fbpx

Epstein-Barr Virus Infectious Mononucleosis

Updated : July 18, 2024





Background

Epstein-Barr Virus Infectious Mononucleosis (EBV) is called human herpes virus 4 is a common DNA herpesvirus that causes infectious mononucleosis. 

It is recognized as a clinical syndrome with fever and adenopathy. German physicians in 1889 termed Drusenfieber known as glandular fever. 

It is transmitted through saliva, thus referred to as the “kissing disease”. 

EBV infects oropharynx epithelial cells, spreads to B cells, induces their proliferation. Symptoms of mono caused due to immune response with cytotoxic T cells. 

Epidemiology

Globally this virus is extremely common. Approximately 90% of people worldwide are seropositive for EBV, with developed nations having lower rates. 

It is more seen in young adults and adolescents. Lower socioeconomic areas may have earlier onsets of primary infection. 

Direct contact with infected saliva is the area through which the infection is spread. In the US, 66.5% of children and adolescents aged between 6 to 19 years old have EBV, with females and minority groups shows higher rates. 

Anatomy

Pathophysiology

EBV targets and infects B lymphocytes. It infects epithelial cells. When the virus interacts with cell surface receptors then it enters B cells. 

T-cell dysfunction leads to uncontrolled B-cell growth. EBV infection triggers fever due to B-lymphocyte invasion. 

Lymphocytosis observed in the reticuloendothelial system (RES) is caused by a proliferation of EBV-infected B lymphocytes and similar proliferation in the lymphatic tissue of the oropharynx causes pharyngitis. 

Lymphocytosis in RES due to EBV-infected B cells causes pharyngitis from lymphatic tissue proliferation. 

Etiology

The causes for EBV as follows: 

Immune Status 

Genetic and Environmental Factors 

Genetic Susceptibility 

Environmental Factors 

Clinical Manifestations 

Fever 

Pharyngitis 

Genetics

Prognostic Factors

People with weakened immune systems and those with AIDS may have more severe and protracted infectious mononucleosis episodes. The degree of weariness, sore throat and fever experienced during the acute phase are among the symptoms. 

Even though they are infrequent may impact on its the outcome. Depending on how effectively their underlying health is maintained during infectious mononucleosis, individuals with pre-existing medical disorders may have a variable prognosis. 

Clinical History

Infectious mononucleosis affects young adults and adolescents.

Physical Examination

Oropharyngeal Examination  

Examination of lymph nodes 

Age group

Associated comorbidity

People with infectious mononucleosis are frequently suggested to not participate in contact sports or other activities that put their spleen at danger of injury. 

There are instances where hepatitis or liver inflammation has been developing. Alcohol and several drugs should be avoided throughout recovery. 

Other vulnerable groups include people who suffer from pre-existing illnesses such as immunodeficiency disorders which lowers their immune function to catastrophic levels or even with chronic illnesses leading to the worsening of their symptoms.

Chronic tiredness is increasingly persistent and most problematic symptom of infectious mononucleosis. The recovery course generally starts with the active phase of the illness, during which people may have to alter their level of physical activity and rest enough to improve. 

Associated activity

Acuity of presentation

The onset of symptoms is usually gradual in people those who first reporting as moderate symptoms. Usually malaise, and an overall feeling of being unwell are common symptoms. 

The flu-like symptoms appear as the illness develops.  

e.g., fever, sore throats, and enlarged lymph nodes.  

Differential Diagnoses

Cytomegalic Inclusion Disease 

Adenovirus Infection 

Streptococcal Pharyngitis 

Acute HIV Infection 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Monitor patients closely with enlarged tonsils for airway issues, use steroids as required. 

Treatment of immunocompromised patients with EBV lymphoproliferative disease is controversial. Acyclovir drug is not proven beneficial in treatment phase. 

EBV lymphoproliferative disease in immunocompromised patients is controversial while acyclovir is not effective. 

EBV mononucleosis patients with streptococcal colonization may develop rash. 

Positive group A streptococci throat cultures in EBV patients do not need treatment for colonization. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Use of non-pharmacological approach for Epstein-Barr Virus Infectious Mononucleosis

Patients should avoid sports activities and heavy lifting for a minimum of a month. Patients are advised to take rest and avoid any strenuous activities for specific period. 

Patients should follow good hygiene practices to avoid spreading the virus. 

Proper education and awareness about infectious mono should be provided and its related causes, and how to stop it with management strategies. 

Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort. 

Role of Corticosteroids

No antiviral therapy is available for Epstein-Barr virus (EBV) infectious mononucleosis in immunocompetent persons. 

Corticosteroids:  

The short courses of corticosteroids are indicated with hemolytic anemia and extreme tonsillar enlargement. It should be considered in those with airway obstruction. 

Use of Intervention with a procedure in treating Epstein-Barr Virus Infectious Mononucleosis

In cases of substantial splenomegaly, splenic rupture is an uncommon but potentially dangerous consequence for infectious mononucleosis.  

Surgical care may be required if there is a suspicion of splenic rupture. 

Use of phases in managing Epstein-Barr Virus Infectious Mononucleosis

In the diagnosis phase, evaluation of symptoms such as fever, sore throat, swollen lymph nodes, and fatigue to confirm diagnosis. 

Pharmacologic therapy is very effective in the treatment phase as it includes use of corticosteroids and surgical intervention. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation. 

The regular follow-up visits with the physician are schedule to check the improvement of patients along with treatment response. 

Medication

Media Gallary

Epstein-Barr Virus Infectious Mononucleosis

Updated : July 18, 2024




Epstein-Barr Virus Infectious Mononucleosis (EBV) is called human herpes virus 4 is a common DNA herpesvirus that causes infectious mononucleosis. 

