Glandular fever

Question 1

Epstein–Barr mononucleosis (EBM) is?

Answer 1

is a febrile illness caused by the herpes (Epstein–Barr) virus.

It can mimic diseases such as:

• HIV primary infection
• streptococcal tonsillitis
• cytomegalovirus
• toxoplasmosis
• viral hepatitis
• acute lymphatic leukaemia.

It may occur at any age but usually between 10–35 yrs,

• commonest in 15–25 yr olds.

Affects >95% of the population worldwide

Question 2

DxT:

Answer 2

sore throat + fever + lymphadenopathy ± rash (also malaise, anorexia)

Question 3

Diagnosis

Answer 3

WCC—absolute lymphocytosis

Blood film—atypical lymphocytes

+ve Paul Bunnell test/monospot test

EBV specific viral capsule antigen (IgM, IgG) antibodies (most reliable)

Question 4

Prognosis

Answer 4

usually runs an uncomplicated course over 6–8 wks.

Major symptoms subside within 2–3 wks.

Pts should be advised to take about 4 wks off work.

Question 5

Common complications are:

Answer 5

antibiotic-induced skin rash

hepatitis

depression

prolonged debility.

Question 6

Treatment

Answer 6

Supportive measures (no specific treatment)

est (the best treatment) during the acute stage, preferably at home and indoors

NSAIDs or paracetamol to relieve discomfort

Gargle soluble aspirin or 30% glucose to soothe the throat

Advise against: alcohol, fatty foods, continued activity, esp. contact sports

Corticosteroids reserved for various complications (e.g. neurological)

Be cautious of giving penicillins, esp. ampi/amoxycillin in misdiagnosed cases of EBM tonsillitis.

• It may precipitate a severe rash.

Question 7

Post-EBM malaise

Answer 7

Some young adults remain debilitated and depressed for some months.

Lassitude and malaise may extend up to a year or so.