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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest remedies for glandular fever

Answered by
Dr.
Dr. Noble Zachariah

Internal Medicine Specialist

Practicing since :1974

Answered : 2276 Questions

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Posted on Mon, 6 Jun 2016 in Medicines and Side Effects
Question: My 18 yr old daughter had what at first seemed to be severe tonsillitis but after being unable to breathe at night about 7 days later was tested and had serious glandular fever and acute primary CMV. We don’t know if inability to breathe was allergic reaction but she’s a smart girl who described this as suddenly happening and different from the serious tonsil swelling she already. Her only known allergy is choloramphenico eyedrops but she had strep B infection treated with antibiotics when newborn and so I'm wondering if she’s developed anything as I was told allergy was likely later in life.
Also she had sensitive stomach etc when diagnosed with these two illnesses and the same tests showed she had no resistance to Hep A (no antibodies at all) or Hep B so was revaccinated for same. I don’t know why this happened. I believe when you have these illnesses (especially when together) you can suffer damage to liver, spleen or kidneys etc but I don’t know what exactly, why, how serious or if possible allergic reaction would have anything to do with it. Can you explain and advise what we should be doing?
doctor
Answered by Dr. Noble Zachariah 1 hour later
Brief Answer:
Relax, it resolves in most cases

Detailed Answer:
Hello,
Welcome and thanks for your query.
I understand your concern.
This is unlikely to be a serious illness and so please don't be so worried. Glandular fever and CMV produce an inflammation of the upper airway and produces breathing difficulty.
There can be mild inflammation of the liver and elevation of liver enzymes but these usually settle when the infection is cured.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah 12 minutes later
Hi
Thanks for reassurance but why are her memory cells now missing and what should we be doing about it. E.g. why does she now have no antibodies to Hep A & Hep B when she'd been immunised for them both before?
Should we not be testing for seroconversion ability re all the other illnesses she has been vaccinated against such as MMR, diptheria, tetanus etc? If - waht is the side effect of revaccinating?
Rgds XXXXXXX
doctor
Answered by Dr. Noble Zachariah 1 hour later
Brief Answer:
Yes, she could be tested for the antibodies

Detailed Answer:
It is a good idea to test her for antibodies of the diseases she had been vaccinated against. If she has antibodies, then the hepatitis vaccine may have been defective and only revaccination is required. If they are absent she may require to be tested for conditions that decrease immune response.
There's no harm in revaccination with killed viral and bacterial vaccines. Revaccination boosts immunity already present.
The side effects are not dangerous in those not allergic to the components.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah 55 minutes later
1 Just wondering about comment re allergy to vaccination compounds. What would that be for Hep A & Hep B vaccinations? Is it Aluminium oxide?
2 As mentioned she was tested for EBV & CMV after she showed some kind of allergy/sensitivity like adverse drug reaction or effect when on phenotype penicillin with inability to breathe and raised white skin like if cold -and then on amoxicillin for another 7 days. This can show up in response similar to allergy. I suspect this occurred and wondering about what to do moving forward.
3 Understand if you take antibiotics with virus you can affect your immunity and resistance to antibiotics. Has that occurred here?
doctor
Answered by Dr. Noble Zachariah 1 hour later
Brief Answer:
Discussion follows

Detailed Answer:
Aluminium salts are used as adjuvant to boost the immune response to vaccines like HepA, HepB, DTaP etc. One can develop allergy to anything under the Sun including Sun, is the dictum regarding allergy and it can occur at any age.
Penicillin group of drugs are sometimes prescribed in sore throat suspected to be caused by Strep. If EBV is the cause, it may cause a flare up of the problem and also produce rashes. This usually does not occur with other groups of antibiotics or other groups of viruses.
The problem caused usually subsides without significant problems.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah 10 hours later
How dose the antibiotic resistance i.e. loss memory cells occur? Also is it tied to liver function or another part of the body?
doctor
Answered by Dr. Noble Zachariah 6 hours later
Brief Answer:
Liver inflammation is due to EBV infection

Detailed Answer:
The reason why Amoxicllin and other Penicillin group of drugs produce rash in EBV infection is not fully understood. EBV interacts with B cells responsible for immune memory for its own survival. This way it can remain in the body without being destroyed for long periods.
Liver inflammation is due to the EBV infection and enzymes are elevated in the majority during the acute infection. It settles with cure of the infection.
Most other symptoms also resolve without sequale
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah 57 minutes later
1 We are about to go overseas for a week - is it worth her looking at a immuno globulin injection in meantime before we can't sort out her antibody testing and (re)vaccination programme to boost her immunity so she isn't sick the whole time?

2 or are there side effects or other considerations we should be doing e.g. if need to test for deficient immunity conditions?

3 is decresed immunity conditions which you mention above likely from EBV or CMV?
doctor
Answered by Dr. Noble Zachariah 1 hour later
Brief Answer:
Be cautious when traveling abroad

Detailed Answer:
If she has got over the acute infection and is asymptomatic, nothing more is to be done. If she's is going to a country where the risk of getting infected from the infection to which her immune status is doubtful, passive immunization with immunoglobulin can be considered. A better option would be to take care to avoid an infection by adequate precautions.
Immune deficiency can be detected through blood tests and skin tests. Needs to be done only if she doesn't not have antibodies to the other diseases she has vaccinated against.
CMV and EBV if occurring in immunocompromised people can produce severe disease. These do not produce overall immune deficiency.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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