Infectious mononucleosis

Question 1

Define infectious mononucleosis

Answer 1

Clinical syndrome caused by primary EBV infection – HHV4

Question 2

What are the causes/risk factors of infectious mononucleosis?

Answer 2

• Close contact e.g. kissing, sharing eating utensils

Question 3

What are the symptoms of infectious mononucleosis?

Answer 3

Incubation period is 4-8 weeks
• Sore throat
• Fever
• Fatigue
• Headache
• Malaise
• Anorexia
• Sweating
• Abdominal pain

Question 4

What are the signs of infectious mononucleosis?

Answer 4

• Pyrexia
• Oedema/erythema
• White creamy exudate on tonsils
• Palatal petechiae
• Cervical/generalised lymphadenopathy
• Splenomegaly
• Hepatomegaly
• Jaundice
• Erythematous rash
• Widespread maculopapular rash with amoxicillin/ampicillin

Question 5

What investigations are carried out for infectious mononucleosis?

Answer 5

• Bloods
- FBC – leucocyctosis
- LFTs – elevated transaminases
• Blood film – atypical lymphocytosis
• Paul-Bunnell monospot – heterophile antibodies

Question 6

What is the management for infectious mononucleosis?

Answer 6

• Give information and advice:
- Advise on the use of paracetamol or ibuprofen to relieve pain and fever symptoms.
- Explain the expected course of the illness and reassure the person that symptoms usually last for 2–3 weeks. Tiredness is common and is often the last symptom to resolve.
- Advise the person:
That exclusion from work or school is not necessary.
- To return to normal activities as soon as possible. If they are tired, they should tailor their activities to what they can manage comfortably.
- To limit spread of the disease, by avoiding kissing and sharing eating or drinking utensils, and to thoroughly clean all items that may have been contaminated by saliva.
- To avoid contact or collision sports or heavy lifting for the first month of the illness (to reduce the risk of splenic rupture).

• Advise the person to seek urgent medical advice if they:
- 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).
- If a person has ongoing fatigue
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Question 7

What are the complications of infectious mononucleosis?

Answer 7

• Ruptured spleen.
• Kidney inflammation.
• Hemolytic anemia.
• Nervous system problems, such as encephalitis, meningitis, and other conditions.
• Inflammation of the heart muscle.
• Heart rhythm problems.
• Obstruction of the upper airways.