Infectious Mononucleosis and Epstein Barr virus

Infectious mononucleosis is a clinical syndrome that present with pharyngitis, cervical lymphadenopathy, fever and lymphocytosis. It is also known as glandular fever. It is most commonly caused by Epstein-Barr virus but other infections such as HIV-1 primary infection, cytomegalovirus, Toxoplasmosis and human herpes virus -6 or 7 can also produce this clinical syndrome. The virus is transmitted through saliva and can affect children and adult both. Infectious mononucleosis treatment, signs and symptoms, and diagnosis have been illustrated below in detail.

Signs and symptoms of Infectious Mononucleosis

The patients present with following signs and symptoms.

• Fever
• Headache
• Sore throat (pharyngitis)
• Non tender cervical lymphadenopathy
• Macular, petechial or erythema multiform rash
• Splenomegaly

Diagnosis

The diagnosis of IM is highly challenging in adult age. A physician may ask for CBC along with other investigations.

• CBC — lymphocytosis
• Paul-Bunnel or Monospot test — heterophile antibodies are detected
• EBV serology — antibodies to Epstein-Barr early antigen and after one month antibodies to EBV nuclear antigen(anti-EBNA) are detected
• Viral DNA in CSF – in case of CNS infection

Management

The management of IM is symptomatic. Suppurative infection with beta hemolytic streptococcus is managed with antibiotics such as penicillin. In sever case oral or IV steroids are also given. Rest is mandatory to reduce the danger of splenic rupture or hemorrhage. 10% of patient with IM suffer a chronic relapsing syndrome.

Complications

IM can progress to life threatening complications that are

• Nasopharyngeal carcinoma
• Hodgkin lymphoma
• Burkett’s lymphoma
• X-linked lymphoproliferative (Duncan’s syndrome)