Infectious mononucleosis

Changed by Yaïr Glick, 3 Aug 2021

Updates to Article Attributes

Body was changed:

Infectious mononucleosis (also known as glandular fever) is the term for infection with Epstein-Barr virus (EBV). The infection classically occurs in teenagers and young adults, hence its otherpopular name kissing disease. It is usually a clinical diagnosis, with confirmation by serum testing, but may have suggestive findings on imaging.

Epidemiology

Exposure to Epstein-Barr virus, is extremely widespread: 90% of adults are seropositive. When acquired during childhood it often remains subclinical but often a subclinical infectionof those who acquire it during adolescence or young adulthood, especially in children25% will become symptomatic 5. Young adults (15-24In about 5% of cases, cytomegalovirus (CMV) are more likely to be symptomaticis the causative pathogen for infectious mononucleosis.

Clinical presentation

Complications

Pathology

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

Epstein-Barr virus is in the herpesvirus class and is also called human herpesvirus 4. It is thought to be spread primarily through a person-to-person route through salivary secretions. The Epstein-Barr virus infects B-cells in the lymphoid tissue. Like other herpes viruses, it becomes a lifelong chronic infection with periodic shedding of virus.

Elevated transaminases are occasionally seen.

Radiographic features

Diagnosis is usually through serum lab work which shows 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 infarction has been reported 3
  • 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.

Complications

Differential diagnosis

Imaging differential diagnoses include:

  • -<p><strong>Infectious mononucleosis </strong>(also known as <strong>glandular fever</strong>) is the term for infection with <a href="/articles/epstein-barr-virus-ebv">Epstein-Barr virus (EBV)</a>. The infection classically occurs in teenagers and young adults, hence its other name <strong>kissing disease</strong>. It is usually a clinical diagnosis, with confirmation by serum testing, but may have suggestive findings on imaging.</p><h4>Epidemiology</h4><p>Exposure to Epstein-Barr virus, but often a subclinical infection, especially in children. Young adults (15-24) are more likely to be symptomatic.</p><h4>Clinical presentation</h4><ul>
  • +<p><strong>Infectious mononucleosis </strong>(also known as <strong>glandular fever</strong>) is the term for infection with <a href="/articles/epstein-barr-virus-ebv">Epstein-Barr virus (EBV)</a>. The infection classically occurs in teenagers and young adults, hence its popular name <strong>kissing disease</strong>. It is usually a clinical diagnosis, with confirmation by serum testing, but may have suggestive findings on imaging.</p><h4>Epidemiology</h4><p>Exposure to Epstein-Barr virus is extremely widespread: 90% of adults are seropositive. When acquired during childhood it often remains subclinical but of those who acquire it during adolescence or young adulthood, 25% will become symptomatic <sup>5</sup>. In about 5% of cases, cytomegalovirus (CMV) is the causative pathogen for infectious mononucleosis.</p><h4>Clinical presentation</h4><ul>
  • -<li>splenic rupture: may be <a href="/articles/spontaneous-splenic-rupture">spontaneous</a>
  • -</li>
  • +<li>splenic rupture: may be <a href="/articles/spontaneous-splenic-rupture">spontaneous</a> but is quite rare</li>
  • -</ul><h4>Pathology</h4><p>It was originally called "mononucleosis" after abnormal mononuclear cells were found in patients with the clinical syndrome.</p><p>Epstein-Barr virus is in the <a title="Herpesvirus" href="/articles/herpesvirus">herpesvirus class</a>. It is thought to be spread primarily through a person-to-person route through salivary secretions. The Epstein-Barr virus infects B-cells in the lymphoid tissue. Like other herpes viruses, it becomes a lifelong chronic infection with periodic shedding of virus.</p><p>Elevated transaminases are occasionally seen.</p><h4>Radiographic features</h4><p>Diagnosis is usually through serum lab work which shows lymphocytosis and a positive heterophile antibody test. Imaging is usually not necessary, but certain findings on imaging can be suggestive:</p><h5>CT</h5><ul>
  • +</ul><h4>Pathology</h4><p>It was originally called "mononucleosis" after abnormal mononuclear cells were found in patients with the clinical syndrome.</p><p>Epstein-Barr virus is in the <a href="/articles/herpesvirus">herpesvirus class</a> and is also called human herpesvirus 4. It is thought to be spread primarily through a person-to-person route through salivary secretions. The Epstein-Barr virus infects B-cells in the lymphoid tissue. Like other herpes viruses, it becomes a lifelong chronic infection with periodic shedding of virus.</p><p>Elevated transaminases are occasionally seen.</p><h4>Radiographic features</h4><p>Diagnosis is usually through serum lab work which shows lymphocytosis and a positive heterophile antibody test. Imaging is usually not necessary, but certain findings on imaging can be suggestive:</p><h5>CT</h5><ul>

References changed:

  • 5. Thomas M. Schmidt. Encyclopedia of Microbiology. (2019) <a href="https://books.google.co.uk/books?vid=ISBN9780128117361">ISBN: 9780128117361</a><span class="ref_v4"></span>
Images Changes:

Image 1 Pathology ( update )

Caption was added:
Figure 1: Mononucleosis (cytology)

Image 2 CT (Portal-excretory phase) ( create )

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