Infectious mononucleosis
Is a clinical syndrome characterized by pharyngitis,cevical lymphadenopathy, fever and lymphocytosis ,it is caused by Epstein Barr virus EBV ,subclinical infection in childhood is universal ,the virus is transmitted via direct contact through saliva.Clinical features
1-prodrome of headache,fever,and malaise.2-severe pharyngitis which may include tonsillar exudate.
3-non tender anterior and posterior cervical lymphadenopathy.
4-palatal and periorbital edema, soft splenomegaly, inguinal and axillary lymphadenopathy and macular rash,petechiae ,erythema multiforme may occurred.
Causes of death: ruptured spleen, thrombocytopenia causing hemorrhage, respiratory obstruction from pharyngeal edema.
Long term complications
1-nasopharyngeal carcinoma2-Hodgkins disease
3-burkitts lymphoma
Investigations:
1-paull –bunnell test and monospot test detect heterophiles antibody.
2- atypical lymphocytes occurred also in mumps and rubella ,HIV,viral hepatitis.
3-serology.
4-Throat culture.
Common complication of infectious mononucleosis:
1- severe pharyngeal edema.
2- prolonged post viral fatigue.
3-antibiotic induced rash.
4-hepatitis.
5-jaundice.
Uncommon complications
1-polyneurotitis.
2-minengoencephalitis.
3-transverse myelitis.
4-cranial nerve palsy.
5-hemolytic anemia.
6-thrombocytopenia
7-pericarditis
8-myocarditis.
9-rare but significant is rupture spleen.
Management
1- treatment is largely symptomatic2-if throat culture confirm b-hemolytic streptococcus penicillin should be given
3-if penicillin is given to patient with infectious mononucleosis maculopapular rash occurred and should be avoided.
4- antiviral agents is not effective
5-short course of prednisolone 30 mg for 5 days is given only to patient with pharyngeal edema.