cells at the back of the throat

4) Spread through inhalation of respiratory droplets of infected person, come in contact with contaminated objects

5) RNA, Single stranded, enveloped and negative-sense RNA viruses