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.