Infectious mononucleosis mono is an infection that causes sore throat, fever, swollen glands, and tiredness or fatigue. Since its discovery in the late 1960s, epsteinbarr virus infection has been known to cause a syndrome of infectious mononucleosis or primary infection, which typically strikes adolescents and. Ebv is found worldwide and infects about 90% of people by adulthood, although most people never show symptoms centers for disease control and prevention cdc. Infectious mononucleosis im, mono, also known as glandular fever, is an infection usually caused by the epsteinbarr virus ebv. In an examination of excretion patterns of epsteinbarr virus in 104 throat washings from 20 patients with infectious mononucleosis we found that three persons regularly shed virus from the second week through the third month after onset. The second most common cause is probably cmv infection. Illness usually lasts between one week and several weeks. Mar 01, 2010 infectious mononucleosis im is an acute selflimiting disease caused by primary epsteinbarr virus ebv infection. Clinical note from the new england journal of medicine infectious mononucleosis complicated by bilateral papilloretinal edema. Infectious mononucleosis is a virus infection in which there is an increase of white blood cells that are mononuclear with a single nucleus mono and kissing disease are popular terms for this very common illness caused by the epsteinbarr virus ebv. Learn infectious mononucleosis pediatric infectious disease for medicine faster and easier with picmonics unforgettable images and stories. Deep jaundice in infectious mononucleosis jama jama. Recently, we observed a case of infectious mononucleosis with one of its more unusual complications, total peripheral agranulocytosis. The presenting symptoms of acute im can range from the obvious, such as persistent exudative tonsillitis and marked cervical lymphadenopathy, to the more vague symptoms of fatigue and malaise.
The title for figure 1 page 1996 should have ended with wrightgiemsa rather than hematoxylin and eosin. Infectious mononucleosis adolescent medicine jama jama. Dec 21, 2000 infection with epsteinbarr virus ebv is 1 putative cause of this syndrome. Infectious mononucleosis in university students in the united. It is therefore important to dispel the many myths relating to the condition with appropriate patient education. Epsteinbarr virus and infectious mononucleosis nejm. Infectious mononucleosis im is characterized by a triad of fever, tonsillar pharyngitis, and lymphadenopathy. From 1999 to 2003, the boynton health service of the university of minnesota cared for an average of 301 students with acute infectious mononucleosis annually international classification of disease revision 9, code 075. Therefore, it is best to think of the term infectious mononucleosis as a clinical syndrome of fever, pharyngitis, and adenopathy, regardless of the specific infecting agent. Patients usually present with a sore throat and often presume that an antibiotic is required. Severe infectious mononucleosis in immunocompetent adults. Infectious mononucleosis is a fairly common disease of adolescents and young adults. Both adults and children can be infected by the epsteinbarr virus and show similar symptoms. It is also known as mononucleosis, mono, glandular fever, or the kissing disease.
Mononucleosis caused by epsteinbarr virus and cytomegalovirus in children. Epstein barr virus adolescents and adults any infectious mononucleosis 80%. Infectious mononucleosis, or mono, is an infection usually caused by the epsteinbarr virus. Infectious mononucleosis is a common infection that results in fever, sore throat, and cervical lymphadenopathy accompanied by a lymphocytosis. Infectious mononucleosis msd manual professional edition. Hiv, ebv infectious mononucleosis, viral exanthematous diseases, and hepatitis a should be considered in the differential and, in case of childhood viral infections, rsv, parvovirus, influenza a and b.
Deep jaundice in infectious mononucleosis is generally considered rare. Mononucleosis syndrome, caused by ebv in up to 90% cases, typically presents with fever, pharyngitis. The disease is spread through saliva and can cause fever, sore throat, and swollen lymph nodes. Streptococcal pharyngeal infection not only causes acute illness but also can trig ger the postinfectious. Infectious mononucleosis im is an acute selflimiting disease caused by primary epsteinbarr virus ebv infection. When infection with ebv occurs during adolescence or young adulthood, it causes infectious mononucleosis 35% to 50% of the time. In young adults, the disease often results in fever, sore throat, enlarged lymph nodes in the neck, and tiredness.
