INFECTIOUS MONONUCLEOSIS (epstein-barr virus)

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INFECTIOUS MONONUCLEOSIS(epstein-barr virus)

• Professor Ma lian

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Typical features

• Prolong fever
• Exudative pharyngitis
• Generalized adenopathy
• Hepatosplenomegaly
• Atypical lymphocytes
• Heterophil antibodies

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General considerations

• Infectious mononucleosis (mono) is a common acute
  infectious disease usually found in individuals
  between the ages of 5 and 30. 
• Pathogeny
• Epstein-Barr virus (90)
• CMV, HIV, HHV-6, toxoplasma gondii, Hepatitis
  virus etc (5-10).

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EBV

• Occur worldwide
• Transmitted by saliva and blood transfusion
• Related with the following diseases
• Mono
• Burkitt lymphoma
• Nasopharyngeal cancer

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Clinical findings

• Symptoms and signs
• Prolong fever(gt39?)
• Soft palate petechiae and Exudative pharyngitis
• Generalized adenopathy
• Splenomegaly and hepatomegaly
• Rash (macular,scarlatiniform or urticarial)
• eye edema
• X-linked lymphoproliferative syndrome (XLP)
  occur in the children with primary
  immunodeficiency disease

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Sore throat
Soft palate petechiae
Exudative pharyngitis
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Generalized adenopathy

• usually in the neck, armpit, and throat

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Rash
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Clinical findings

• Laboratory findings
• Peripheral blood
• Atypical lymphocytes
• Leukopenia
• Heterophil antibodies
• Anti-EBV antibodies
• aminotransferase

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• No clumping of the red bloods cells indicates the
  person's serum does not contains heterophile
  antibodies. The few clumps that are seen are red
  blood cells from the test reagent that did not
  separate during shaking of the reagent prior to
  placing it on the slide.

Clumping of the red bloods cells indicates the
person's serum contains heterophile antibodies.
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Differantial diagnosis

• Group A streptococcal infection
• Rubella
• Adenovirus
• Hepatitis A or B
• Toxoplasmosis
• Drug reaction
• Leukemia
• CMV mononucleosis
• HIV infection

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Complication

• CardiorespiratoryInterstitial pneumonitisMyocard
  itisPericarditisPleuritis
• HematologicAutoimmune hemolytic anemiaImmune
  granulocytopenia or thrombocytopeniaPancytopenia
  

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Complication

• HepaticCholestatic jaundice (severe
  hepatitis)Massive hepatic necrosis and failure
• NeurologicCranial nerve palsiesGuillain-Barré
  syndromeMeningoencephalitisTransverse
  myelitisOthers

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• Infectious mononucleosis hepatitis
• Marked mononuclear cell infiltration of the
  sinusoids without significant necrosis. HE
  stain.

Infectious mononucleosis heapatitis High power of
previous illustration showing the signs of high
regenerative activity binucleate cells and a
mitotic figure. HE stain.
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Treatment

• No specific therapy exists for IM, but general
  support helps
• rest and fluids
• acetaminophen or aspirin for fever and aches
• lozenges, salt-water gargles,
• viscous lidocaine hydrochloride for sore throat.

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Treament

• Acyclovir, ganciclovir, and foscarnet
• IVIG
• a-interferon
• Antibiotics and corticosteroids are indicated
  only for complications.
• Patients with splenomegaly should advoid sport
  for 6-8 weeks.