Infectious mononucleosis
Infectious mononucleosis (glandular fever) is caused by the Epstein-Barr virus (also known as human herpesvirus 4, HHV-4). It is most common in adolescents and young adults.
Features
Diagnosis
Management is supportive and includes:
Features
- sore throat
- lymphadenopathy
- pyrexia
- malaise, anorexia, headache
- palatal petechiae
- splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
- hepatitis
- presence of 50% lymphocytes with at least 10% atypical lymphocytes
- haemolytic anaemia secondary to cold agglutins (IgM)
- a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis
Diagnosis
- heterophil antibody test (Monospot test) - NICE guidelines suggest FBC and Monospot in the second week of the illness to confirm a diagnosis of glandular fever.
Management is supportive and includes:
- rest during the early stages, drink plenty of fluid, avoid alcohol
- simple analgesia for any aches or pains
- consensus guidance in the UK is to avoid playing contact sports for 8 weeks after having glandular fever to reduce the risk of splenic rupture