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. Ebvspecific antibody profiles are the best choice for staging ebv infection. Deep jaundice in infectious mononucleosis jama jama. Over 50% of college studentshave antibodies to the eb virus, implying prior infection. 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. Infectious mononucleosis mono in teens and young adults. The title for figure 1 page 1996 should have ended with wrightgiemsa rather than hematoxylin and eosin. Both viruses are members of the herpes simplex virus family. Learn infectious mononucleosis pediatric infectious disease for medicine faster and easier with picmonics unforgettable images and stories. Infectious mononucleosis pediatric infectious disease.
The disease is spread through saliva and can cause fever, sore throat, and swollen lymph nodes. Modern diagnosis of epsteinbarr virus infections and post. Infectious mononucleosis is a fairly common disease of adolescents and young adults. Infectious mononucleosis is a disease primarily of adolescence and early adulthood. Knowledge of the clinical course of the disease, as well as potential. The presenting symptoms of acute im can range from the obvious, such as persistent exu. Mononucleosis caused by epsteinbarr virus and cytomegalovirus in children. They described the clinical characteristics of epsteinbarr virus ebv infectious mononucleosis. 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.
Dec 21, 2000 infection with epsteinbarr virus ebv is 1 putative cause of this syndrome. Sep 20, 2018 infectious mononucleosis was first described by sprunt and evans in the bulletin of the johns hopkins hospital in 1920. Infectious mononucleosis does not present as monocytosis an increase in the number of monocytes. It is usually passed to susceptible people through intimate contact with infected saliva.
Infectious mononucleosis, or mono, is an infection usually caused by the epsteinbarr virus. Classic physical findings include fever, splenomegaly, pharyngitis, and lymphadenopathy. Clinical signs and laboratory abnormalities associated with hemophagocytic lymphohistiocytosis % of patients clinical sign affected reference fever 60100. 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. Infectious mononucleosis mono is an epsteinbarr virus ebv infection of the lymphatic system. Picmonic is research proven to increase your memory retention and test scores.
Symptoms in children are milder than they are expressed in adults. Barr virus ebv infection in adolescents and young adults often presents as acute infectious mononucleosis 1, 2. Nejm journal watch is produced by nejm group, a division of the. Clinical note from the new england journal of medicine infectious mononucleosis complicated by bilateral papilloretinal edema. On examination, he was mildly pyrexial with posterior cervical lymphadenopathy, palatal petechiae and pharyngeal inflammation without an exudate. In addition to causing acute illness, longterm consequences are. A 20yearold carpet fitter presented with a 1week history of a sore throat, stiffness and tenderness of his neck, and extreme malaise. Review article medical progress columbia university. It is therefore important to dispel the many myths relating to the condition with appropriate patient education. The most targeted age range is the adolescent years.
Epsteinbarr virus ebv infectious mononucleosis mono. Infectious mononucleosis adolescent medicine jama jama. The new england journal of medicine 1994 n engl j med 362. 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 and mononucleosis syndromes. Physicians are not well aware of its complications.
Vcaigm usually is measurable at symptom onset, peaks at 23 weeks, then declines and not measurable by 34 months. 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. It is most commonly caused by the epsteinbarr virus ebv. This journal feature begins with a case vignette highlighting a common clinical problem. Infectious mononucleosis etiology bmj best practice. 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. Infectious mononucleosis new england journal of medicine. In 1979, hlh was described in a cohort of patients who had serologic evidence of recent table.
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. Mononucleosis syndrome, caused by ebv in up to 90% cases, typically presents with fever, pharyngitis. Some data derived in the united kingdom suggest that infectious mononucleosis im cases may be occurring later in life with increasing severity, requiring hospitalization. Infectious mononucleosis mono is an infection that causes sore throat, fever, swollen glands, and tiredness or fatigue. Severe infectious mononucleosis in immunocompetent adults. 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. Rossiintroduction infectious mononucleosis mono, often called the kissing disease, is a virus that is transmitted through primarily saliva. The causative agent of infectious mononucleosis is epsteinbarr virus known as ebv or human herpes virus 4 hhv4.
The second most common cause is probably cmv infection. In short, epstein barrassociated infectious mononucleosis is only one variant of the universe of similar infections. 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. Deep jaundice in infectious mononucleosis is generally considered rare. We now know that the characteristic atypical lymphocytes, carefully described. Infectious mononucleosis, or glandular fever, was first described in 1889 by pfeiffer. Epstein barr virus adolescents and adults any infectious mononucleosis 80%. It is mostly common among the teenagers and young people. Infectious mononucleosis im is an acute selflimiting disease caused by primary epsteinbarr virus ebv infection. Acute mononucleosis and chronic fatigue nejm journal watch.
Patients usually present with a sore throat and often presume that an antibiotic is required. Our study helped confirm that age above 30 years was associated with the onset of severe im, as demonstrated in previous works. 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 clinical practice, n engl j med 2010. Streptococcal pharyngeal infection not only causes acute illness but also can trig ger the postinfectious. The virus spreads through saliva, which is why its sometimes called kissing disease.
