Health Awareness blog

EBV or Epstein Barr Virus is the main agent that contribute to infectious mononucleosis (It cause 90% of the disease). Acute infectious mononucleosis presents with a history of 1-2 weeks of fatigue and malaise. However, onset may be abrupt. The incubation period in adolescents is 30-50 days. In young children, the incubation period is shorter. Most of the time, the course of this disease is benign and the prognosis is good.

Signs and symptoms:

• sore throat
• headache
• high grade fever
• myalgias (muscle pain)
• nausea
• abdominal pain
• splenomegaly (spleen enlargement)
• hepatomegaly (liver enlargement)
• pharyngitis (inflammation of the pharynx)
• Lymphadenopathy
• Maculopapular rash
• Eyelid edema

Investigations:

• Classic criteria: The 3 classic criteria for laboratory confirmation of acute infectious mononucleosis include (1) lymphocytosis, (2) the presence of at least 10% atypical lymphocytes on peripheral smear, and (3) a positive serologic test result for Epstein-Barr virus (EBV).
• Full blood count
• Liver function test - most patients have elevated liver function test results.
• Heterophile antibody test - Epstein-Barr virus infection stimulates polyclonal secretion of antibodies by infected B cells, including transient production of heterophile antibodies.
• Epstein-Barr virus serology

Complications:

• Hepatitis develops in more than 90% of patients with infectious mononucleosis.
• Approximately 50% of patients with infectious mononucleosis develop mild thrombocytopenia.
• Hemolytic anemia occurs in 0.5-3% of patients with infectious mononucleosis.
• Upper airway obstruction due to hypertrophy of tonsils and other lymph nodes in the Waldeyer ring ( 0.1-1% of patients).
• Splenic rupture (0.1-0.2% of patients with infectious mononucleosis).
• Hematologic complications (e.g.: hemophagocytic syndrome)
• Neurologic complications are rare (<1% of patient with EBV infection):
• Cardiac and pulmonary complications - rare
  
• Autoimmune complications like autoimmune diseases and Reye syndrome.

Treatment:

• Treatment is supportive
• Corticosteroids (potent anti-inflammatory drugs) - used to modify the immune response, however, it do not significantly alter the course of infectious mononucleosis
• Acyclovir (is the only antiviral drug used to treat infectious mononucleosis in placebo-controlled clinical trials)
• Intravenous immunoglobulin is used to modulate immune function in the presence of autoantibodies. It has been used successfully in the treatment of immune thrombocytopenia associated with infectious mononucleosis.
• Splenic rupture is one of the complication of infectious monnucleosis. It is an acute abdominal emergency and usually requires surgical intervention.

Reference

1. http://www.emedicine.com/ped/topic705.htm
2. Clinical Handbooks of Pediatrics. 3rd Edition. Lippincott Williams and Wilkins.

Developmental milestones are a set of functional skills or tasks that most children can do at a certain age range. It has a lot of individual variations. Some children can achieve their milestones earlier than others. Delay in one part doesn’t mean anything. You have to see the big picture before saying that your child is abnormal.

Check your child’s developmental progress using following tables. Should you see significant delays in any of the parts, seek your physician’s advice. Your child might suffer for developmental delay. The earlier action taken gives better benefit to your child.

The part two consists of hearing, language and social behaviour development. Please read part one of the articles that provide you the information about physical skills (gross motor), vision and fine motor development of your child.  

 Hearing and language: 

 Social behaviour and play: 

Reference:

1. Oxford Handbook of Clinical Specialties. 5^th edition. 2001.
2. Quick reference cards by Medical Protection Society. 2001.
3. A mom’s essential guide book by Dutch Lady.