Mononucleosis is the term for infection with Epstein Barr Virus (EBV). The infection classically occurs in teenagers and young adults. It usually is diagnosed clinically and with serum lab work, but also may have suggestive imaging findings.
Exposure to EBV, but symptoms are often subclinical, especially in children. Young adults (15-24) are more likely to be symptomatic.
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 transamines are possible.
Diagnosis is usually through serum labwork 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 infarct 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