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Infectious Mononucleosis ("Mono" or IM) - Coggle Diagram
Infectious Mononucleosis ("Mono" or IM)
PATHOGENESIS
OVERVIEW
Most common cause is the Epstein-Barr Virus (EBV)
Acute viral infection of B Lymphocytes
INFECTION
Exposure occurs in the oral cavity
Mononucleosis is transmitted through saliva and blood products
Sharing a glass, utensils, kissing, etc...
Nicknamed "The Kissing Disease"
Atypical lymphocytes form from CD8+ T cells that then respond to the infection
The Epstein-Barr Virus cannot be acquired from the environmental factors and is not generally contagious
PROGRESSION
Overall, IM progresses very slowly
EBV has an incubation period of 4-6 weeks to 1-2 months
Pt. will not show symptoms during incubation period, but will be able to infect others
After incubation, IM has sudden onset of symptoms followed by a long phase of viral fatigue
Symptom length and severity will vary with each patient
The initial illness usually lasts for about 2-3 weeks
Viral fatigue lasts for many weeks after the initial illness
These lower fitness levels can last up to 6 months
RISK FACTORS
The act of sharing glasses, utensils, drinks, toothbrushes, or anything that comes in contact with the mouth and saliva
Sexual contact, including kissing
Blood transfusions
Organ transplantation
Individuals with a compromised immune system
More likely to develop symptoms after their first exposure to EBV
Virus more likely to reactivate, causing a second bout of IM
INCIDENCE / PREVALENCE
It is shown that around 90% of adults worldwide carry EBV, however this virus does not always cause disease
"Approximately 50% to 85% of children are infected with EBV by the age of 4, and more than 90% of adits have indications of subclinical EBV infections" (pg. 519).
Usually effects young adults between the ages of 15-24
Overall incidence (ages 15-24) is 6-8 cases per 1000 people per year
DIAGNOSIS
Many times a throat culture will be ordered to first rule out Strep throat (
Streptococcal pharyngitis
)
In teenagers and young adults, IM can by diagnosed through a physical assessment paired with the classic signs and symptoms
In the absence of symptoms, blood tests can detect the presence of the EBV
Heterophile Antibody Test
looks for antibodies that are present while fighting off a viral infection
these antibodies are not unique to IM
Abnormal white blood cells that are present while fighting off a viral infection
common diagnosis for young children and older adults
CLINICAL MANIFESTATIONS
30-50 day incubation period
Early symptoms:
Headache, Malaise, joint pain, fatigue, flu-like symptoms
Occur 3-5 days after infected
Classic group of symptoms:
fever, pharyngitis, cervical lymph node enlargement, fatigue
Present at the time of diagnosis
Pharyngitis: white/gray exudate present, may be painful causing the pt. to seek treatment
Progression Characteristics:
lymphadenopathy, enlarged spleen, appearance on atypical T-lymphocytes
Complications:
Splenic Rupture: occur spontaneously from mild trauma. 0.1%-0.5% of cases
usually men under the age of 35, most common cause of death from IM
Splenomegaly: 50% of cases
Other Causes of Death from IM:
hepatic failure, systemic bacterial infection, viral myocarditis
Respiratory can occur in immunocompromised patients
TREATMENTS
Very self-limiting, medical intervention is rarely required
Supportive therapy and rest:
Treat symptoms: analgesics and antipyretics
Streptococcal pharyngitis: Penicillin or Erythromycin
Bed rest, avoid strenuous activity and contact sports
Splenic Rupture: surgical removal of spleen or scenic repair (very rare)
Repair will avoid overwhelming postsplenectomy infection (children are at great risk for OPSI)
