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Infectious Mononucleosis
Epstein-Barr Virus [EBV]
McKenna Craig
McKenna Craig
“The Kissing Disease”
(Google Images)
Epstein-Barr Virus The Epstein-Barr Virus is a form
Symptoms The incubation period of IM is 30-50 days
of herpes virus that causes a condition in the affected
host called Infectious Mononucleosis [IM] (SingerLeshinsky). Infectious Mononucleosis is often times
referred to as Pfeiffer's Disease and Filatov's Disease
named after two men that described this disease as an
infectious process of the body in the 1880’s (Boe, 1).
The majority of cases of Infectious Mononucleosis are
primarily tied to EBV (Vouloumanou, 1). However, there
are some instances when this condition is specifically
observed with a T-cell dysfunction (Vouloumanou, 1).
Therefore, it is important to make a distinction between
the two causes of IM when planning a course of
treatment for an individual.
after the individual has been exposed to EBV (SingerLeshinsky). IM is a self-limiting disease that often
presents itself through flulike symptoms including a
sore throat, swollen lymph nodes, fever and fatigue
(Singer-Leshinsky). Symptoms of malaise, low-grade
fever and headaches are included in the prodromal
period of the infection (Singer-Leshinsky). Other
common symptoms may include vomiting, diminished
appetite and petechiae (Boe, 1).These symptoms are
usually presented for an average of one to several
weeks and in some cases, several months (FactSheet:
IM, 1). In adults, the disease will present itself with
prolonged periods of fever and liver malfunctions
(Putukian, 312).There is a direct correlation between
symptoms of Infectious Mononucleosis and the amount
of cytokines that are released from activated T cells
(Singer-Leshinsky). The larger the amount of virus
particles detected in the body, the larger the amount of
cytokines released from T helper cells which will cause a
more severe presentation of symptoms (SingerLeshinsky). With further tests, the doctor may find
inflammation of the spleen or liver (FactSheet: IM, 1).
Etiology of EBV Infectious Mononucleosis is caused
by a virus called Epstein-Barr Virus (Singer-Leshinsky).
The name ‘Mononucleosis’ is based on the viruses
targeted attack site: the mononuclear lymphocytes
(Singer-Leshinsky). Viruses carry out specific functions
by replicating themselves within living cells (Smith and
Helenius, 1). Viruses synthesize their genome by taking
over cellular machinery of the host which allows them
to meticulously manipulate the cell and incorporate
their genes and proteins into the host cell genome
(Smith and Helenius, 1). The host cell recognizes the
nucleic acid of the virus as part of itself which allows the
animal virus, in this case Epstein-Barr Virus, to be
guided by the host cell through the process of
molecular transformation (Smith and Helenius, 1).
Exudate in the
Tonsils
(Google Images)
Mode of Transmission Epstein-Barr Virus is spread
through saliva (Boe, 1). The transmission of this virus
requires very close contact with an infected individual
which can be done through kissing or through sharing
drinking cups (Singer-Leshinsky). This form of herpes
virus attacks the epithelial cells of the oropharynx and
tonsils (Singer-Leshinsky). An infection in the tonsil
crypts causes the epithelial cells to undergo a process
called viral shedding (Singer-Leshinsky). Viral shedding
occurs most frequently during the first year
postinfection but can continue to shed particles
throughout life and will continue to transmit the virus
to others (Singer-Leshinsky).
virus has been known to invade B lymphocytes, T
lymphocytes, squamous epithelial cells, glandular
epithelial cells and natural killer cells (Singer-Leshinsky).
If T cells of the adaptive immune system are ineffective
against Epstein-Barr Virus, there will be a proliferation
of B cells that can result in B-lymphocyte malignancies
and lymphomas (Singer-Leshinsky). Inflammation of the
spleen can be seen in 50% of patients dealing with
Infectious Mononucleosis (Rinderknecht, 1,377).
Spontaneous splenic rupture (SSR) will be presented
through abdominal pain and possibly even cardiac
arrest (Rinderknecht, 1,377). SSR occurs in 0.1% to 0.2%
of all IM cases (Rinderknecht, 1,377).
Populations at Risk Infectious Mononucleosis is
Course of Infectious Mononucleosis (Wikipedia)
Key Virulence Factors Virulence factors of EBV
allow the virus particles to infect B lymphocytes which
results in the rapid replication and release of EpsteinBarr Virus specific antibodies (Singer-Leshinsky). The
detection of EBV specific antibodies in a blood sample
will indicate that the individual is infected with EBV
(Singer-Leshinsky). The manipulation of cells by the
Epstein-Barr Virus permits the development of
Infectious Mononucleosis (Singer-Leshinsky). Even
though natural killer T cells and cytotoxic T cells keep
the virus in control, limit the further development of IM
and regulate chronic infection, it is possible for EBV to
remain in a latent state within infected B cells as a
lifelong reservoir (Singer-Leshinsky).
