A Family Doctor's Tale - INFECTIOUS MONONUCLEOSIS

DOC I HAVE INFECTIOUS MONONUCLEOSIS

Infectious mononucleosis is a rare disease which affects the lymph nodes of the neck and jaws.

It is also called glandular fever in the past.

The Epsein Barr virus is the main culprit of this disease.

There may be complications such as breathing problems or heart disease.

In rare cases there may be association with nasopharyngeal cancer.

Treatment is usually symptomatic unless there are heart or lung complications .


Infectious Mononucleosis is an infectious disease which typically cause swelling of the lymph nodes of neck, sore throat and fever.

The cause of Infectious Mononucleosis is the Epstein Barr virus which can be spread by droplets and kissing.

It is more common in young adults.


The incubation period (from contact to illness) is 10-15 days.


It is usually sporadic but may be epidemic.

The triad of symptoms which are common to Infectious Mononucleosis are:

1.Neck and axillary lymph nodes are enlarged

2.Fever with headache

3.sore throat with sometimes extensive tonsillar exudates and swelling

Other symptoms are:

4.fatigue

5.bodyaches

6.jaundice(rare)

Signs:

1.Throat is red and inflamed with enlarged tonsils

2.Pinpoint petechiae at junction of hard and soft palate

3.Enlarged lymph nodes are felt below the jaw and neck region; sometimes in the axillary region

4.Swelling of lacrimal glands and eyelids

5.Spleen is enlarged in 50% of cases

6.Generalised maculopapular rash may occur

Onset is usually insidious with mild fever which may becomes worse and lasts for 2 to 21 days.

Disease usually lasts for 2-3 weeks.

Diagnosis
1.Classical symptoms and signs as above especially lymph nodes enlargement.

2.blood tests (complete blood count, ESR, liver function tests and blood culture).


Blood count usually shows more than 10% atypical mononuclear cells.

3.Blood for Epstein Barr antibody

4.X-rays of chest and abdomen

5.CT Scan or ultrasound of the abdomen to detect presence of other lymph nodes and enlarged spleen.

Complications of Infectious Mononucleosis are:


1.Obstruction to airway from enlarged lymph nodes

2.thrombopenic purpura

3.myocarditis

4.pericarditis

5.lymphocytic meningitis

6.encephalitis

7.polyneuritis

8.hepatitis

Treatment routine of Infectious Mononucleosis is:


1.Bed rest in isolation ward

2.Adequate fluids

3.Antipyretic medicines such as paracetamol for fever

3.corticosteroids is useful to reduce complications such as upper airway obstruction and severe hepatitis

4.High-flow oxygen and tracheostomy in airway obstruction

5.Isolation of cases at home or in hospital. Avoid contacts.

Prognosis of Infectious Mononucleosis is generally good.

Epstein Barr infections has been associated with nasopharyngeal cancer.