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Infectious mononucleosis

Definition
  • Infectious mononucleosis (IM): Also known as ‘glandular fever’, it’s a clinical syndrome typically caused by the Epstein-Barr virus (EBV) characterised by fever, sore throat, and lymphadenopathy.
Aetiology
  • Most commonly due to Epstein-Barr virus (EBV).
  • Less frequently, caused by Cytomegalovirus (CMV) or other agents.
Clinical Features
  • Fever.
  • Pharyngitis (sore throat) – may resemble streptococcal pharyngitis.
  • Cervical lymphadenopathy.
  • Fatigue.
  • Palatal petechiae.
  • Splenomegaly.
  • Skin rash, especially if exposed to ampicillin or amoxicillin.
Investigations
  • Monospot test (Paul-Bunnell test): Detects heterophile antibodies, positive in most cases.
  • Full blood count: Lymphocytosis with atypical lymphocytes.
  • EBV-specific serology: For definitive diagnosis.
  • Liver function tests: Can show elevated liver enzymes.
  • Throat swab: To rule out other causes like streptococcal infection.
Management
  • Mostly supportive: Analgesics, antipyretics (like paracetamol).
  • Avoid contact sports or heavy lifting due to risk of spleen rupture.
  • Stay hydrated and adequate rest.
  • Avoid giving ampicillin or amoxicillin due to rash risk.
  • Corticosteroids: Reserved for complications like severe throat obstruction or haemolytic anaemia.
Complications
  • Splenic rupture: Rare but life-threatening.
  • Hepatitis.
  • Haemolytic anaemia.
  • Guillain-BarrΓ© syndrome.
  • Neurological complications such as encephalitis.
Prevention
  • No vaccine available for EBV.
  • Avoid sharing utensils, straws, or contact with an infected person’s saliva.

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