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 other name kissing disease. It is usually a clinical diagnosis, with confirmation by serum testing, but may have suggestive findings on imaging.
Exposure to EBV, but often a subclinical infection, especially in children. Young adults (15-24) are more likely to be symptomatic.
- lymphadenopathy and splenomegaly
- occasionally hepatosplenomegaly
- occasionally: rash
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 transaminases are occasionally seen.
Diagnosis is usually through serum lab work which would show lymphocytosis and a positive heterophile antibody test. Imaging is usually not necessary, but certain findings on imaging can be suggestive:
- possible splenic rupture
- splenic infarction has been reported 3
- generalized 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.
Imaging differential diagnoses include:
- 1. Evans AS, Niederman JC, Cenabre LC et-al. A prospective evaluation of heterophile and Epstein-Barr virus-specific IgM antibody tests in clinical and subclinical infectious mononucleosis: Specificity and sensitivity of the tests and persistence of antibody. J. Infect. Dis. 1976;132 (5): 546-54. Pubmed citation
- 2. Kinderknecht JJ. Infectious mononucleosis and the spleen. Curr Sports Med Rep. 2003;1 (2): 116-20. Pubmed citation
- 3. Trevenzoli M, Sattin A, Sgarabotto D et-al. Splenic infarct during infectious mononucleosis. Scand. J. Infect. Dis. 2002;33 (7): 550-1. Pubmed citation
- 4. Luzuriaga K, Sullivan JL. Infectious mononucleosis. (2010) The New England journal of medicine. 362 (21): 1993-2000. doi:10.1056/NEJMcp1001116 - Pubmed