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INFECTIOUS
MONONUCLEOSIS
(epstein-barr virus)
Professor: Ma lian
Typical features
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Prolong fever
Exudative
pharyngitis
Generalized
adenopathy
Hepatosplenomegaly
Atypical lymphocytes
Heterophil
antibodies
General considerations
Infectious mononucleosis (mono) is a
common acute infectious disease
usually found in individuals between the
ages of 5 and 30.
 Pathogeny

Epstein-Barr virus (90%)
 CMV, HIV, HHV-6, toxoplasma gondii,
Hepatitis virus etc (5-10%).

EBV
Occur worldwide
 Transmitted by
saliva and blood
transfusion
 Related with the
following diseases
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Mono
Burkitt lymphoma
Nasopharyngeal
cancer
Clinical findings
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Symptoms and signs
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Prolong fever(>39℃)
Soft palate petechiae and Exudative pharyngitis
Generalized adenopathy
Splenomegaly and hepatomegaly
Rash (macular,scarlatiniform or urticarial)
eye edema
X-linked lymphoproliferative syndrome (XLP):
occur in the children with primary
immunodeficiency disease
Sore throat
Soft palate petechiae
Exudative pharyngitis
Generalized adenopathy
usually in the neck, armpit, and throat
Rash
Clinical findings
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Laboratory findings
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Peripheral blood
Atypical lymphocytes
 Leukopenia
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Heterophil antibodies
 Anti-EBV antibodies
 aminotransferase

No clumping of the red bloods cells
indicates the person's serum does
not contains heterophile antibodies.
The few clumps that are seen are
red blood cells from the test
reagent that did not separate during
shaking of the reagent prior to
placing it on the slide.
Clumping of the red bloods cells
indicates the person's serum
contains heterophile antibodies.
Differantial diagnosis
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Group A streptococcal infection
Rubella
Adenovirus
Hepatitis A or B
Toxoplasmosis
Drug reaction
Leukemia
CMV mononucleosis
HIV infection
Complication
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Cardiorespiratory
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Hematologic
Interstitial pneumonitis
Myocarditis
Pericarditis
Pleuritis
Autoimmune hemolytic anemia
Immune granulocytopenia or thrombocytopenia
Pancytopenia
Complication
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Hepatic
Cholestatic jaundice (severe hepatitis)
Massive hepatic necrosis and failure
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Neurologic
Cranial nerve palsies
Guillain-Barré syndrome
Meningoencephalitis
Transverse myelitis
Others
Infectious mononucleosis hepatitis
Marked mononuclear cell
infiltration of the sinusoids
without significant necrosis.
H&E stain.
Infectious mononucleosis heapatitis
High power of previous illustration
showing the signs of high regenerative
activity: binucleate cells and a mitotic
figure. H&E stain.
Treatment

No specific therapy exists for IM,
but general support helps
rest and fluids
 acetaminophen or aspirin for fever
and aches;
 lozenges, salt-water gargles,
 viscous lidocaine hydrochloride for
sore throat.

Treament
Acyclovir, ganciclovir, and foscarnet
 IVIG
 α-interferon
 Antibiotics and corticosteroids are
indicated only for complications.
 Patients with splenomegaly should
advoid sport for 6-8 weeks.
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