Infectious Mononucleosis – Mono


Infectious mononucleosis is a clinical syndrome caused by  Epstein-Barr virus, but other viruses can also cause similar symptoms.

-The virus is transmitted through bodily fluids such as saliva (‘kissing disease) and sputum 

-It occurs mainly in adolescents and young adults 

Symptoms & Signs 

-It is characterized by a triad of fever, pharyngitis, and lymphadenopathy.

-Other symptoms include malaise, anorexia, myalgia, transient bilateral upper lid edema (Hoagland sign), radiation of pain to the left shoulder (Kehr’s sign) and splenomegaly 

-Highly suggestive findings: Epitrochlear adenopathy, posterior cervical lymphadenopathy 

-A morbilliform or papular rash, usually on the arms or trunk 


Antibody Tests: The most commonly performed diagnostic test is a rapid heterophile antibody test (Monospot test) 

White blood cell counts: Increased number of circulating white blood cells with a predominance of lymphocytes

Other labs: Elevated aminotransferases 


-The typical illness is self-limited and most symptoms resolve within 2–4 weeks.

-Symptomatic treatment: Antipyretics, analgesics, oral fluids, rest 

-Misdiagnosing it  as Strep throat and treating with amoxicillin can result in patient getting a rash and you getting a disappointed patient and their parents 

-Upper airway obstruction and severe hematologic complications: Consider corticosteroids 

-Potential complications: Splenic rupture, airway obstruction, pneumonitis, hemolytic anemia, thrombocytopenia, aplastic anemia, encephalitis, optic neuritis, meningitis, Guillain-Barré syndrome

– Patients should avoid contact sports and heavy lifting for 4 weeks due to the risk of splenic rupture

Herpes Zoster (Shingles)


-Herpes zoster results from reactivation of latent varicella-zoster virus infection within the sensory ganglia 

-It is usually characterized by a painful, unilateral vesicular eruption in a dermatomal distribution 

-It is usually occurs among adults, but rarely occurs in other age groups also. 

Symptoms & Signs 

-Most commonly involved sites of herpes zoster: trigeminal, thoracic and lumbar 

-It is usually confined to a single dermatome on one side and associated with burning pain in the affected area, fever, malaise, headache

-The rash starts as grouped vesicles and later become pustular and crusty. 

Herpes zoster ophthalmicus: Lesions on tip of nose, inner corner of eye and root and side of nose (Hutchinson sign) 

Herpes zoster oticus (Ramsay Hunt syndrome): vesicles in the ear canal, hearing loss, vertigo, tinnitus, Bell palsy; due to reactivation of VZV within the geniculate ganglion. 

-The lesions are considered infectious until they dry and crust over 


-Diagnosis is based on the clinical presentation


Antiviral agents: Acyclovir, valacyclovir, famciclovir, beneficial if started within 72 hours after the eruption of the rash 

Anterior uveitis: topical steroids, cycloplegics 

Corticosteroids do not prevent the development of postherpetic neuralgia


-Two shingles vaccines (Zostavax and Shingrix) are available for adults who have had chickenpox. 

-Shingrix is preferred over Zostavax.

-Shingrix is approved and recommended for people age 50 and older, including those who’ve previously received Zostavax. 

-Zostavax isn’t recommended until age 60. 

-Shingles can spread through direct contact with herpes zoster lesions 

-Patients should avoid contact with pregnant women who have never had chickenpox or varicella vaccine, immune deficiencies, and premature infants. 

Q.What is the most common complication of zoster in elderly adults? Postherpetic neuralgia 

Q. What is the most common cause of acute retinal necrosis? Herpes zoster virus

Chickenpox by Dr.Paul Kattupalli


-Chickenpox is an infection caused by the varicella-zoster virus. 

-VZV is a double-stranded, linear DNA virus 

-VZV infection causes two clinically distinct forms of disease: varicella (chickenpox) and herpes zoster (shingles).

-It is highly contagious, spreads readily by airborne droplets and by direct contact. 

Symptoms & Signs 

-Varicella most frequently occurs in children <10 years old but may occur at any age. 

-Varicella usually is a mild, self-limited illness in healthy children. 

-Fever, headache, malaise, papules, vesicles, crusts and scabs 

-It appears on the back of the head and ears, and then spreads centrifugally to the face, neck, trunk, and proximal extremities. 

-Vesicles are described as ‘dew drops on a rose petal’


-Diagnosis is clinically made based on history and physical examination

-Tzanck smear of the vesicle: Giant cells with inclusion bodies

-Histology: “Balloon degeneration” of cells with basophilic nuclei 


-For healthy children  ≤12 years, varicella is mostly self-limited; no antiviral therapy

-Immunosuppressed children and adults: antiviral therapy 

-Do not give aspirin because it is associated with the onset of Reye syndrome in the setting of a viral infection 

-Breastfeeding is encouraged in infants exposed to or infected with varicella. 


-A live attenuated varicella vaccine is available. 

-It is administered subcutaneously

-It is given in two doses; first dose at age 12 through 15 months, the second dose at age 4 through 6 years

Herpes Simplex Infections


Herpes simplex virus infections occur equally between the sexes throughout the year. 

-Penn State Students in State College are at high risk when they touch lesions of herpes

HSV-1 transmission typically occurs via oral-oral, oral-genital, or genital-genital contact.

HSV-2 lesions largely involve the genital tract, with the virus remaining latent in the sacral nerve root ganglia (S2–S5) 

Symptoms & Signs 

Both viral subtypes can cause genital and oral–facial infections

The infections caused by the two subtypes are clinically indistinguishable.

Gingivostomatitis and pharyngitis:   the most frequent clinical manifestations of primary HSV-1 infection; presents as small, grouped vesicles on an erythematous base, burning and stinging sensation, swollen and tender burning and stinging 

Genital: most genital infections are caused by HSV-2; presents with bilateral genital ulcerations and tender lymphadenopathy. 

Ocular disease: HSV keratitis presents with vision loss, pain, and discharge; it is a major cause of blindness from corneal scarring and opacity. 

Neonatal & Congenital infection: Neonatal HSV can present as excessive tearing, eye pain, conjunctival edema, vesicular lesions of the mouth, palate, tongue, seizures, irritability, fever, multiple organ failure

CNS Disease: Both viruses can cause encephalitis; the temporal lobe is often involved; it presents with 

the rapid onset of fever, headache, seizures, focal neurologic signs, and impaired consciousness

Bell’s Palsy: HSV-1 is a cause of Bell palsy (facial nerve paralysis)

Esophagitis & Proctitis: usually presents with dysphagia or odynophagia, fever, retrosternal chest pain 

Erythema multiforme: HSV infection is the most common cause of EM; Cutaneous eruptions occur 2 to 7 days after herpes simplex infection 


Diagnosis can be made by physical examination; Direct fluorescent antibody slide tests, viral culture, polymerase chain reaction 


Early antiviral therapy within 72 hours of symptom onset

Antiviral drugs: Acyclovir, Famciclovir, Valacyclovir 

Severe or frequent recurrences: Chronic suppressive therapy with antivirals 

Keratitis: The usage of topical corticosteroids may exacerbate the infection


Male circumcision is associated with a lower incidence of acquiring HSV-2 infection.


Q. What is the most frequent sign of HSV reactivation disease? Herpes labialis 

Q. What is the most frequent etiologic agent of Erythema multiforme? Herpes simplex virus 

Q. What is the most common cause of fatal sporadic encephalitis in the United States? HSV-1 encephalitis