Infectious mononucleosis (EB)

Causes and Risks:
Mononucleosis-like disease may be caused by the Cytomegalovirus (CMV) as well as the classical mononucleosis of the Epstein-Barr virus (EBV). Both viruses are members of the herpes virus family. Mononucleosis caused by EBV is the most frequently encountered type and is responsible for approximately 85% of infectious mononucleosis cases. The infection is probably transmitted by saliva. While peak incidence occurs in 15- to 17-year-olds, the infection may occur in any age, being most often diagnosed between ages 10 to 35 years.

Infectious mononucleosis may begin slowly with fatigue , malaise , headache , and sore throat . The sore throat becomes progressively worse, often with enlarged tonsils covered with a whitish-yellow fibrinous exudate . The lymph nodes in the neck are frequently enlarged and painful. A pink measles-like rash may occur in approximately 1 out of 5 individuals with mono. Four out of five patients with mononucleosis who are given ampicillin or amoxicillin for their "throat infection" will develop the rash but it is significantly darker and denser than the rash in those not given medication. Symptoms of mononucleosis gradually subside over a period of weeks to a month. The disease is generally self limiting.

Risk factors other than age are not known. The incidence in the United States is 2 out of 1,000 in adolescents and young adults. It is significantly lower for the entire U.S. population. Age of infection varies from country to country. For example, in Africa most individuals have been infected by age 3 years, an age at which there are very few symptoms. EBV infection may be associated with some types of malignancy . In Africa EBV is associated with Burkitt's lymphoma , while in China and among the Eskimos, EBV may be associated with cancers of the nose and throat (nasopharyngeal carcinoma ).

Prevention:
Infectious mononucleosis can be contagious when in close or intimate contact with an infected person. Since the infection is probably spread by saliva, kissing or other transfer of oral secretions should be avoided.

Symptoms:

Less frequently occurring symptoms include:



Signs and Tests:
A physical examination reveals an enlarged liver and (or) enlarged spleen . The liver and spleen may be tender when they are gently pressed ( palpation ). There may be a skin rash present. Laboratory findings often include such characteristic findings as atypical lymphocytes, unusual appearing white blood cells which are seen when the blood is examined under a microscope and may persist for 2 to 8 weeks. Abnormalities of liver function are also characteristic.

Common tests for EB include:

Other tests that may reflect changes:



Treatment:
Most patients recover within 4 to 6 weeks without medication. There is no specific treatment available; antiviral medications do not help. Rest is needed, sometimes for a month or longer. Relieve pain and fever with analgesics , and use warm salt water gargles for sore throat . A high protein , decreased fat diet and vitamin supplements may be recommended.

Prognosis:
Fever usually abates in 10 days, and swollen lymph glands and spleen heal in 4 weeks. Fatigue may linger for 2 to 3 months.

Complications:



Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms indicate mononucleosis.

Go to the emergency room or call the local emergency number (such as 911) if a sharp, sudden pain in left upper abdomen occurs. This could indicate a ruptured spleen, which requires emergency surgery.


Mononucleosis is an infectious disease caused by the Epstein-Barr virus (EBV). A rash may appear early in the illness which is red (erythematous), flat (macular) to slightly raised, and does not itch. Individuals with mono who are given ampicillin or amoxicillin may develop a significant rash which is very noticeable.



Mononucleosis is an infectious disease caused by the Epstein-Barr virus (EBV). A rash may appear early in the illness which is red (erythematous), flat (macular) to slightly raised, and does not itch. People with mono who are given ampicillin or amoxicillin may develop a significant rash which is very noticeable.



This so-called "Downy cell" is typical of lymphocytes infected by EBV (Epstein Barr Virus) or CMV (Cytomegalovirus) in infectious mononucleosis. Downy cells may be classified as types I, II, or III. This is a type II Downy cell.



This is a lymphocyte that has been infected by the Epstein-Barr Virus (EBV) or Cytomegalovirus (CMV) in infectious mononucleosis and is referred to as a "Downy cell". Downy cells may be classified as types I, II, or III; this is a type I Downy cell.







Erythema nodosum consists of red to reddish purple hard (indurated) nodules which are painful to the slightest touch. These are most commonly seen on the shins (as pictured), but may occur on the thighs or elsewhere. They often occur in association with a group of widely varied diseases such as tuberculosis (TB), sarcoidosis, coccidioidomycosis, SLE, other fungal infections, and some drugs.



Erythema nodosum usually occurs in association with specific infections, inflammatory conditions, or medications. It consists of painful, hot, red skin lumps, usually over the shins. People with erythema nodosum should be evaluated for other disease processes.



Mononucleosis is an infectious disease usually thought of as causing fatigue and swollen lymph nodes. However, mononucleosis has multiple other symptoms including various rashes. Interestingly, the antibiotic ampicillin significantly increases the rash.



This picture shows large, atypical lymphocytes (white blood cells). These cells are seen in viral infections, most commonly caused by the Epstein-Barr virus (infectious mononucleosis), cytomegalovirus diseases, and occasionally infectious hepatitis. This is an example of a type I Downy cell.



Gianotti-Crosti disease is associated with hepatitis B infection and is also called acrodermatitis of childhood. These red, elevated lesions (papules) do not contain pus (non-pruritic) and can occur on the extremities, buttocks, face, and neck. A similar appearing condition is associated with other types of infection an is referred to as a syndrome rather than a disease. (Other diseases include RSV, EBV, cytomegalovirus, coxsackie, streptococcus and several others)



Infectious mononucleosis causes a sore throat, enlarged lymph nodes, and fatigue. The throat may appear red and the tonsil(s) covered with a whitish material (exudate). Mononucleosis and sever streptococcal tonsillitis appear quite similar. Unless there are other findings to suggest mononucleosis, a throat culture and blood studies may be necessary to make an accurate diagnosis.



Infectious mononucleosis is caused by the Epstein-Barr virus. In teenagers and young adults, there is frequently a sore throat and red tonsils with whitish spots (exudate), as seen in this picture. Enlarged lymph nodes and fatigue are also common.