Infectious mononucleosis

Question 1

Causes

Answer 1

EBV (90%)
- Others cytomegalovirus and HHV-6

Question 2

Classic triad

Answer 2

sore throat, pyrexia and lymphadenopathy

Question 3

Other features
malaise, anorexia, headache
[…] petechiae
[…] - occurs in around 50% of patients and may rarely predispose to splenic rupture
[…], transient rise in […]
[…]: presence of 50% lymphocytes with at least 10% atypical lymphocytes
[…] […] secondary to […] […] (IgM)

Answer 3

malaise, anorexia, headache
palatal petechiae
splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
hepatitis, transient rise in ALT
lymphocytosis: presence of 50% lymphocytes with at least 10% atypical lymphocytes
haemolytic anaemia secondary to cold agglutins (IgM)

Question 4

Typical feature if they take ampicillin/amoxicillin whilst ill

Answer 4

a maculopapular, pruritic rash develops in around 99% of patients

Question 5

Advice
Management is […] and includes:
- […] during the early stages, drink plenty of fluid, avoid […]
- simple […] for any aches or pains
- consensus guidance in the UK is to avoid playing contact sports for […] weeks after having glandular fever to reduce the risk of splenic rupture

Answer 5

Management is supportive and includes:
rest during the early stages, drink plenty of fluid, avoid alcohol
simple analgesia for any aches or pains
consensus guidance in the UK is to avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture

Question 6

Diagnosis
[…] antibody test ([…] test) - NICE guidelines suggest […] and Monospot in the […] week of the illness to confirm a diagnosis of glandular fever.

Answer 6

Diagnosis
heterophil antibody test (Monospot test) - NICE guidelines suggest FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.

Question 7

When do symptoms resolve?

Answer 7

Symptoms typically resolve after 2-4 weeks.

Question 8

In early childhood, primary infection is often […]. However, acquiring EBV in adolescence or early adulthood results in […] disease.

Answer 8

In early childhood, primary infection is often subclinical. However, acquiring EBV in adolescence or early adulthood results in symptomatic disease.