-
American Family Physician Mar 2015Epstein-Barr is a ubiquitous virus that infects 95% of the world population at some point in life. Although Epstein-Barr virus (EBV) infections are often asymptomatic,... (Review)
Review
Epstein-Barr is a ubiquitous virus that infects 95% of the world population at some point in life. Although Epstein-Barr virus (EBV) infections are often asymptomatic, some patients present with the clinical syndrome of infectious mononucleosis (IM). The syndrome most commonly occurs between 15 and 24 years of age. It should be suspected in patients presenting with sore throat, fever, tonsillar enlargement, fatigue, lymphadenopathy, pharyngeal inflammation, and palatal petechiae. A heterophile antibody test is the best initial test for diagnosis of EBV infection, with 71% to 90% accuracy for diagnosing IM. However, the test has a 25% false-negative rate in the first week of illness. IM is unlikely if the lymphocyte count is less than 4,000 mm3. The presence of EBV-specific immunoglobulin M antibodies confirms infection, but the test is more costly and results take longer than the heterophile antibody test. Symptomatic relief is the mainstay of treatment. Glucocorticoids and antivirals do not reduce the length or severity of illness. Splenic rupture is an uncommon complication of IM. Because physical activity within the first three weeks of illness may increase the risk of splenic rupture, athletic participation is not recommended during this time. Children are at the highest risk of airway obstruction, which is the most common cause of hospitalization from IM. Patients with immunosuppression are more likely to have fulminant EBV infection.
Topics: Adolescent; Airway Obstruction; Antibodies, Viral; Disease Management; Herpesvirus 4, Human; Humans; Immunoglobulin M; Infectious Mononucleosis; Serologic Tests; Splenic Rupture; Young Adult
PubMed: 25822555
DOI: No ID Found -
British Journal of Biomedical Science Jul 2021EBV is the sole causative agent of the acute illness in humans described either as infectious mononucleosis (IM), or glandular fever. IM, when not clinically silent, can... (Review)
Review
EBV is the sole causative agent of the acute illness in humans described either as infectious mononucleosis (IM), or glandular fever. IM, when not clinically silent, can present in patients with at least two of the classic triad of symptoms of fever, pharyngitis, and lymphadenopathy. Challenges for the clinician arise when atypical cases present. Early, accurate and informed laboratory test results are vital for diagnosis, appropriate treatment, and management. A key challenge for the practitioner, particularly in cases where the illness can present atypically, is distinguishing bacterial tonsillitis infections from early acute IM. The ability to draw on timely, clear, and insightful laboratory results to distinguish viral from bacterial infection is vital. Correct and prompt diagnosis of IM can help prevent the unnecessary administration of antibiotics and mitigate the need for other expensive exploratory tests in cases of IM that present with splenomegaly, lymphadenopathy, or suspect haematological conditions. Good communication between the requesting clinician and those carrying out the investigative process, and between the different laboratory departments involved, is good practice and would ultimately benefit the patient. This communication will comprehensively review the aetiology, clinical presentation, and laboratory findings in IM with a view to promoting further research and so derive a standard diagnostic algorithm of the condition.
Topics: Algorithms; Decision Support Techniques; Herpesvirus 4, Human; Host-Pathogen Interactions; Humans; Infectious Mononucleosis; Predictive Value of Tests; Prognosis; Virology
PubMed: 33721513
DOI: 10.1080/09674845.2021.1903683 -
American Family Physician Oct 2004Infectious mononucleosis should be suspected in patients 10 to 30 years of age who present with sore throat and significant fatigue, palatal petechiae, posterior... (Review)
Review
Infectious mononucleosis should be suspected in patients 10 to 30 years of age who present with sore throat and significant fatigue, palatal petechiae, posterior cervical or auricular adenopathy, marked adenopathy, or inguinal adenopathy. An atypical lymphocytosis of at least 20 percent or atypical lymphocytosis of at least 10 percent plus lymphocytosis of at least 50 percent strongly supports the diagnosis, as does a positive heterophile antibody test. False-negative results of heterophile antibody tests are relatively common early in the course of infection. Patients with negative results may have another infection, such as toxoplasmosis, streptococcal infection, cytomegalovirus infection, or another viral infection. Symptomatic treatment, the mainstay of care, includes adequate hydration, analgesics, antipyretics, and adequate rest. Bed rest should not be enforced, and the patient's energy level should guide activity. Corticosteroids, acyclovir, and antihistamines are not recommended for routine treatment of infectious mononucleosis, although corticosteroids may benefit patients with respiratory compromise or severe pharyngeal edema. Patients with infectious mononucleosis should be withdrawn from contact or collision sports for at least four weeks after the onset of symptoms. Fatigue, myalgias, and need for sleep may persist for several months after the acute infection has resolved.
