Please enable JavaScript.
Coggle requires JavaScript to display documents.
Glandular fever (infectious mononucleosis) (Complications (Upper airway…
Glandular fever
(infectious mononucleosis)
Definition
Self-limiting viral illness affecting URT
and other systems, caused by EBV
Epidemiology
Usually 15-25y
Most people have symptomatic infection
Pathophysiology
EBV herpesvirus
Saliva spread
Incubation 30-50d, lasts 2-3wk
Atypical presentations in elderly and young children (<3y)
Infection of tonsils with enlargement and exudate,
spread to local LNs and systemic symptoms
Clinical
presentation
Typical
Lymphadenopathy
Sore throat
Fever
Rash (rare)
Jaundice (rare)
Atypical
Prolonged fever
(>2wk)
Jaundice
Diagnosis
Examination
ENT
Ears: erythema, otitis media
Nose: nil
Throat: swollen, erythematous tonsils, exudate
Neck: enlarged LNs
Resp
Generally nil
Investigations
Bloods
FBC (high WCC), CRP (high), U+E,
LFTs (often deranged)
Monospot test (heterophile Abs +ve)
Bedside
Obs (sats, RR, HR, BP, temp)
History
DH
Current meds
Allergies
FH
H+N problems, cancers
PMH
Previous ENT problems
Known medical and surgical conditions
SH
Smoking, alcohol, support
PC/HPC
Fever, sore throat, LNs, rash, jaundice
Check LRTI (cough, sputum) and meningitis
(photophobia, neck stiffness, rashes)
Ability to eat and drink
Red flags (night sweats, weight loss)
Management
Medical
Analgesia
Indication: pain
E.g. paracetamol, NSAIDs
Conservative
Safety netting
Stridor/difficulty breathing, difficulty swallowing,
dehydration, systemically unwell, abdominal pain
Referral
Urgent if stridor, dehydration, suspected
splenic rupture, serious complication
Information and advice
Lasts 2-3wk, fatigue may last longer, return to normal activities ASAP, limit spread, avoid heavy lifting/collision sports (spleen)
Complications
Upper airway obstruction
Gross tonsillar enlargement
Peritonsillar abscess (quinsy)
Other
Prolonged fatigue (>6m)
Splenic rupture
Acute interstitial nephritis
Abnormal LFTs
Neurological (rare)
Encephalitis
Aseptic meningitis
Facial nerve palsy
Transverse myelitis
Guillain-Barre syndrome
Optic/retrobulbar neuritis
Mononeuritis multiplex
Brachial plexus neuropathy
Haematological
Autoimmune haemolytic anaemia
Thrombocytopenia, neutropenia
Cardiovascular
Pericarditis, myocarditis
Conduction abnormalities
Immunocompromised patients
Malignancy (lymphomas, solid cancers)
HIV patients: oral hairy leukoplakia, interstitial pneumonitis
Prognosis
Self limiting
Illness lasts 2-3wk most people
Sore throat 3-5d, may persist for 4wk
Fatigue last to resolve, may take months
Carrier state
Lifelong, with periodic viral shedding in saliva
Differentials
Infection
Viral: CMV, hepatitis, rubella, roseola, mumps, HIV
Bacterial: strep pharyngitis
Parasitic: toxoplasmosis
Neoplastic
Lymphoma/leukaemia
Met solid tumour