Makindo Medical Notes

For individual infections, please see the specific viral infections mentioned.

About Infectious Mononucleosis

• A clinical syndrome typically caused by Epstein-Barr Virus (EBV) but can also be associated with various other infectious agents, which should be considered in differential diagnoses.

Epidemiology

• Commonly presents in late teens and early 20s, with initial exposure often occurring during adolescence or early adulthood.

Spread

• Primary infection usually occurs in adolescence, primarily spread through saliva.
• Transmission is common via kissing among adolescents and young adults or through droplet infection and environmental contamination in childhood.

Causes of Infectious Mononucleosis-like Symptoms

• Epstein-Barr Virus (EBV): A gamma herpesvirus and most common cause.
• Cytomegalovirus (CMV)
• Human Herpes Virus 6 and 7 (HHV-6/7)
• HIV-1 infection and Toxoplasmosis can also mimic mononucleosis.

Clinical Presentation

• Common symptoms: Pharyngitis, cervical lymphadenopathy, fever, fatigue, and splenomegaly.
• Ampicillin Rash: A rash that occurs with ampicillin use suggests EBV infection.
• Severe symptoms: Laryngeal edema, cranial nerve palsies, meningoencephalitis, hemolytic anemia, glomerulonephritis, pericarditis, pneumonitis.
• Complications: Splenic rupture, thrombocytopenia with potential hemorrhage.

Rare Long-Term Complications

• Hodgkin's lymphoma
• Burkitt's lymphoma
• Nasopharyngeal carcinoma

Investigations

• Serological Screening for possible causative agents (EBV, CMV, etc.).
• Monospot Test (heterophile antibody test): May be initially negative; repeat if clinical suspicion remains high.
• Blood film showing atypical lymphocytes and presence of EBV IgM antibodies for EBV infection.

Management

• ABC support (Airway, Breathing, Circulation).
• Warm saline gargles and aspirin to relieve sore throat.
• Oral prednisolone for significant laryngeal edema.
• General supportive care and hydration.
• Avoid contact sports with splenomegaly until fully resolved to reduce risk of splenic rupture.