Download Infectious Mononucleosis Fever Sore Throat

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January 13, 2011
Epstein-Barr Virus

Identified in 1964 in Burkitt lymphoma
 Lab
technician
 became
ill with mononucleosis
 EBV seroconversion

Ubiquitous
 Harbored

by nearly all adults
No seasonal variation or clustering of cases
Epstein-Barr Virus

Most infected by oral route
 “kissing

disease”
Other modes of transmission
 Blood
transfusions
 Bone Marrow transplants
 Sexually transmitted
Epstein-Barr Virus


Incubation period 30-50 days
Age at infection varies with living conditions
 Age
2 to 3
 20%
to 80% infected
 Industrialized
 More
countries:
common primary EBV in adolescents
 IM in 30% to 50% of these cases
Infectious Mononucleosis
Illness Script
Infectious Mononucleosis
Fever
Sore Throat (exudative pharyngitis)
Malaise
Lymphadenitis (Cervical)
+/- Hepatosplenomegaly
Atypical Lymphocytosis
Infectious Mononucleosis

Highly suggestive findings
 Palatal
petechiae
 Splenomegaly
 Posterior cervical adenopathy

Absence of cervical lymphadenopathy and fatigue
make the diagnosis much less likely.
Clinical Manifestations

Rash
 4%

of older patients
With antibiotic (ampicillin)
administration
 Nonallergic
morbilliform rash
 Seen in nearly 100%.
 Benzyl-penicilloyl-specific
IgM
Rare Clinical Manifestations

CNS (5%)
 Aseptic
meningitis
 Encephalitis
 Optic neuritis
 CN palsies
 Transverse myelitis
 Guillian-Barre
Rare Clinical Manifestations

Hematologic
 Splenic
rupture
 Thrombocytopenia
 Neutropenia
 Hemolytic anemia

Others
 Respiratory
 Pneumonia
 Orchitis
 Myocarditis
Compromise
Diagnostic Tests


Viral culture is difficult
Diagnosis implicated by:
 Characteristic
clinical signs
 Lymphocytosis (>50%)
 Absolute
 Atypical

(> 4500/mL)
Lymphocytosis (>10%)
Confirmed by:
 Criteria
above + positive heterophile
Heterophile Test (Monospot)


Heterophile antibodies react to antigens from
unrelated species
Monospot- Latex agglutination assay using horse
erythrocytes and patient serum.
 Peak
levels at 2-6 weeks
 May remain elevated for up to 1 year
 Sensitivity 85%
 Less
sensitive in children < age 3.
 Specificity
100%
Diagnostic Testing

Other antibody Testing (useful if heterophile
negative)
 anti-VCA
 Some
IgM
evidence for active/recent infection
 anti-EBNA
 Excludes
active primary infection
Treatment




“Take it easy”
No contact sports until spleen no longer palpable
Avoid ampicillin and amoxicillin
Steroids reserved for most severe of cases
Associated Conditions

X-linked Lymphoproliferative Disease (XLP)
 Defect
in signaling lymphocytic activation moleculeassociated protein
 Characterized by
 Nodular
B-cell lymphomas +/- CNS involvement
 Profound hypogammaglogulinemia
 Aplastic anemia
 Severe infectious mono early in life

4% survival
Associated Conditions

EBV associated B-Cell Lymphoproliferative Disease
 10%
of transplant recipients
 Donor organ is common vehicle of EBV infection
 Occurs early after transplant
 Time
of most severe immunosuppression
Other Associated Conditions



Hemophagocytic Lymphohistiocytosis
Chronic Active EBV Infection
Malignancies
 Burkitt
Lymphoma
 Nasopharyngeal Carcinoma
 Hodgkin Disease
 T-Cell Lymphoma
 Gastric carcinoma