infectious mononucleosis

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Infectious mononucleosis (also known as glandular fever) is the term for infection with Epstein-Barr virus (EBV). The infection classically occurs in teenagers and young adults, hence its other name kissing disease. It is usually a clinical diagnosis, with confirmation by serum testing, but may have suggestive findings on imaging.

Epidemiology

Exposure to Epstein-Barr virus, but often a subclinical infection, especially in children. Young adults (15-24) are more likely to be symptomatic.

Clinical presentation

Complications

Pathology

It was originally called "mononucleosis" after abnormal mononuclear cells were found in patients with the clinical syndrome.

Epstein-Barr virus is in the herpesvirus class. It is thought to be spread primarily through a person-to-person route through salivary secretions. The Epstein-Barr virus infects B-cells in the lymphoid tissue. Like other herpes viruses, it becomes a lifelong chronic infection with periodic shedding of virus.

Elevated transaminases are occasionally seen.

Radiographic features

Diagnosis is usually through serum lab work which shows lymphocytosis and a positive heterophile antibody test. Imaging is usually not necessary, but certain findings on imaging can be suggestive:

CT
  • splenomegaly
    • possible splenic rupture
    • splenic infarction has been reported
  • generalized lymphadenopathy, including cervical lymphadenopathy
  • tonsillar enlargement
  • possible hepatomegaly

Treatment and prognosis

Symptomatic therapy is usually sufficient. Athletes are encouraged to discontinue sports during the acute phase (<3-4 weeks) to lower the risk of splenic rupture .

Complications

Differential diagnosis

Imaging differential diagnoses include:

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