Glandular Fever (Infectious Mononucleosis)

Question 1

What is infectious mononucleosis?

Answer 1

Glandular Fever, viral infection most commonly caused by

EBV (a special Herpes Virus, HHV-4)

Might also be caused by othe viruses

Question 2

How is Glandular Fever transmittet?

Answer 2

Via tramission of causing viruses

• E.g. EBV
  
  • saliva, also from asymptomatic carriers
  • semen and blood, blood transfusion /organ donation
• EBV leads to life-long carrier state

Question 3

What is the incubation piriod of Infectious mononucleosis?

Answer 3

4-7 Weeks

• contaigeous in incubation period + while symptoms are present (up to 18 Months after infection)

Question 4

What is the prevalence of infectious mononucleasis?

Answer 4

Most commonly found in 15-24 YO

• 5-48 Patients /1000
• Might be <1/1000 if <10Y, >30Y

Question 5

What are possible complications of glandular fever?

Answer 5

• Hepatic
  
  • Abnormal liver function tests (LFTs)
    
    • in 90% with elevated AST and ALT
  • Hepatitis
    
    • normally early, self limiting
• Upper airway obstruction due to enlarged tonsils
• Cardiac
  
  • percarditis, myocarditis
• renal or
• neurological complications
  
  • enceohalitis
• Haematological
  
  • mild throbocytopaenia
• Splenic rupture
• Cancer
  
  • especially Hodgkin’s lymphoma and Burkitt lymphoma (due to EBV infection)

Question 6

What is the prognosis of someone with glandular fever?

Answer 6

Normally self-limiting within 2-4 Weeks

• might be prolonged
• might lead to complications
• Associated with chronic fatigue (about 10% up to a couple of months)

EBV infection will lead to life-long carrier state

Question 7

What are signs of glandular fever?

Answer 7

• Fever
• Lymphadenopathy
  
  • Bilateral posterior cervica lymphadenopathy is typical
• tonsillar enlargement (severe) with ‘whitewash’ exudate
• Pharyngeal inflammation and palatal petechiae
• splenomegaly (hepatomegaly)

Question 8

What are typical presenting symptoms of glandular fever?

Answer 8

• Sore throat (severe)
• Feeling general malaise, fatigue, myalgia, chills, sweats, anorexia, and retro-orbital headache
• ild tenderness in the right hypochondrium (liver)

Question 9

Which investigations would you do in a patient with suspected infectious mononucleosis?

Answer 9

• Bloods
  
  • FBC with diff
    
    • likely if 20% are atypical lymphocytes
  • Monospot test
    
    • AB test to detect EBV
    • If negative or in children: arrange EBV serology
    • If 2nd negative ? HIV?
  • LFT
• Throat swap : role out Streptococcal sore throat
  *

Question 10

What is the general management of glandular fever?

Answer 10

Symptomatic approach, normally self-limiting after 2-4 Weeks

• Pracetamol / iboprofen as analgesia
• Avoid Amoxicillin /ABX as they might cause rash
• Exclusion + limiting contact w. people is necessary
• Return to normal activity ASAP
• limit contact to people + clean everything that is possibly contaminated

Consider hospital admission if:

• develop stridor or respiratory difficulty.
• Have difficulty swallowing fluids or have signs of dehydration, such as reduced urine output.
• Become systemically very unwell.
• Develop abdominal pain (may indicate splenic rupture).

Question 11

How do streptocooal tonsilitis and infectious mononucleosis differ?

Answer 11

Glandular Fever

• lymphadenopathy in posterior cervical lymph nodes
• possible hepato/splenomegaly

Streprococcal sore throat

• normally anterior and submandibular cervical lymph nodes
• no hepato/splenomegaly

Question 12

Which other conditions are also associated with EBV?

Answer 12

• Burkitt’s lymphoma (other Hodegkins lymphomas)
• Guillan-Barre syndrome
• Viral meningits