Infectious mononucleosis

Last revised by Andrew Murphy on 22 Sep 2022

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.

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.

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:

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:

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Cases and figures

  • Figure 1: Mononucleosis (cytology)
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  • Case 1
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  • Case 2: bilateral tonsillitis
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