It is recognized as a clinical syndrome with fever and adenopathy. German physicians in 1889 termed Drusenfieber known as glandular fever. 

It is transmitted through saliva, thus referred to as the “kissing disease”. 

EBV infects oropharynx epithelial cells, spreads to B cells, induces their proliferation. Symptoms of mono caused due to immune response with cytotoxic T cells. 

Globally this virus is extremely common. Approximately 90% of people worldwide are seropositive for EBV, with developed nations having lower rates. 

It is more seen in young adults and adolescents. Lower socioeconomic areas may have earlier onsets of primary infection. 

Direct contact with infected saliva is the area through which the infection is spread. In the US, 66.5% of children and adolescents aged between 6 to 19 years old have EBV, with females and minority groups shows higher rates. 

EBV targets and infects B lymphocytes. It infects epithelial cells. When the virus interacts with cell surface receptors then it enters B cells. 

T-cell dysfunction leads to uncontrolled B-cell growth. EBV infection triggers fever due to B-lymphocyte invasion. 

Lymphocytosis observed in the reticuloendothelial system (RES) is caused by a proliferation of EBV-infected B lymphocytes and similar proliferation in the lymphatic tissue of the oropharynx causes pharyngitis. 

Lymphocytosis in RES due to EBV-infected B cells causes pharyngitis from lymphatic tissue proliferation. 

The causes for EBV as follows: 

Immune Status 

Genetic and Environmental Factors 

Genetic Susceptibility 

Environmental Factors 

Clinical Manifestations 

Fever 

Pharyngitis 

People with weakened immune systems and those with AIDS may have more severe and protracted infectious mononucleosis episodes. The degree of weariness, sore throat and fever experienced during the acute phase are among the symptoms. 

Even though they are infrequent may impact on its the outcome. Depending on how effectively their underlying health is maintained during infectious mononucleosis, individuals with pre-existing medical disorders may have a variable prognosis. 

Infectious mononucleosis affects young adults and adolescents.

Oropharyngeal Examination  

Examination of lymph nodes 

People with infectious mononucleosis are frequently suggested to not participate in contact sports or other activities that put their spleen at danger of injury. 

There are instances where hepatitis or liver inflammation has been developing. Alcohol and several drugs should be avoided throughout recovery. 

Other vulnerable groups include people who suffer from pre-existing illnesses such as immunodeficiency disorders which lowers their immune function to catastrophic levels or even with chronic illnesses leading to the worsening of their symptoms.

Chronic tiredness is increasingly persistent and most problematic symptom of infectious mononucleosis. The recovery course generally starts with the active phase of the illness, during which people may have to alter their level of physical activity and rest enough to improve. 

The onset of symptoms is usually gradual in people those who first reporting as moderate symptoms. Usually malaise, and an overall feeling of being unwell are common symptoms. 

The flu-like symptoms appear as the illness develops.  

e.g., fever, sore throats, and enlarged lymph nodes.  

Cytomegalic Inclusion Disease 

Adenovirus Infection 

Streptococcal Pharyngitis 

Acute HIV Infection 

Monitor patients closely with enlarged tonsils for airway issues, use steroids as required. 

Treatment of immunocompromised patients with EBV lymphoproliferative disease is controversial. Acyclovir drug is not proven beneficial in treatment phase. 

EBV lymphoproliferative disease in immunocompromised patients is controversial while acyclovir is not effective. 

EBV mononucleosis patients with streptococcal colonization may develop rash. 

Positive group A streptococci throat cultures in EBV patients do not need treatment for colonization. 

Patients should avoid sports activities and heavy lifting for a minimum of a month. Patients are advised to take rest and avoid any strenuous activities for specific period. 

Patients should follow good hygiene practices to avoid spreading the virus. 

Proper education and awareness about infectious mono should be provided and its related causes, and how to stop it with management strategies. 

Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort. 

No antiviral therapy is available for Epstein-Barr virus (EBV) infectious mononucleosis in immunocompetent persons. 

Corticosteroids:  

The short courses of corticosteroids are indicated with hemolytic anemia and extreme tonsillar enlargement. It should be considered in those with airway obstruction. 

In cases of substantial splenomegaly, splenic rupture is an uncommon but potentially dangerous consequence for infectious mononucleosis.  

Surgical care may be required if there is a suspicion of splenic rupture. 

In the diagnosis phase, evaluation of symptoms such as fever, sore throat, swollen lymph nodes, and fatigue to confirm diagnosis. 

Pharmacologic therapy is very effective in the treatment phase as it includes use of corticosteroids and surgical intervention. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation. 

The regular follow-up visits with the physician are schedule to check the improvement of patients along with treatment response. 

Free CME credits

Both our subscription plans include Free CME/CPD AMA PRA Category 1 credits.

Digital Certificate PDF

On course completion, you will receive a full-sized presentation quality digital certificate.

medtigo Simulation

A dynamic medical simulation platform designed to train healthcare professionals and students to effectively run code situations through an immersive hands-on experience in a live, interactive 3D environment.

medtigo Points

medtigo points is our unique point redemption system created to award users for interacting on our site. These points can be redeemed for special discounts on the medtigo marketplace as well as towards the membership cost itself.
 
  • Registration with medtigo = 10 points
  • 1 visit to medtigo’s website = 1 point
  • Interacting with medtigo posts (through comments/clinical cases etc.) = 5 points
  • Attempting a game = 1 point
  • Community Forum post/reply = 5 points

    *Redemption of points can occur only through the medtigo marketplace, courses, or simulation system. Money will not be credited to your bank account. 10 points = $1.

All Your Certificates in One Place

When you have your licenses, certificates and CMEs in one place, it's easier to track your career growth. You can easily share these with hospitals as well, using your medtigo app.

Our Certificate Courses

Up arrow