Infectious mononucleosis

Question 1

What is infectious mononucleosis

Answer 1

Glandular fever

Question 2

What are the features of infective mononucleosis

Answer 2

The classic triad of sore throat, pyrexia and lymphadenopathy is seen in around 98% of patients:
sore throat
lymphadenopathy: may be present in the anterior and posterior triangles of the neck, in contrast to tonsillitis which typically only results in the upper anterior cervical chain being enlarged
pyrexia
Other features include:
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)
a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis

Question 3

How do you diagnose infectious mononucleosis?

Answer 3

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 4

What is the management for infectious mononucleosis?

Answer 4

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 5

What is infectious mononucleosis caused by?

Answer 5

Epstein-Barr virus (EBV, also known as human herpesvirus 4, HHV-4)

Question 6

Who is most at risk of infectious mononucleosis?

Answer 6

It is most common in adolescents and young adults.

Question 7

What is the correlation between socioeconomic groups and EBV?

Answer 7

Lower socioeconomic groups have high rates of EBV seropositivity, having frequently acquired EBV in early childhood when the primary infection is often subclinical. However, higher socioeconomic groups show a higher incidence of infectious mononucleosis, as acquiring EBV in adolescence or early adulthood results in symptomatic disease.

Question 8

What is the difference between tonsillitis and Infectious mononucleosis?

Answer 8

lymphadenopathy may be present in the anterior and posterior triangles of the neck, in contrast to tonsillitis which typically only results in the upper anterior cervical chain being enlarged