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Ear, Nose & Throat > Infectious Mononucleosis > Flashcards

Infectious Mononucleosis Flashcards

1
Q

Define Infectious Mononucleosis?

A

Clinical syndrome caused by primary EBV infection

aka glandular fever

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2
Q

What is the aetiology of Infectious Mononucleosis?

A

EBV is a gamma-Herpes virus (dsDNA)
It is found in the pharyngeal secretions of infected individuals and is transmitted by close contact (e.g. kissing, sharing eating utensils)
EBV infection of the epithelial cells of the oropharynx leads to B cell infection
The infected B cells disseminate EBV across the body leading to a humoral and cellular immune response
EBV remains latent in lymphocytes
Reactivation may occur following stress or immunosuppression

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3
Q

What is a classic feature of Infectious Mononucleosis?

A

Atypical Lymphocytes in the peripheral blood

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4
Q

What is the epidemiology of Infectious Mononucleosis?

A

COMMON
Two age peaks:
- 1-6 yrs
- 14-20 yrs

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5
Q

What is the incubation period of Infectious Mononucleosis?

A

4-8 weeks

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6
Q

What is the onset of symptoms for Infectious Mononucleosis?

A

Abrupt onset

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7
Q

What are the presenting symptoms of Infectious Mononucleosis?

A 
Sore Throat 
Fever 
Fatigue 
Headache 
Malaise 
Anorexia 
Sweating 
Abdominal Pain
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8
Q

What are the signs of Infectious Mononucelosis on physical examination?

A 
Pyrexia 
Oedema and erythema of the pharynx 
White/creamy exudate on the tonsils
Palatal Petechiae
Cervical/generalised lymphadenopathy
Splenomegaly
Hepatomegaly 
Jaundice (5-10%)
Widespread maculopapular rash (in patients who have received ampicillin)
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9
Q

What investigations would you do for Infectious Mononucleosis?

A

Bloods
Blood Film
Heterophil Antibody Test (aka Monospot Test, Paul Bunnell Test)
Throat Swabs
IgM or IgG to EBV viral capsid antigen
IgG against Epstein-Barr nuclear antigen (EBNA)

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10
Q

What bloods would you do for Infectious Mononucleosis and what might you expect?

A

FBC - leucocytosis

LFTs - high AST/ALT

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11
Q

What might you expect to see on a Blood Film for Infectious Mononucleosis?

A

Lymphocytosis with atypical lymphocytes

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12
Q

What are some of the characteritics of a Heterophil Antibody Test for Infectious Mononucleosis?

A

Based on EBV antigens being similar to antigens on RBCs of many animals but NOT humans
Mixing blood of an EBV-positive human with animal blood will make the animal’s red cells aggregate and precipitate out of solution
May give false-negatives in the early stages of infection before antibodies are generated

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13
Q

Why do we do Throat Swabs for Infectious Mononucleosis?

A

Exclude Streptococcal Tonsillitis

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14
Q

What is the management plan for Infectious Mononucleosis?

A

Bed Rest
Paracetamol and NSAIDs - helps with fever, malaise
Corticosteroids in SEVERE cases
Advice - avoid contact sports for 2 weeks (because of risk of rupturing your spleen)

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15
Q

What do we avoid if Infectious Mononucleosis is suspected?

A

Don’t give Ampicillin or Amoxicillin if Infectious Mononucleosis is suspected
Nearly 100% of patients with glandular fever develop a maculopapular rash

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16
Q

What is a common general complication of Infectious Mononucleosis?

A

Lethargy for several months

17
Q

What are some common respiratory complications of Infectious Mononucleosis?

A

Airway obstruction from oedematous pharynx
Secondary bacterial throat infection
Pneumonitis

18
Q

What are some common Haematological complications of Infectious Mononucleosis?

A

Haemolytic or aplastic anaemia

Thrombocytopenia

19
Q

What are some common GI/Renal complications of Infectious Mononucleosis?

A 
Splenic Rupture 
Fulminant Hepatitis
Pancreatitis 
Mesenteric Adenitis 
Renal Failure
20
Q

What are some CNS complications of Infectious Mononucleosis?

A

Guillain-Barre Syndrome
Encephalitis
Viral Meningitis

21
Q

What are some EBV-associated malignancies that can be complications of Infectious Mononucleosis?

A

Burkitt’s Lymphoma (in sub-Saharan Africa)
Nasopharyngeal Cancer
Hodgkin’s Lymphoma

22
Q

What is the prognosi for patients with Infectious Mononucleosis?

A

Most make uncomplicated recovery (within 3 weeks)

Immunodeficiency and death are VERY RARE

Ear, Nose & Throat (6 decks)

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