Infectious mononucleosis

Question 1

Describe infectious mononucleosis?

Answer 1

• aka Glandular fever / Mono
• Caused by EBV
• Children: few/no symptoms
• Adults: fever, sore throat, lymphadenopathy, tiredness

Question 2

Who tends to be affected by EBV?

Answer 2

• Adolescents
• Young adults

Question 3

Complications of infectious mononucleosis?

Answer 3

• Swelling of liver or spleen
• Splenic rupture occurs in rare cases

Question 4

How can mono be spread?

Answer 4

• Saliva
  
  • rarely semen or blood

Question 5

What are the main symptoms of infectious mononucleosis?

Answer 5

• Malaise, anorexia, headache
• Palatal petechiae
• Splenomegaly (may rupture)
• Hepatitis
• Lymphocytosis
• Haemolytic anaemia secodnary to cold agglutins (IgM)

Question 6

How does mono usually present in adolescents and young adults?

Answer 6

• Triad:
  
  • Fever (mild)
  • Sore throat
  • Swollen glands
    
    • Mobile, usually posterior cervical nodes

Question 7

Describe the diagnosis of infectious mononucleosis?

Answer 7

• Clinical features
• Heterophile antibody test (monospot)
• Serology
  
  • EBV IgG (past infection) G = gone
  • EBV IgM (current infection)

Question 8

Describe the management of mono?

Answer 8

• Generally self limiting condition
• Reduce risk of splenic rupture:
  
  • Avoid contact sports, weight training for 8 weeks/until spleen has normalised
• Paracetamol + NSAIDs to reduce fever and pain

Question 9

A 17-year-old female presents for review. Four days ago she presented to her doctor with a severe sore throat, lethargy and headache. Her doctor prescribed a course of amoxicillin to treat an upper respiratory tract infection. Two days ago she developed a widespread, pruritic maculopapular rash. Her original symptoms have also not improved. What is the most likely diagnosis?

Answer 9

• Infectious mononucleosis
  
  • People treated with amoxicillin often develop a maculopapular rash
  • Usually resolves and does not indicate future penicillin reactions

Question 10

What is infectious mononucleosis a classical risk factor for?

Answer 10

Multiple sclerosis

Question 11

What is another name for EBV?

Answer 11

Human herpes virus 4

Question 12

Other causes of infectious mononucleosis?

Answer 12

• CMV
• HHV-6

Question 13

What is the classic triad of features in EBV?

Answer 13

• Fever
• Sore throat
• Lymphadenopathy
  
  • Anterior or posterior triangles of the neck

Question 14

How can the lymphadenopathy of infectious mononucleosis and tonsilitis be differentiated?

Answer 14

• MONO
  
  • Lymphadenopathy in anterior and posterior triangles of the neck
• TONSILITIS
  
  • Lymphadnopathy in upper anterior cervical chain