Infectious mononucleosis

MononucleosisInfectious mononucleosis (also known as glandular fever) is the term for infection with Epstein Barr-Barr Virus (EBV). The infection classically occurs in teenagers and young adults. It usually is diagnosed clinically and withsupported by serum lab worktesting, but also may have suggestive imaging findings.

Epidemiology

Exposure to EBV, but symptoms are often a subclinical infection, especially in children. Young adults (15-24) are more likely to be symptomatic.

Clinical findingspresentation

• fever
• tonsilitistonsillitis
• lymphadenopathy and splenomegaly
• fatigue
• occasionally: rash

Pathology

It was originally called "mononucleosis" after abnormal mononuclear cells were found in patients with the clinical syndrome.

EBV is in the herpesvirus class. It is thought to be spread primarily through a person-to-person route through salivary secretions. The EBV virus infects B-cells in the lymphoid tissue. Like other herpes viruses, it becomes a lifelong chronic infection with periodic shedding of virus.

Elevated transamines are possible.

Radiographic findingsfeatures

Diagnosis is usually through serum labworklab work which would show lymphocytosis and a positive heterophile antibody test. Imaging is usually not necessary, but certain findings on imaging can be suggestive:

CT

• splenomegaly
  • possible splenic rupture
  • splenic infarct hasinfarction has been reported ³
• generalized generalised lymphadenopathy, including cervical lymphadenopathy
• tonsillar enlargement
• possible hepatomegaly

Treatment and prognosis

Symptomatic therapy is usually sufficient. Athletes are encouraged to discontinue sports during the acute phase (<3-4 weeks) to lower the risk of splenic rupture ².

Differential diagnosis

Imaging differential diagnoses include:

• acute HIV infection
• acute CMV infection (usually more clinically mild than EBV)
• non-Hodgkin lymphoma
• leukaemia