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Year 3 > Infectious mononucleosis (I) > Flashcards

Infectious mononucleosis (I) Flashcards

1
Q

What is infectious mononucleosis also known as? (3)

A
  • glandular fever
  • mono
  • kissing disease
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2
Q

What is infectious mononucleosis caused by?

A

Epstein-Barr virus (EBV) infection in 80-90% of cases

(Other causes are much less common and result in a diagnosis of mononucleosis syndrome rather than infectious mononucleosis)

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3
Q

How is infectious mononucleosis spread?

A

Highly contagious and spreads via bodily secretions especially saliva (hence ‘kissing disease’)

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4
Q

What is peak incidence for infectious mononucleosis?

A

15-24 year olds

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5
Q

How long is the incubation period of infectious mononucleosis?

A

6 weeks

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6
Q

How long are symptoms of infectious mononucleosis shown for in adults vs children?

A
  • 2-4 weeks in adults
  • asymptomatic in children
  • often subclinical in young children
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7
Q

What is the classic triad of infectious mononucleosis?

A

Fever, pharyngitis and lymphadenopathy (along with atypical lymphocytosis)

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8
Q

What are the clinical features of infectious mononucleosis? (8)

A
  • fever
  • pharyngitis (exudative or non-exudative)
  • lymphadenopathy (cervical or generalised - tender, non-erythematous and discrete nodes)
  • malaise
  • splenomegaly
  • rash
    • erythematous
    • maculopapular - 99% of patients who take ampicillin/amoxicillin while they have mono
    • morbilliform
  • signs of hepatitis (hepatomegaly, jaundice)
  • myalgia
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9
Q

When does maculopapular rash develop in infectious mononucleosis?

A

99% of patients who take ampicillin/amoxicillin while they have mono

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10
Q

What might you see on examination of a patient with infectious mononucleosis? (2)

A
  • petechiae on soft palate
  • splenomegaly
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11
Q

What are the risk factors for infectious mononucleosis? (2)

A
  • kissing
  • sexual behaviour
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12
Q

What are the first-line investigations for infectious mononucleosis? (4)

A
  • FBC
  • heterophile antibodies AKA Monospot test (non-specific)
  • EBV-specific antibodies (high sensitivity and specificity)
  • LFTs
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13
Q

What would you see on FBC for infectious mononucleosis?

A
  • lymphocytosis
  • atypical lymphocytosis
  • neutropenia
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14
Q

What would you see on LFTs for infectious mononucleosis?

A

Elevated - raised AST and ALT by 2-3x

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15
Q

What would heterophile and EBV-specific antibodies show for infectious mononucleosis?

A
  • positive heterophile antibodies
  • positive for EBV-specific antibodies: VCA-IgM, VCA-IgG, EA, EBV, EBNA
    • IgG to EBV nuclear antigens appears 6-12 weeks after infection and are lifelong
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16
Q

What imaging can be considered for infectious mononucleosis and what would you see?

A
  • ultrasonography of abdomen - splenomegaly
  • CT of abdomen - splenic rupture
17
Q

What would a blood film for infectious mononucleosis show?

A

Atypical lymphocytes

18
Q

What are some differential diagnoses for infectious mononucleosis?

A
  • group A streptococcal pharyngitis - do throat culture
  • hepatitis A
  • acute HIV infection
  • adenovirus - coryza, cough, pneumonia, conjunctivitis, diarrhoea
  • HSV-6
  • CMV infection
  • HSV-1: exudative pharyngitis, gingivostomatitis, odynophagia
  • influenza - no lymphadenopathy
19
Q

What does treatment for infectious mononucleosis mainly focus on?

A

Symptomatic

20
Q

What is the 1st line treatment for infectious mononucleosis?

A

Supportive care:

  • rest
  • fluids
  • avoid alcohol
  • avoid physical activity for 4 weeks due to risk of splenic rupture
  • analgesics/antipyretics - paracetamol or ibuprofen
  • corticosteroids (prednisolone) in severe cases
21
Q

What is the 1st line treatment for infectious mononucleosis with upper airway obstruction or haemolytic anaemia?

A

Supportive care + corticosteroid (prednisolone)

22
Q

What is the 1st line treatment for infectious mononucleosis with thrombocytopenia?

A

Supportive care + corticosteroids or IV immunoglobulin

23
Q

What are some complications of infectious mononucleosis?

A
  • antibiotic-induced rash (maculopapular rash)
  • chronic fatigue
  • splenic rupture
  • neurological complication
  • chronic disease
  • renal complications
24
Q

Describe the prognosis of infectious mononucleosis.

A
  • very good for healthy people
  • death occurs rarely and is caused by airway obstruction, splenic rupture, neurological complications, haemorrhage or secondary infection

Year 3 (22 decks)

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