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Infectious mononucleosis

Overview
  • Definition: Clinical syndrome typically caused by the **Epstein-Barr virus (EBV)**, characterised by fever, pharyngitis, lymphadenopathy, and fatigue.
  • Often referred to as ‘mono’ or ‘glandular fever’.
  • Most commonly affects adolescents and young adults.
Etiology
  • Primarily due to **EBV**, a member of the herpesvirus family.
  • Transmission typically through saliva (β€œkissing disease”).
  • Less common causes include cytomegalovirus (CMV) and other agents.
Clinical Features
  • Triad: Fever, pharyngitis (sore throat), and cervical lymphadenopathy.
  • Fatigue and malaise, which can persist for weeks to months.
  • Possible splenomegaly and hepatomegaly.
  • Rash, especially if given ampicillin or amoxicillin.
Investigations
  • Monospot test (heterophile antibody test): Diagnostic in majority but not 100% specific or sensitive.
  • EBV-specific serology for uncertain cases.
  • Full blood count: Atypical lymphocytes, lymphocytosis.
  • Liver function tests: Raised alanine transaminase (ALT) and aspartate transaminase (AST).
Management
  • Primarily supportive care:
    • Rest, hydration, analgesia (paracetamol or ibuprofen).
  • Avoid contact sports due to risk of splenic rupture.
  • Avoid ampicillin or amoxicillin to prevent rash.
  • Corticosteroids may be considered in severe cases, airway obstruction, or haemolytic anaemia, but routine use is controversial.
Complications
  • Splenic rupture (though rare).
  • Neurological complications: Meningitis, encephalitis, Guillain-BarrΓ© syndrome.
  • Hepatitis, jaundice.
  • Secondary bacterial pharyngitis or tonsillitis.
Key Points
  • EBV is the most common cause of infectious mononucleosis.
  • Diagnosis primarily clinical but supported by Monospot and serology.
  • Management is mainly supportive; be cautious of splenic rupture in physical activity.

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