Infectious Mononucleosis

Alisa AlkerMorning report 2010

Tuesday, April 13, 2010

Infectious Mononucleosis

IM = triad of fever, tonsi"ar pharyngitis, and lymphadenopathy

most common cause is EBV

transmission is through close contact. Found in saliva, semen, and cervical epithelial tissue

EBV establishes latency and causes periodic asymptomatic shedding

Tuesday, April 13, 2010

Demographics

at age 4, seroprevalence is 100% in developing nations and between 20-50% in developed nations

In adults, seroprevalence is 90-95%

infections in children are usua"y subclinical

peak incidence of infectious mononucleosis is age 15-24 years old

Tuesday, April 13, 2010

Clinical Manifestations

From Mande" et al.

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Laboratory findings

very common: lymphocytosis--o'en atypical lymphocytes

less common: absolute or relative neutropenia and mild thrombocytopenia

rare: hemolytic anemia, severe thrombocytopenia, aplastic anemia

common: abnormal LFTs, alkphos, bilirubin

Tuesday, April 13, 2010

DiagnosisHeterophile antibodies (HA)

predominately IgM produced by EBV-infected B lymphocytes directed against viral and unrelated antibodies. In the laboratory, they a)lutinate horse RBCs (Monospot)high false negative rate (25% in the first week of symptoms)

 EBV serology

-IgM and IgG directed against viral caspid antigen 

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Typhoid IM

predominately fever and lymphadenopathy

This is more likely to be caused by agents other than EBV such as CMV, toxoplasma, acute HIV, HHV-6, HHV-7

Tuesday, April 13, 2010

References

1. Aronson M, Auwaerter P, Hirsch M, Kaplan, Sheldon. Infectious mononucleosis in adults and adolescents. 2010 Jan 31; UpToDate

2. Mande" G, Bennett J, Dolin R. Mande", Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Elsevier Churchi" Livingstone; 2005.

Tuesday, April 13, 2010

Tuesday, April 13, 2010