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. Infectious mononucleosis im is characterized by a triad of fever, tonsillar pharyngitis, and lymphadenopathy. Adenopathy, fever, and pharyngitis are the common triad of symptoms of infectious mononucleosis. Epsteinbarr virus, frequently referred to as ebv, is a member of the herpesvirus family and one of the most common human viruses. Infectious mononucleosis msd manual professional edition. Acute mononucleosis and chronic fatigue journal watch. Infectious mononucleosis in university students in the. Cases of infectious mononucleosis in young children have been reported, although ebv infection in this age group is usually subclinical.
When infection with ebv occurs during adolescence or young adulthood, it causes infectious mononucleosis 35% to 50% of the time. Epsteinbarr virus infection and infectious mononucleosis. Common questions about infectious mononucleosis jason womack, md, and marissa jimenez, do, rutgers university, robert wood johnson medical school, new. Epstein barr virus ebv, also known as human herpes virus 4, is the etiologic agent in approximately 80% to 90% of im cases. Infectious mononucleosis is a highly contagious viral disease caused by the epsteinbarr virus ebv.
To determine how often persistent fatigue follows infectious. Downloaded from by ayman bakkar on january 12, 2011. Monocytosis has sometimes been called mononucleosis, but that name is usually reserved specifically for infectious mononucleosis. The risk of splenic injury and chronic fatigue make returntoplay decisions a challenge for the clinician. It is also known as mononucleosis, mono, glandular fever, or the kissing disease. Epsteinbarr virus and infectious mononucleosis nejm. In young adults, the disease often results in fever, sore throat, enlarged lymph nodes in the neck, and tiredness.
Infectious mononucleosis im is a common childhoodadolescent illness. The cell type increased in infectious mononucleosis is the lymphocyte population, as infectious mononucleosis is a. Most people are infected by the virus as children, when the disease produces few or no symptoms. Lab time course of antibody production ea is rising at symptom onset. Mar 01, 2010 infectious mononucleosis im is an acute selflimiting disease caused by primary epsteinbarr virus ebv infection. Infectious mononucleosis was first described by sprunt and evans in the bulletin of the johns hopkins hospital in 1920. Infectious mononucleosis is a acute infectious disease, caused by epsteinbarr virus evb that belongs to the herpesviridae. Both adults and children can be infected by the epsteinbarr virus and show similar symptoms.
Infectious mononucleosis mostly affects teenagers and young adults. 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. Pediatric mononucleosis and epsteinbarr virus infection. A 16yearold, previously healthy girl presents with a severalday history of fever, sore throat, and malaise. Mar 12, 2020 infectious mononucleosis, or mono, is an infection usually caused by the epsteinbarr virus. Acute infectious mononucleosis im is a common illness that presents to urgent care facilities. Infectious mononucleosis in university students in the united. 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.
I nfectious mononucleosis is a clinical syndrome caused by epsteinbarr virus ebv that is particularly common in adolescents and children. Infectious mononucleosis im and cytomegalovirus cmv mononucleosis are caused by a primary infection with related viruses, epsteinbarr virus ebv and cmv. Enlarged epitrochlear nodes are very suggestive of infectious mononucleosis. Illness usually lasts between one week and several weeks. Infectious mononucleosis is caused by epsteinbarr virus ebv, human herpesvirus type 4 and is characterized by fatigue, fever, pharyngitis, and lymphadenopathy. Pathophysiology and clinical presentation correct diagnosis. Cytomegalovirus infection cmv and human immunodeficiency. Recently, we observed a case of infectious mononucleosis with one of its more unusual complications, total peripheral agranulocytosis.
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. The systemic nature of infectious mononucleosis has been recognized for many years. Infectious mononucleosis an overview sciencedirect topics. Epsteinbarr virus ebv, or human herpesvirus 4, is a gammaherpesvirus that infects more than 95% of the worlds population. People with infectious mononucleosis should avoid kissing others, regularly wash their hand and not share drink containers. Nevertheless, the presence of fever, pharyngitis, and jaundice in a young person should stimulate the. Defining factors associated with severity could be useful in primary care settings. Infectious mononucleosis im, mono, also known as glandular fever, is an infection usually caused by the epsteinbarr virus ebv. Dec 05, 2018 epsteinbarr virus ebv, or human herpesvirus 4, is a gammaherpesvirus that infects more than 95% of the worlds population. Ebv is in the herpes virus family, and is also known as human herpes virus type 4. Infection with epsteinbarr virus ebv is 1 putative cause of this syndrome. Common questions about infectious mononucleosis jason womack, md, and marissa jimenez, do, rutgers university, robert wood johnson medical school, new brunswick, new jersey. Severe complications, including airway obstruction, splenic rupture, and neurologic syndromes, occasionally occur.
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