INFECTIOUS INFECTIOUS MONONUCLEOSIMONONUCLEOSISS((epstein-barr epstein-barr virus)virus)

Professor: Ma lianProfessor: Ma lian

Typical featuresTypical features Prolong feverProlong fever Exudative Exudative

pharyngitispharyngitis Generalized Generalized

adenopathyadenopathy HepatosplenomegalHepatosplenomegal

yy Atypical Atypical

lymphocyteslymphocytes Heterophil Heterophil

antibodiesantibodies

General considerationsGeneral considerations

Infectious mononucleosis (mono) is a Infectious mononucleosis (mono) is a common acute infectious disease common acute infectious disease usually found in individuals between the usually found in individuals between the ages of 5 and 30. ages of 5 and 30. 

PathogenyPathogeny Epstein-Barr virusEpstein-Barr virus (90%) (90%) CMV, HIV, HHV-6, toxoplasma gondiiCMV, HIV, HHV-6, toxoplasma gondii, ,

Hepatitis virusHepatitis virus etc (5-10%). etc (5-10%).

EBVEBV

Occur worldwideOccur worldwide Transmitted by Transmitted by

saliva and blood saliva and blood transfusiontransfusion

Related with the Related with the following diseasesfollowing diseases MonoMono Burkitt lymphomaBurkitt lymphoma Nasopharyngeal Nasopharyngeal

cancercancer

Clinical findingsClinical findings

Symptoms and signsSymptoms and signs Prolong fever(>39℃)Prolong fever(>39℃) Soft palate Soft palate petechiaepetechiae and and ExudativeExudative

pharyngitispharyngitis Generalized Generalized adenopathyadenopathy Splenomegaly and hepatomegalySplenomegaly and hepatomegaly RashRash (macular,scarlatiniform or urticarial) (macular,scarlatiniform or urticarial) eye edemaeye edema X-linked lymphoproliferative syndrome (XLP): X-linked lymphoproliferative syndrome (XLP):

occur in the children with primary occur in the children with primary immunodeficiency diseaseimmunodeficiency disease

Sore throatSore throat

Exudative pharyngitisExudative pharyngitisSoft palate petechiaeSoft palate petechiae

Generalized Generalized adenopathyadenopathy

usually in the neck, armpit, and throatusually in the neck, armpit, and throat

Rash Rash

Clinical findingsClinical findings

Laboratory findingsLaboratory findings Peripheral blood Peripheral blood

Atypical lymphocytes Atypical lymphocytes LeukopeniaLeukopenia

HeterophilHeterophil antibodies antibodies Anti-EBV antibodiesAnti-EBV antibodies aminotransferaseaminotransferase

No clumping of the red bloods cells indicates the person's serum does not contains heterophile antibodies. The few clumps that are seen are red blood cells from the test reagent that did not separate during shaking of the reagent prior to placing it on the slide.

Clumping of the red bloods cells indicates the person's serum contains heterophile antibodies.

Differantial diagnosisDifferantial diagnosis

Group A streptococcal infectionGroup A streptococcal infection RubellaRubella AdenovirusAdenovirus Hepatitis A or BHepatitis A or B ToxoplasmosisToxoplasmosis Drug reactionDrug reaction LeukemiaLeukemia CMV CMV mononucleosis mononucleosis HIV infectionHIV infection

ComplicationComplication CardiorespiratoryCardiorespiratory

Interstitial pneumonitisInterstitial pneumonitisMyocarditisMyocarditisPericarditisPericarditisPleuritisPleuritis

HematologicHematologicAutoimmune hemolytic anemiaAutoimmune hemolytic anemiaImmune granulocytopenia or thrombocytopeniaImmune granulocytopenia or thrombocytopeniaPancytopeniaPancytopenia

ComplicationComplication

HepaticHepaticCholestatic jaundice (severe hepatitis)Cholestatic jaundice (severe hepatitis)Massive hepatic necrosis and failureMassive hepatic necrosis and failure

NeurologicNeurologicCranial nerve palsiesCranial nerve palsiesGuillain-Barré syndromeGuillain-Barré syndromeMeningoencephalitisMeningoencephalitisTransverse myelitisTransverse myelitisOthersOthers

Infectious mononucleosis hepatitisMarked mononuclear cell

infiltration of the sinusoids without significant necrosis. H&E stain.

Infectious mononucleosis heapatitisHigh power of previous illustration showing the signs of high regenerative activity: binucleate cells and a mitotic figure. H&E stain.

TreatmentTreatment

No specific therapy exists for IM, No specific therapy exists for IM, but general support helpsbut general support helps rest and fluidsrest and fluids acetaminophen or aspirin for fever acetaminophen or aspirin for fever

and aches;and aches; lozenges, salt-water gargles, lozenges, salt-water gargles, viscous lidocaine hydrochloride for viscous lidocaine hydrochloride for

sore throat.sore throat.

TreamentTreament

Acyclovir, ganciclovir, and Acyclovir, ganciclovir, and foscarnetfoscarnet

IVIG IVIG α-interferonα-interferon Antibiotics and corticosteroids are Antibiotics and corticosteroids are

indicated only for complications. indicated only for complications. Patients with Patients with splenomegaly should splenomegaly should

advoid sport for 6-8 weeks.advoid sport for 6-8 weeks.