Mononucleosis

Infectious mononucleosis (IM) is a systemic, benign, self-limiting infectious lymphopro-liferative disease, primarily caused by the Epstein-Barr virus (EBV). This disease is discussed in more detail in Chapter 10.

Epidemiology. The disease primarily affects adolescents and young adults; however, it may occur in all age groups and has no gender predilection.

Pathogenesis. Infection with EBV has been implicated in 85% to 95% of all episodes of IM. EBV is a DNA virus of the family Herpes viride. Other microorganisms associated with IM syndrome include cytomegalovirus, Toxoplasma gondii, rubella, hepatitis A virus, and certain adenoviruses. The infection is passed on by close personal contact (salivary and respiratory inhalation) with an infected individual.

Clinical Manifestations. Clinical manifestations of mononucleosis vary considerably from patient to patient. Constitutional symptoms including fever, myalgia, malaise, and anorexia are initial complaints. Acute exudative pharyngotonsillitis is accompanied by tender cervical lymphadenopathy, especially in the posterior cervical chain. Hepatosple-nomegaly is a part of the systemic presentation.

Diagnosis. The diagnosis is confirmed by serologic testing. Paul-Bunnell heterophile agglutination test detects heterophil agglutinins to sheep red blood cells in the serum of patients with IM. A titer of 1:112 or more is considered diagnostic. The Mono Spot test uses horse erythrocytes for antibody detection and is more sensitive. The differential diagnosis of cervical adenitis from IM ranges from acute inflammatory reactive lymphadenopathy to lymphoma (16).

Treatment. Therapy for IM is supportive including rest, hydration, and antipyretics.

Complications and Prognosis. In general, the clinical course of IM is self-limited with a favorable prognosis for the majority of patients. Rarely, complications such as airway obstruction, splenic rupture, or cranial neuropathy may develop and can be life threatening.

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