Infectious Mononucleosis – Mono

Introduction

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 

Diagnosis 

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 

Treatment 

-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

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