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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 popular name kissing disease. It is usually a clinical diagnosis, with confirmation by serum testing, but may have suggestive findings on imaging.
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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 5. In about 5% of cases, cytomegalovirus (CMV) is the causative pathogen for infectious mononucleosis.
- lymphadenopathy and splenomegaly
- occasionally hepatosplenomegaly
- occasionally: rash
- splenic rupture: may be spontaneous but is quite rare 6
- splenic infarction 3
It was originally called "mononucleosis" after abnormal mononuclear cells were found in patients with the clinical syndrome.
The 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.
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:
- possible splenic rupture 6
- 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.
- myocarditis rarely seen 4
- CNS infections rarely seen 4
Imaging differential diagnoses include:
- acute HIV infection
- acute CMV infection (usually more clinically mild than EBV)
- non-Hodgkin lymphoma
- 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
- 5. Thomas M. Schmidt. Encyclopedia of Microbiology. (2019) ISBN: 9780128117361
- 6. Won A & Ethell A. Spontaneous Splenic Rupture Resulted from Infectious Mononucleosis. Int J Surg Case Rep. 2012;3(3):97-9. doi:10.1016/j.ijscr.2011.08.012 - Pubmed