Epsteinbarr virus, frequently referred to as ebv, is a member of the herpesvirus family and one of the most common human viruses. Infectious mononucleosis in university students in the. Physicians are not well aware of its complications. Infectious mononucleosis etiology bmj best practice. A 16yearold, previously healthy girl presents with a severalday history of fever, sore throat, and malaise. The virus spreads through saliva, which is why its sometimes called kissing disease. Downloaded from by ayman bakkar on january 12, 2011. Ebv is in the herpes virus family, and is also known as human herpes virus type 4. It is usually passed to susceptible people through intimate contact with infected saliva. Vcaigm usually is measurable at symptom onset, peaks at 23 weeks, then declines and not measurable by 34 months. We now know that the characteristic atypical lymphocytes, carefully described.
Epstein barr virus ebv, also known as human herpes virus 4, is the etiologic agent in approximately 80% to 90% of im cases. Pediatric mononucleosis and epsteinbarr virus infection. Infectious mononucleosis is the name coined by sprunt and evans in 1920 1 for an acute infectious disease consisting of fever, cervical lymphadenopathy and pharyngitis accompanied by atypical large peripheral blood lymphocytes. It is mostly common among the teenagers and young people. Infectious mononucleosis is caused by epsteinbarr virus ebv, human herpesvirus type 4 and is characterized by fatigue, fever, pharyngitis, and lymphadenopathy. To determine how often persistent fatigue follows infectious. Infectious mononucleosis is a acute infectious disease, caused by epsteinbarr virus evb that belongs to the herpesviridae. Infectious mononucleosis pediatric infectious disease. Serologic evidence of past exposure to epsteinbarr virus, the most common cause of infectious mononucleosis, can be found in almost all adults throughout the world. Infectious mononucleosis im is a common childhoodadolescent illness.
Ebvspecific antibody profiles are the best choice for staging ebv infection. In short, epstein barrassociated infectious mononucleosis is only one variant of the universe of similar infections. Infectious mononucleosis mono in teens and young adults. On examination, he was mildly pyrexial with posterior cervical lymphadenopathy, palatal petechiae and pharyngeal inflammation without an exudate.
A 20yearold carpet fitter presented with a 1week history of a sore throat, stiffness and tenderness of his neck, and extreme malaise. Our study helped confirm that age above 30 years was associated with the onset of severe im, as demonstrated in previous works. The presenting symptoms of acute im can range from the obvious, such as persistent exu. Infectious mononucleosis mono is an epsteinbarr virus ebv infection of the lymphatic system. Dec 05, 2018 epsteinbarr virus ebv, or human herpesvirus 4, is a gammaherpesvirus that infects more than 95% of the worlds population.
The risk of splenic injury and chronic fatigue make returntoplay decisions a challenge for the clinician. Epsteinbarr virus ebv, or human herpesvirus 4, is a gammaherpesvirus that infects more than 95% of the worlds population. Picmonic is research proven to increase your memory retention and test scores. Large studies of infectious mononucleosis are now decades old, but traditionally, the peak incidence of infection has been described in the 15 to 24year age range. The most targeted age range is the adolescent years. Mar 12, 2020 infectious mononucleosis, or mono, is an infection usually caused by the epsteinbarr virus. To determine how often persistent fatigue follows infectious mononucleosis caused by ebv, these researchers prospectively examined 150 patients with acute infectious mononucleosis and serologic evidence of acute ebv infection. Ebv persistently infects 90% of adults worldwide and is usually transmitted subclinically between young children via saliva. Infectious mononucleosis is a disease primarily of adolescence and early adulthood.
Modern diagnosis of epsteinbarr virus infections and post. The cell type increased in infectious mononucleosis is the lymphocyte population, as infectious mononucleosis is a. Symptoms in children are milder than they are expressed in adults. Knowledge of the clinical course of the disease, as well as potential. Acute mononucleosis and chronic fatigue nejm journal watch. Infectious mononucleosis mostly affects teenagers and young adults. Infectious mononucleosis im and cytomegalovirus cmv mononucleosis are caused by a primary infection with related viruses, epsteinbarr virus ebv and cmv. Monocytosis has sometimes been called mononucleosis, but that name is usually reserved specifically for infectious mononucleosis. This journal feature begins with a case vignette highlighting a common clinical problem. I nfectious mononucleosis is a clinical syndrome caused by epsteinbarr virus ebv that is particularly common in adolescents and children. Common questions about infectious mononucleosis jason womack, md, and marissa jimenez, do, rutgers university, robert wood johnson medical school, new brunswick, new jersey. Infectious mononucleosis does not present as monocytosis an increase in the number of monocytes.
