Infectious Mononeucleosis (Glandular Fever)

Aetiology

• Disease of young adults

• Caused by the Ebstein-Barr Virus

Pathophysiology

• EBV is a virus of the Herpes family - establishes a persistent infection in epithelial cells, notably in the pharynx

• Primary infection in early childhood rarely results in infectious mononeucleosis

• Primary infection in those >10 years often causes infectious mononucleosis

Clinical presentation

• Classic traid of fever, pharyngitis and lymphadenopathy seen in 70% of patients

Symptoms

• Fever

• Malaise, lethargy

• Sore throat, tonsillitis, pharyngitis

Signs

• Gross tonsillar enlargement with membranous exudates

• Marked cervical lymphadenopathy

• Generalised lymphadenopathy

• Palatal petchial haemorrahages

• Hepatosplenomegaly, jaundice, hepatitis

• Rash

Investigations

• Blood count and film - atypical lymphocytes/lymphocytosis in peripheral blood

• EVB serology is the most accurate test, antibody tests (monospot or Paul-Bunnel test) are sometimes used

• Low CRP

• Deranged liver function tests

Management

• Protracted but self-limiting illness - symptomatic treatment
• Bed rest, paracetamol
• Antivirals not clinically affective

• Role of antibiotics (penicillin) in prevention of secondary infection
• Do NOT prescribe ampicillin/amoxicillin - diagnostic generalised macular rash will result

• Systemic steroids if severe and failing to improve

• Avoid sport for 6 weeks due to risk of splenic rupture

Complications

• Anaemia, thrombocytopenia

• Splenic rupture

• Upper airway obstruction

• Increased risk of lymphoma, especially in immunosuppressed