Mononucleosis

Clinic

• Infectious mononucleosis (IM, Mono) is also known as glandular fever
• It is an infectious disease usually caused by EBV
• Fever, Sore throat, Neck lymphadenopathy, and Fatigue.
• Hepatosplenomegaly that may results in splenic rupture in less than 1%.

Entities

• Exudative pharyngitis (The most prominent entity)
  • Mild pharyngitis with or without tonsillitis esp occurred before puberty
• Maculopapular rash (Esp due to amoxicillin allergy)
• Posterior cervical lymphadenopathy (esp in adolescence)
• Erythema nodosum
• Erythema multiforme
• Seizures

SSPs

• Another major symptom is feeling tired.
• Headaches are common
• Abdominal pains with nausea or vomiting sometimes also occur.
• Fatigue lasts more than one month in an estimated 28% of cases. Mild fever, swollen neck glands and body aches may also persist beyond 4 weeks. Most people are able to resume their usual activities within 2–3 months.
• In about 50% of cases, small reddish-purple spots called petechiae can be seen on the roof of the mouth.
• Palatal enanthem can also occur, but is relatively uncommon.

Cause

• EBV: About 90%

• CMV: About 5–7%

Note

• CMV, ADV and TPG infections can cause symptoms similar to infectious mononucleosis, but a heterophile antibody test will test negative and differentiate those infections from infectious mononucleosis.

Related disease

• Secondary cold agglutinin disease
• Autoimmune hemolytic anemia

Complications

Dynamic

Static

Meningitis Encephalitis, Hemiplegia Guillain–Barré syndrome Transverse myelitis Multiple sclerosis Hemolytic anemia Various cytopenias and Thrombocytopenia Hepatitis Myocarditis Pericarditis Postural orthostatic tachycardia syndrome Chronic fatigue syndrome Burkitt's lymphoma, Hodgkin's lymphoma and lymphomas in general as well as Nasopharyngeal carcinoma Gastric carcinoma Hemophagocytic lymphohistiocytosis

Upper airway obstruction from tonsillar hypertrophy Splenic rupture is rare.

Miasmatic analysis

1. EBV
2. CMV
3. HSV-1, HSV-2: Esp when Erythema nodosum and Erythema multiforme are present.