Glandular fever - Infectious mononucleosis Flashcards Preview

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Flashcards in Glandular fever - Infectious mononucleosis Deck (5):

What is a telltale sign that a patient has infectious mononucleosis?

URTI symptoms + amoxicillin → rash ?glandular fever

A rash develops in around 99% of patients who take amoxicillin whilst they have infectious mononucleosis.


What is infectious mononucleosis?

Infectious mononucleosis (glandular fever) is caused by the Epstein-Barr virus (also known as human herpesvirus 4, HHV-4). It is most common in adolescents and young adults.


What are the features of infectious mononucleosis?

- sore throat
- lymphadenopathy
- pyrexia
- malaise, anorexia, headache
- palatal petechiae
- splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
- hepatitis
- presence of 50% lymphocytes with at least 10% atypical lymphocytes
- haemolytic anaemia secondary to cold agglutins (IgM)
- a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis


How is it diagnosed?

- Heterophil antibody test (Monospot test).
- The test is specific for heterophile antibodies produced by the human immune system in response to EBV infection.
- Commercially available test kits are 70-92% sensitive and 96-100% specific, with a lower sensitivity in the first two weeks after clinical symptoms begin.
- It will generally not be positive during the 4-6 week incubation period before the onset of symptoms. It will also not generally be positive after active infection has subsided, even though the virus persists in the same cells in the body for the rest of the carrier's life.


What is the management of infectious mononucleosis?

- rest during the early stages, drink plenty of fluid, avoid alcohol
- simple analgesia for any aches or pains
- consensus guidance in the UK is to avoid playing contact sports for 8 weeks after having glandular fever to reduce the risk of splenic rupture
- Although antivirals are not recommended for patients presenting with simple infectious mononucleosis, they may be useful (in conjunction with steroids) in the management of patients with severe EBV manifestations, such as EBV meningitis, peripheral neuritis, hepatitis, or hematologic complications.