Mononucleosis
Basics
Description
Description
- Results in most cases from infection with the Epstein–Barr virus (EBV) (a herpesvirus):
- Non-EBV causes of infectious mononucleosis (IM):
- Cytomegalovirus (CMV)
- Adenovirus
- Hepatitis A
- Herpesvirus 6
- HIV
- Rubella
- Toxoplasma gondii
- Group A β-hemolytic streptococci
- Non-EBV causes of infectious mononucleosis (IM):
- >90% of adults on serologic testing demonstrate prior infection with EBV:
- Most do not recollect specific IM symptoms
- Mode of transmission is close or intimate contact particularly with saliva from “shedders” who may or may not be symptomatic:
- Nickname “kissing disease”
- Viral shedding in saliva can persist intermittently for life
- May occur after transfusions/transplants
- Incubation period: 4–6 wk
- Immunologic response:
- T-cells response:
- T-cell response is responsible for an elevated absolute lymphocyte count and the associated clinical symptoms and complications
- Subtype of the T-cell lineage, cytotoxic CD8 cells (Downey cells), contain eccentrically placed and lobulated nuclei with vacuolated cytoplasm: The “atypical lymphocytes” seen on differential
- B-cell response:
- EBV infects and replicates in B-cells
- B-cells are then transformed into plasmacytoid cells that secrete immunoglobulins
- IgM antibody secreted: The heterophile antibody which is reactive against red cell antigens
- T-cells response:
- Mortality from IM is rare, but may occur due to the following complications:
- Airway edema
- Neurologic complications
- Secondary bacterial infection
- Splenic rupture
- Hepatic failure
- Myocarditis
- EBV infection has also been strongly linked to African Burkitt lymphoma and nasopharyngeal carcinoma
Pediatric Considerations
- In children <4 yr, infection with EBV is often asymptomatic
- In children who do become symptomatic, there is propensity toward atypical presentations:
- Neutropenia, pneumonia, and varied rashes
- Mesenteric lymphadenopathy and splenomegaly can cause the illness to present with abdominal pain and be confused with appendicitis
- Infants and toddlers can present with only irritability and failure to thrive so must be considered when no other source can be identified
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Citation
Schaider, Jeffrey J., et al., editors. "Mononucleosis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307015/all/Mononucleosis.
Mononucleosis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307015/all/Mononucleosis. Accessed November 14, 2024.
Mononucleosis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307015/all/Mononucleosis
Mononucleosis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 14]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307015/all/Mononucleosis.
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