Infectious mononucleosis
Updates to Article Attributes
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
- fever
- tonsillitis
- lymphadenopathy and splenomegaly
- occasionally hepatosplenomegaly
- fatigue
- occasionally: rash
Complications
- splenic rupture: may be spontaneous but is quite rare
- splenic infarction 3
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
- myocarditis rarely seen 4
- CNS infections rarely seen 4
Differential diagnosis
Imaging differential diagnoses include:
- acute HIV infection
- acute CMV infection (usually more clinically mild than EBV)
- non-Hodgkin lymphoma
- leukaemia
-<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>