Sep 20, 2018 infectious mononucleosis was first described by sprunt and evans in the bulletin of the johns hopkins hospital in 1920. Acute infectious mononucleosis im is a common illness that presents to urgent care facilities. Feb 27, 2015 infectious mononucleosis is the name coined by sprunt and evans in 1920 1 for an acute infectious disease consisting of fever, cervical lymphadenopathy and pharyngitis accompanied by atypical large peripheral blood lymphocytes. Cases of infectious mononucleosis in young children have been reported, although ebv infection in this age group is usually subclinical. It has even been stated that a total serum bilirubin level of over 6 mg100 ml. Pathophysiology and clinical presentation correct diagnosis. The systemic nature of infectious mononucleosis has been recognized for many years. Common questions about infectious mononucleosis jason womack, md, and marissa jimenez, do, rutgers university, robert wood johnson medical school, new. Over 50% of college studentshave antibodies to the eb virus, implying prior infection. Epsteinbarr virus ebv infectious mononucleosis mono.
Rossiintroduction infectious mononucleosis mono, often called the kissing disease, is a virus that is transmitted through primarily saliva. Cytomegalovirus infection cmv and human immunodeficiency. Infectious mononucleosis, or glandular fever, was first described in 1889 by pfeiffer. Infectious mononucleosis and mononucleosis syndromes. Infectious mononucleosis an overview sciencedirect topics. Infectious mononucleosis definition is an acute infectious disease associated with epsteinbarr virus that is characterized especially by fever, sore throat, swelling of lymph nodes, fatigue, and lymphocytosis and occurs primarily in adolescents and young adults abbreviation imcalled also kissing disease, mono. Defining factors associated with severity could be useful in primary care settings. Causes of infectious mononucleosis infectious mononucleosis is transmitted by exposure to saliva, so it can be spread by kissing, by sharing glasses or cutlery, and by droplets spread by coughing. Infectious mononucleosis new england journal of medicine. In addition to causing acute illness, longterm consequences are. People with infectious mononucleosis should avoid kissing others, regularly wash their hand and not share drink containers.
Classic physical findings include fever, splenomegaly, pharyngitis, and lymphadenopathy. Infection with epsteinbarr virus ebv is 1 putative cause of this syndrome. Infectious mononucleosis was first described by sprunt and evans in the bulletin of the johns hopkins hospital in 1920. The causative agent of infectious mononucleosis is epsteinbarr virus known as ebv or human herpes virus 4 hhv4. Adenopathy, fever, and pharyngitis are the common triad of symptoms of infectious mononucleosis. The most common manifestation of primary infection with this organism is acute infectious mononucleosis, a selflimited clinical syndrome that most frequently affects adolescents and young adults. Severe complications, including airway obstruction, splenic rupture, and neurologic syndromes, occasionally occur. It is most commonly caused by the epsteinbarr virus ebv. Infectious mononucleosis clinical practice, n engl j med 2010.
The hematologic aspects of the process were extensively studied during the first three decades of this century and were crystallized by the work of downey. Infectious mononucleosis is a highly contagious viral disease caused by the epsteinbarr virus ebv. Clinical signs and laboratory abnormalities associated with hemophagocytic lymphohistiocytosis % of patients clinical sign affected reference fever 60100. Barr virus ebv infection in adolescents and young adults often presents as acute infectious mononucleosis 1, 2. In 1979, hlh was described in a cohort of patients who had serologic evidence of recent table. Infectious mononucleosis of immunocompetent adults is commonly thought to be benign. Lab time course of antibody production ea is rising at symptom onset. Some data derived in the united kingdom suggest that infectious mononucleosis im cases may be occurring later in life with increasing severity, requiring hospitalization. Epsteinbarr virus infection and infectious mononucleosis. Infectious mononucleosis infectious diseases merck. Enlarged epitrochlear nodes are very suggestive of infectious mononucleosis. Both viruses are members of the herpes simplex virus family.
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