Infectious mononucleosis
Infectious mononucleosis: Excerpt from Professional Guide to Diseases (Eighth Edition)
Infectious mononucleosis is an acute infectious disease caused by the Epstein-Barr virus (EBV), a member of the herpes group. It primarily affects young adults and children, although in children it's usually so mild that it's generally overlooked. This infection characteristically produces fever, sore throat, and cervical lymphadenopathy (the hallmarks of the disease) as well as hepatic dysfunction, increased lymphocyte and monocyte counts, and development and persistence of heterophil antibodies. The prognosis is excellent, and major complications are uncommon.
Causes and incidence
Apparently, the reservoir of EBV is limited to humans. Infectious mononucleosis probably spreads by the oral-pharyngeal route because about 80% of patients carry EBV in the throat during the acute infection and for an indefinite period afterward. It can also be transmitted by blood transfusions and has been reported after cardiac surgery as the post-pump perfusion syndrome. Infectious mononucleosis is probably contagious from before symptoms develop until the fever subsides and oral-pharyngeal lesions disappear.
Infectious mononucleosis is fairly common in the United States, Canada, and Europe and affects both sexes equally. Incidence varies seasonally among college students but not among the general population.
Signs and symptoms
The symptoms of mononucleosis mimic those of many other infectious diseases, including hepatitis, rubella, and toxoplasmosis. Typically, after an incubation period of about 10 days in children and from 30 to 50 days in adults, infectious mononucleosis produces prodromal symptoms, such as headache, malaise, and fatigue. After 3 to 5 days, patients typically develop a triad of symptoms: sore throat, cervical lymphadenopathy, and temperature fluctuations, with an evening peak of 101° to 102° F (38.3° to 38.9° C). Splenomegaly, hepatomegaly, stomatitis, exudative tonsillitis, or pharyngitis may also develop.
Sometimes, early in the illness, a maculopapular rash that resembles rubella develops; also, jaundice occurs in about 5% of patients. Major complications are rare but may include splenic rupture, aseptic meningitis, encephalitis, hemolytic anemia, idiopathic thrombocytopenic purpura, and Guillain-Barré syndrome. Symptoms usually subside about 6 to 10 days after onset of the disease but may persist for weeks.
Diagnosis
Physical examination demonstrating the clinical triad suggests infectious mononucleosis.
CONFIRMING DIAGNOSIS The following abnormal laboratory results confirm the diagnosis:
❑Monospot test is positive for infectious mononucleosis.
❑Leukocyte count increases to 10,000 to 20,000/µl during the second and third weeks of illness. Lymphocytes and monocytes account for 50% to 70% of the total white blood cell (WBC) count; 10% of the lymphocytes are atypical.
❑Heterophil antibodies (agglutinins for sheep red blood cells) in serum drawn during the acute illness and at 3- to 4-week intervals rise to four times the normal number.
❑Indirect immunofluorescence shows antibodies to EBV and cellular antigens. Such testing is usually more definitive than heterophil antibodies.
❑Liver function studies are abnormal.
Treatment
Infectious mononucleosis resists prevention and antimicrobial treatment. Therapy is essentially supportive: relief of symptoms; bed rest during the acute febrile period; and acetaminophen or ibuprofen for headache and sore throat. Sore throat can also be helped with warm salt-water gargles. If severe throat inflammation causes airway obstruction, steroids can be used to relieve swelling and avoid tracheotomy. Splenic rupture, marked by sudden abdominal pain, requires splenectomy. About 20% of patients with infectious mononucleosis will also have streptococcal pharyngotonsillitis; these patients should receive antibiotic therapy.
Special considerations
Because uncomplicated infectious mononucleosis doesn’t require hospitalization, patient teaching is essential. Convalescence may take several weeks, usually until the patient's WBC count returns to normal.
❑During the acute illness, stress the need for bed rest. If the patient is a student, tell him he may continue less demanding school assignments and see his friends but should avoid long, difficult projects until after recovery.
❑To minimize throat discomfort, encourage the patient to drink milk shakes, fruit juices, and broths and to eat cool, bland foods. Suggest gargling with saline mouthwash and taking aspirin, as needed.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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