Infectious Mononucleosis (Glandular Fever)
Infectious mononucleosis is usually primary Epstein–Barr virus infection causing fever, exudative pharyngitis, lymphadenopathy and marked fatigue; the high-yield safety issues are avoiding unnecessary aminopenicillins, protecting an enlarged spleen and recognising airway, abdominal, hepatic, neurological and haematological complications.
Definition
Infectious mononucleosis is a clinical syndrome most often caused by primary Epstein–Barr virus infection, characterised by fever, pharyngitis, lymphadenopathy and fatigue, with reactive lymphocytosis and possible splenic or hepatic enlargement. Cytomegalovirus, acute HIV and other infections can produce a similar mononucleosis-like illness.
First principles
The syndrome is an immune response to EBV
Epstein–Barr virus infects B lymphocytes and the host mounts a vigorous cytotoxic T-cell response. Reactive lymphocytes produce the atypical cells on the blood film, while lymphoid expansion produces tonsillar enlargement, generalised lymphadenopathy and splenomegaly. The virus then persists latently, so the acute illness is usually self-limiting but fatigue may outlast the throat symptoms.
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