Topics: Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal; Child; Diagnosis, Differential; Epstein-Barr Virus Infections; Humans; Infectious Mononucleosis
PubMed: 15508538
DOI: No ID Found -
Clinics in Sports Medicine Oct 2019Infectious mononucleosis is a common condition occurring in athletic training rooms. Most cases are due to Epstein-Barr virus infections (upward of 90%). Although... (Review)
Review
Infectious mononucleosis is a common condition occurring in athletic training rooms. Most cases are due to Epstein-Barr virus infections (upward of 90%). Although treatment generally consists of symptomatic care, there is clinical variation in laboratory workup leading to diagnosis and in the method of return to play decision making. The authors suggest a systematic approach to laboratory evaluation and return to play decisions to minimize clinical variation. The most feared complication of infectious mononucleosis is potential splenic rupture. There have been several examples of the successful use of serial ultrasonography to help make maximally informed return to play decisions.
Topics: Decision Making; Humans; Infectious Mononucleosis; Return to Sport; Rupture, Spontaneous; Splenic Rupture; Ultrasonography
PubMed: 31472766
DOI: 10.1016/j.csm.2019.06.002 -
The Nurse Practitioner Mar 1996Infectious mononucleosis is an acute, self-limiting, nonneoplastic lymphoreticular proliferative disorder characterized by peripheral lymphocytosis and circulating... (Review)
Review
Infectious mononucleosis is an acute, self-limiting, nonneoplastic lymphoreticular proliferative disorder characterized by peripheral lymphocytosis and circulating atypical lymphocytes. Epstein-Barr virus is the causative agent in 90% of cases. Highest incidence is in the 15- to 25-year-old age-group, with 1% to 3% of all college students in the United States affected each year. Clinical manifestations vary according to age at presentation. Incubation period is 4 to 7 weeks. Diagnosis is primarily made with the monospot test but may include throat culture and complete blood count with differential. Cytomegalovirus and human immunodeficiency virus are among the many other conditions that may present initially as infectious mononucleosis. Treatment is supportive with prevention of complications as the goal; good personal hygiene and avoidance of contact sports should be stressed.
Topics: Adolescent; Adult; Aged; Antibodies, Heterophile; Diagnosis, Differential; Humans; Infant; Infectious Mononucleosis; Patient Education as Topic; Referral and Consultation
PubMed: 8710247
DOI: No ID Found -
MMW Fortschritte Der Medizin May 2018
Review
Topics: Cytomegalovirus Infections; Diagnosis, Differential; Humans; Infectious Mononucleosis
PubMed: 29855902
DOI: 10.1007/s15006-018-0582-1 -
International Journal of Adolescent... Jan 2019
Topics: Airway Obstruction; History, 19th Century; History, 20th Century; History, Medieval; Humans; Infectious Mononucleosis; Sepsis; Splenic Rupture
PubMed: 30645196
DOI: 10.1515/ijamh-2018-0284 -
JAAPA : Official Journal of the... Nov 2018
Topics: Age Factors; Antibodies, Viral; Biomarkers; Blood Cell Count; Blood Sedimentation; Fatigue; Herpesvirus 4, Human; Humans; Infectious Disease Incubation Period; Infectious Mononucleosis; Lymphadenopathy; Nausea; Saliva; Splenomegaly; Time Factors
PubMed: 30358681
DOI: 10.1097/01.JAA.0000546488.73851.dd -
HNO Apr 2005The primary infection with Epstein-Barr virus in an immunocompetent individual leads to infectious mononucleosis with symptoms of diphtheroid angina, lymph node swelling... (Review)
Review
The primary infection with Epstein-Barr virus in an immunocompetent individual leads to infectious mononucleosis with symptoms of diphtheroid angina, lymph node swelling in the neck and hepatosplenomegaly. The most common age of infection lies between 15 and 25 years. The illness can affect a number of organs simultaneously and thus requires interdisciplinary diagnostics. For differential diagnosis, a differential blood analysis and a EBV quick test are required. The presence of IgM antibodies demonstrates the presence of the infection. Ultrasound of the abdomen can be made to determine the involvement of additional organs. In most cases, recovery occurs without complications. Acute cases can usually be handled successfully with medication. If symptomatic treatment fails, pharyngeal airway obstruction is possible and a tonsillectomy may be necessary. Otherwise, surgical treatment is obsolete. Generally, the prognosis is good. Severe courses and complications are rare.
Topics: Humans; Infectious Mononucleosis; Practice Guidelines as Topic; Practice Patterns, Physicians'
PubMed: 15657747
DOI: 10.1007/s00106-004-1210-1 -
The Pediatric Infectious Disease Journal Jul 2022
Topics: COVID-19; Humans; Infectious Mononucleosis
PubMed: 35389945
DOI: 10.1097/INF.0000000000003535