Infectious Mononucleosis Overview

Diagnosis and Tests

• Diagnosis of infectious mononucleosis (mono) relies on clinical presentation.
• Monospot blood test is a common, rapid diagnostic test for EBV infection.
• Complete blood count (CBC) may show increased bands, neutrophils, lymphocytes, reactive lymphocytes, and thrombocytopenia.

Treatment

• Treatment focuses on managing symptoms.
• Analgesics help alleviate fever and muscle pain (myalgias).
• Short-term oral glucocorticoids might be used for severely enlarged tonsils or airway obstruction risk.
• Antivirals are typically unnecessary, as symptoms stem from the immune response, not viral replication; however, they may be considered in cases of chronic EBV.
• Contact sports should be avoided due to splenic rupture risk until splenomegaly resolves (a few weeks).
• Fatigue can last up to two months, potentially extending to six months.

Complications

• Splenic rupture is a potential complication.
• EBV infection increases the risk of B-cell lymphoma (Burkitt lymphoma, classical Hodgkin lymphoma), and gastric and nasopharyngeal cancers.
• Hemolytic anemia, thrombocytopenia, meningitis, myelitis, Guillain-Barré syndrome, and reactivation in immunosuppressed states are possible complications of EBV and cytomegalovirus (CMV) co-infection.

Cytomegalovirus (CMV) Infection

• Prior CMV infection leads to latent virus in the body.
• Latent CMV resides in all solid organs and can reactivate after transplantation with immunosuppressive therapy.

Diagnosis and Tests

• Diagnosis of infectious mononucleosis (mono) is based on clinical presentation.
• Monospot blood test is a common, rapid diagnostic test.
• Complete blood count (CBC) may show increased bands, neutrophils, lymphocytes, reactive lymphocytes, and thrombocytopenia.

Treatment

• Treatment focuses on managing symptoms.
• Analgesics are used for fever and muscle pain.
• Short-term oral glucocorticoids may be helpful for severely enlarged tonsils or airway obstruction.
• Antiviral medications are typically not necessary, as symptoms stem from the immune response rather than viral replication. Exceptions may include chronic EBV infection.

Activity and Recovery

• Contact sports should be avoided due to splenic rupture risk.
• Resume contact sports only after splenomegaly resolves (usually within a few weeks).
• Fatigue may persist for up to 2 months, possibly up to 6 months.

Complications

• Splenic rupture is a potential complication.
• EBV infection increases the risk of B-cell lymphomas (Burkitt lymphoma, Hodgkin lymphoma), and gastric and nasopharyngeal cancers.
• Hemolytic anemia, thrombocytopenia, meningitis, myelitis, Guillain-Barré syndrome, and reactivation with immunosuppression are possible complications of EBV and CMV infections.

Cytomegalovirus (CMV) Infection

• Prior CMV infection results in latent viral presence in the body, affecting all solid organs.
• Reactivation can occur following transplantation and immunosuppressive therapy.

Diagnosis and Confirmation of EBV Infection

• Diagnosis relies on clinical presentation.
• Monospot blood test is a common, rapid diagnostic tool.
• Complete blood count (CBC) may show increased bands, neutrophils, lymphocytes, reactive lymphocytes, and thrombocytopenia.

Treatment and Symptom Management

• Treatment focuses on managing symptoms.
• Analgesics can alleviate fever and muscle pain (myalgias).
• Short-term oral glucocorticoids might be helpful for severely enlarged tonsils or airway obstruction.
• Antivirals are typically unnecessary, as symptoms stem from the immune response, not viral replication; however, they may be considered in cases like chronic EBV.

Post-Infectious Considerations and Activity Restrictions

• Contact sports should be avoided to prevent splenic rupture until splenomegaly resolves (usually within a few weeks).
• Fatigue can last up to two months, potentially extending to six months.

Complications and Associated Risks

• Splenic rupture is a potential complication.
• EBV infection increases the risk of B-cell lymphoma (Burkitt lymphoma, classical Hodgkin lymphoma), and gastric and nasopharyngeal cancers.
• Hemolytic anemia, thrombocytopenia, meningitis, myelitis, Guillain-Barré syndrome, and reactivation in immunosuppressed states are potential complications of EBV and CMV co-infection.

Cytomegalovirus (CMV) Infection

• Prior CMV infection leads to latent viral presence in various organs.
• Reactivation can occur with transplantation and subsequent immunosuppressive therapy.

This quiz covers the diagnosis, treatment, and complications associated with infectious mononucleosis, commonly known as mono. It highlights key diagnostic tests like the Monospot and discusses treatment strategies, including the use of analgesics and glucocorticoids. Furthermore, it addresses potential complications such as splenic rupture and the link to B-cell lymphoma.