Infectious mononucelosis

Question 1

Definition

Answer 1

infectious mononucleosis (glandular fever) is caused by the Epstein-Barr virus (EBV) and predominantly affects young adults.

DNA herpesvirus with a predeliction for B-lymphocytes and causes proliferation of T cells (Atypical mononuclear cells)

Question 2

Spread

Answer 2

Saliva or droplet

Question 3

Clinical presentation

Answer 3

• Most individuals are affected with this virus at an early age (0-5) with no symptoms
• Infection at older age associated with infectious mononucleosis (glandular fever)
• Fever, headache, malaise and sore throat z(tonsillar enlargemen with exudate)
• Palatal petechiae
• Transient macular rash
• Cervical lymphadenopathy (posterior triangle of the neck)
• Splenomegaly
• Note if the patient is given ampicillin for the sore throat a maculopapular rash develops

Question 4

Investigations

Answer 4

• Blood film
  
  • Increased lymphocyte count with atypical lymphocytes
  • Evidence of haemolytic anaemia (reduced number of mature red cells_
• Mono-spot test
  
  • Detects heterophile antibodies that are common in glandular fever
• Liver function tests
  
  • Hepatic derangement i.e AST and ALT raised, Raised bilirubin

Question 5

Treatment

Answer 5

• no specific treatment
• supportive – paracetamol, throat gargles and bed rest

Question 6

Complications

Answer 6

• thrombocytopenia, haemolytic anaemia and hepatitis
• rarer- aspetic meningitis, encephalitis, pericarditis
• associated tumours – burkitts lymphoma, hodgkins lymphoma, large B cell lymphoma