Infectious mononucleosis Flashcards
(8 cards)
Define
Clinical syndrome of fever, lymphadenopathy, pharyngitis with atypical lymphocytosis caused by primary EBV infection
AKA glandular fever
(Fever, Atypical lymphocytes, Oedema/erythema of pharynx, Sore throat, POSTERIOR CERVICAL lymphadenopathy, splenomegaly – DON’T GIVE AMOXICILLIN (will cause maculopapular rash) and AVOID CONTACT SPORT (risk of rupturing spleen)
Causes
EBV is a gamma-Herpes virus (dsDNA)
It is found in the pharyngeal secretions of infected individuals and is transmitted by close contact (e.g. kissing, sharing eating utensils)
EBV infection of the epithelial cells of the oropharynx leads to B cell infection
The infected B cells disseminate EBV across the body leading to a humoral and cellular immune response
Atypical lymphocytes in the peripheral blood are a classic feature of infectious mononucleosis
EBV remains latent in lymphocytes
Reactivation may occur following stress or immunosuppression
Epidemiology
COMMON
TWO age peaks:
1-6 yrs
14-20 yrs
Symptoms
Incubation period: 4-8 weeks
Abrupt onset of symptoms:
- Sore throat
- Fever
- Fatigue
- Headache
- Malaise
- Anorexia
- Sweating
- Abdominal pain
Signs
PYREXIA
Oedema and erythema of the pharynx
White/creamy exudate on the tonsils
Palatal petechiae
Cervical/generalised lymphadenopathy
Splenomegaly
Hepatomegaly
Jaundice (5-10%)
Widespread maculopapular rash (in patients who have received ampicillin)
Management
Bed rest
Paracetamol and NSAIDs - helps with fever, malaise
Corticosteroids in SEVERE cases
IMPORTANT: do NOT give AMPICILLIN or AMOXICILLIN if infectious mononucleosis is suspected - nearly 100% of patients with glandular fever develop a maculopapular rash
Advice - avoid contact sports for 2 weeks (because of risk of rupturing your spleen)
Complication
Lethargy for several months
Respiratory - airway obstruction from oedematous pharynx, secondary bacterial throat infection, pneumonitis
Haematological - haemolytic or aplastic anaemia, thrombocytopenia
GI/Renal - splenic rupture, fulminant hepatitis, pancreatitis, mesenteric adenitis, renal failure
CNS - Guillain-Barre syndrome, encephalitis, viral meningitis
EBV-associated malignancy - Burkitt’s lymphoma (in sub-Saharan Africa), nasopharyngeal cancer, Hodgkin’s lymphoma
prognosis
Most make uncomplicated recovery (within 3 weeks)
Immunodeficiency and death are VERY RARE
