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Infection & Immunology > 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 type of virus is EBV?

A

It is a gamma-Herpes virus (dsDNA)

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3
Q

Where is EBV found?

A

It is found in the pharyngeal sections of infected individuals and is transmitted by close contact (e.g. kissing, sharing eating utensils)

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4
Q

What happens with an EBV infection in the body?

A

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

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5
Q

What is a classic feature of Infectious Mononucleosis?

A

Atypical Lymphocytes in the peripheral blood

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6
Q

What happens with EBV after infection?

A

It remains latent in lymphocytes

Reactivation may occur following stress or immunosuppression

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7
Q

What is the epidemiology of Infectious Mononucleosis?

A

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

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8
Q

What is the incubation period of Infectious Mononucleosis?

A

4-8 weeks

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9
Q

What is the onset of symptoms of Infectious Mononucleosis?

A

Abrupt

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10
Q

What are the presenting symptoms of Infectious Mononucleosis?

A 
Sore throat 
Fever 
Fatigue
Headache 
Malaise 
Anorexia 
Sweating 
Abdominal pain
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11
Q

What are the signs of Infectious Mononucleosis?

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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12
Q

What investigations do 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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13
Q

What bloods do you do for Infectious Mononucleosis?

A

FBC - leucocytosis

LFTs - high AST/ALT

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14
Q

What do we see on a Blood Film for Infectious Mononucleosis?

A

Lymphocytosis with atypical lymphocytes

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15
Q

What is the Heterophil Antibody Test?

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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16
Q

Why do we do Throat Swabs for Infectious Mononucleosis?

A

Exclude streptococcal tonsillitis

17
Q

What is the management plan for Infectious Mononucleosis?

A

Bed rest
Paracetamol and NSAIDs - helps with fever, malaise
Corticosteroids in SEVERE cases

18
Q

What is the important drug advice you give for Infectious Mononucleosis?

A

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

19
Q

What general advice do you give for Infectious Mononucleosis?

A

Avoid contact sports for 2 weeks (because of risk of rupturing your spleen)

20
Q

What is the main general complication of Infectious Mononucleosis?

A

Lethargy for several months

21
Q

What are the Respiratory complications of Infectious Mononucleosis?

A

Airway obstruction from oedematous pharynx, secondary bacterial throat infection, pneumonitis

22
Q

What are the Haematological complications of Infectious Mononucleosis?

A

Haemolytic or aplastic anaemia

Thrombocytopaenia

23
Q

What are the GI/Renal complications of Infectious Mononucleosis?

A 
Splenic Rupture 
Fulminant Hepatitis 
Pancreatitis 
Mesenteric adenitis 
Renal Failure
24
Q

What are the CNS complications of Infectious Mononucleosis?

A

Guillain-Barre syndrome
Encephalitis
Viral Meningitis

25
Q

What are the EBV-associated malignancy related complications for Infectious Mononucleosis?

A

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

26
Q

What is the prognosis for patients with Infectious Mononucleosis?

A

Most make uncomplicated recovery (within 3 weeks)

Immunodeficiency and death are VERY RARE

Infection & Immunology (40 decks)

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