Infectious Mononucleosis (Glandular Fever) Flashcards
What is Infectious Mononucleosis?
Infectious Mononucleosis (aka Glandular Fever) is a well-known clinical syndrome most commonly caused by Epstein-Barr Virus (EBV).
The names originates from the mononuclear lymphocytosis (about 2/3rds of WCC) with atypical lymphocytes (20-40%) associated with the syndrome.
How does Infectious Mononucleosis present?
- What are the key symptoms of Infectious Mononucleosis?*
- What risk factors are there?*
- What is the incubation period?*
The key features of Infectious Mononucleosis are fatigue, malaise, fever, sore throat, and generalised lymphadenopathy.
Other symptoms may include a macular rash and left upper quadrant (LUQ) tenderness.
Risk factors include kissing and sexual behaviour.
The incubation period can be 1-2 months.
What are the findings on examination in Infectious Mononucleosis?
Examination findings include:
- Lymphadenopathy (generalised) - 90%
- Splenomegaly (about 2-3cm) - 50%
- Hepatomegaly - 10%
- Marked tonsillar enlargement
- Pharyngitis
- Maculopapular rash
- Jaundice
Image Source: https://www.dermnetnz.org/topics/infectious-mononucleosis/
How is Infectious Mononucleosis investigated?
Full Blood Count
May see thrombocytopaenia or anaemia
Liver Function Tests
LFTs may be deranged
Heterophile antibodies (Paul-Bunnell IgM antibodies)
EBV-specific antibodies
How is Infectious Mononucleosis managed?
Infectious Mononucleosis is generally a self-limiting illness, and all that is required is supportive measures:
Hydration
Antipyretics
Rest
Avoid contact sports for 3 weeks
Avoid alcohol
In severe disease, hospital admission may be warranted:
Systemic steroids for severe airway obstruction, severe thrombocytopaenia, or haemolytic anaemia (1-3%).
Antivirals do not affect course or duration of symptoms.
What are the complications of Infectious Mononucleosis?
Think of a young firing nuclear MORTARS…
Very few cases of Infectious Mononucleosis experience complications. Where complications do occur, they include:
- Ampicillin-induced rash
- Splenic rupture
- Airway obstruction
- Thrombocytopaenia with haemorrhage
- Autoimmune haemolytic anaemia
- Seizures
- Meningitis
Nuclear (Mononucleosis) MORTARS:
M - Meningitis
O - Obstruction (airway)
R - Rupture (spleen)
T - Thrombocytopaenia
A - Anaemia (haemolytic)
R - Rash (Ampicillin-induced)
S - Seizures
Other complications include: arthralgia, cranial nerve palsy, encephalitis, Guillain-Barré syndrome, hepatitis, myocarditis, nephritis, optic neuritis, postviral fatigue/depresion, transverse myelitis.
Reference: PasTest Question Bank
Image Source: https://www.businessinsider.com/photos-of-the-120mm-mortar-used-by-us-marines-2017-5?r=US&IR=T
