Infectious Mononucleosis (Glandular Fever)

Question 1

Definition

Answer 1

Triad of fever, pharyngitis, and lymphadenopathy

Question 2

Aetiology

Answer 2

Epstein-Barr Virus (MC)
Rarely:
- cytomegalovirus
- toxoplasmosis
- hpv 6
- HIV
- adenovirus

Question 3

How is the disease spread?

Answer 3

• Saliva via kissing or sharing food
• Sexual contact (through blood and semen)
• Blood transfusions
• Organ transplants
• Intrauterine transmission

Question 4

Epidemiology

Answer 4

Young adults: 15-24
Sharing drinks and toothbrushes
Sexual contact
Blood transfusions/Organ transplant

Question 5

Pathophysiology

Answer 5

EBV introduced into the oropharynx and begins to replicate and infect B-cells of lymphoid tissue. Virus spreads through the lymphatic system, leading to fever and lymphadenopathy. Heterophile antibodies are produced against the EBV which can be measured in the blood serum

Question 6

Signs

Answer 6

• Tonsillar enlargement: may have a white exudate and palatial peichieae
• Lymphadenopathy: bilateral posterior cervical lymphadenopathy
• Splenomegaly and hepatomegaly

Question 7

Symptoms

Answer 7

Sore throat
Abdominal tenderness
Prodromal symptoms:
- Malaise
- Fever
- Fatigue
- Myalgia
- Anorexia
- Retro-orbital headache

Question 8

Diagnosis

Answer 8

FBC: > 20% atypical/reactive lymphocytes or a lymphocytosis
Monospot test (heterophile antibodies): tested in the 2nd week of symptoms to confirm the diagnosis

Question 9

Management

Answer 9

Conservative measures:
- Oral fluids
- Paracetamol/Ibuprofen
Avoid heavy lifting to reduce risk of splenic rupture

Question 10

Why is it important to avoid antibiotics esp ampicillin or amoxicillin?

Answer 10

May lead to the development of a widespread non-blanching maculopapular rash around 48 hours after administration