Major Risk Factors Sever and potentially life
threatening complications of Infectious Mononucleosis
include edema in mucous membranes, lymphoid
hyperplasia which may cause upper respiratory
obstruction and splenic rupture (Singer-Leshinsky). The
found equally in all groups regardless of gender, sexual
orientation, race or ethnicity. This disease peaks in
adolescents and young adults between the ages of 1524 (Rinderknecht, 1,377). IM does not usually occur in
older adults because chances are high that they have
already been exposed to the Epstein-Barr Virus (SingerLeshinsky). If infection happens to occur in an older
adult, the disease will present itself with clinical
manifestations of hepatitis (Singer-Leshinsky). Athletes
commonly develop Infectious Mononucleosis due to
close proximity and easy spread of the virus (Krafczyk,
10). Splenic rupture is most likely to occur within the
first three weeks of infections so it is important to
monitor the athlete’s condition before allowing them to
participate in physical activity, (Krfczyk, 10) especially
contact and collision sports (Putukian, 310).
Epidemiology Incidence in the United States is 500
cases per every 10,000 people per year (SingerLeshinksy). Approximately 70% of people in the U.S. are
infected by Epstein-Barr Virus by the age of 30
(Chamberlain, 1). Infectious Mononucleosis is not a
reportable disease. Therefore case numbers cannot be
found on a Utah governmental website (Utah-Office of
Epidemiology).
Diagnosis The long incubation period of this infection
makes it difficult to diagnose the patient with IM
(Putukian, 309). Diagnosis of Infectious Mononucleosis
is done through presentation of classic symptoms and
evaluation of blood samples (Boe, 1). White blood cell
count will vary with each case but is usually higher than
normal (Boe, 1). Lymphocytes can proliferate up to 60%
above the normal number which is referred to as
lymphocytosis (Boe, 1). There will be a 10% increase in
atypical lymphocytes which are activated cytotoxic T
cells (Singer-Leshinsky). The increased white blood cell
count can oftentimes be mistakenly evaluated as
leukemia (Boe, 1). However, lymphocytosis in Infectious
Mononucleosis will contain a variety of cells whereas
leukemia will have a fairly uniform proliferation of
lymphocyte types (Boe, 1). Neutrophils tend to
decrease in number while eosinophils, basophils and
typical monocytes are slightly increased (Boe, 1).
Hematologic tests are important for analyzing IM in the
blood but serologic tests are crucial for confirming
existence of infected cells (Singer-Leshinsky). A
heterophile antibody or monospot latex agglutination
test can be performed to evaluate the presence of IgM
antibodies to antigens found on surfaces of EBV
infected B cells (Singer-Leshinsky).
patients are advised to refrain from excessive alcohol
use as toxicity in the liver may occur (Putukian, 312).
Prevention Epstein-Barr Virus has a low
transmissibility, therefore it is unnecessary to isolate
the patient from others (Putukian, 312). IM is an
infectious disease and should be handled with common
practices of hand washing with antibacterial soap and
changing gloves between every patient is crucial
(Putukian, 312). The patient should refrain from kissing,
sharing cups or utensils and close contact with another
individual (Putukian, 312).
(Google Images)
References
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2.
Atypical Lymphocytes amongst RBCs (Google Images)
Treatment Management of IM is primarily done
through supportive measures and geared toward
alleviating present symptoms (Putukian, 312). This can
be done through rest, acetaminophen and maintaining
adequate levels of fluid and hydration (Putukian, 312).
To treat a sore throat, the patient can gargle with warm
salt water, using throat lozenges and sprays or a 2%
lidocaine solution (Putukian, 312). Aclovylir may be
given to the patient through an IV or an oral solution
(Putukian, 312). Aclovylir may slow down the process of
viral shedding but lacks a significant benefit for
suppression of symptoms (Putukian, 312).
Corticosteroids can be administered to the patient if
there is severe airway complications, dysphagia,
myocarditis, hemolytic anemia or an enlarged spleen
(Putukian, 312). Treatment of adolescents with aspirin
should be avoided as it will cause increased risk of
bleeding and thrombocytopenia (Putukian, 312). All IM
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CINAHL with Full Text, Ipswich, MA. Accessed September 15, 2013
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Chamberlain, Neal R. "INFECTIOUS MONONUCLEOSIS." Infectious
Mononucleosis (EBV). Osteopathic Medical School, 21 Jan. 2010. Accessed
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"Utah - Office Of Epidemiology." Utah - Office Of Epidemiology. Bureau of
Epidemiology, Accessed December 3, 2013.