The document provides a summary of infectious mononucleosis from Lauren Weisberger's novel "The Devil Wears Prada". It describes symptoms experienced by a character who is diagnosed with mononucleosis, including coughing up phlegm and being unable to travel for 3 weeks. The document then provides historical context on the discovery and identification of Epstein-Barr virus as the cause of mononucleosis. It discusses the work of Denis Parsons Burkitt in first describing Burkitt's lymphoma in African children and the subsequent collaboration between Burkitt and Michael Anthony Epstein that led to the identification of Epstein-Barr virus through examination of tumor samples.

1. Infectious diseases in literature
Part 1.
Pavlov State Medical University,
Department of Infectious diseases
and Epidemiology,
St-Petersburg, Russia
Dr. Andrey Dyachkov
E-mail: cd4@inbox.ru
17.09.2012

2. 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

3. 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.

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

5. 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.

6. 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.

7. 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?

8. 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.

9. … and he was able to find a willing ears
Attending 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).

10. 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».

11. 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

12. 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.

13. 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

14. Lab tests
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

15. 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.

16. Treatment is usually supportive
Unrecognised Mono
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/

17. Here is me working on this quiz =)