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INFECTIOUS MONONUCLEOSIS (epstein-barr virus) Professor: Ma lian Typical features Prolong fever Exudative pharyngitis Generalized adenopathy Hepatosplenomegaly Atypical lymphocytes Heterophil antibodies General considerations Infectious mononucleosis (mono) is a common acute infectious disease usually found in individuals between the ages of 5 and 30. Pathogeny Epstein-Barr virus (90%) CMV, HIV, HHV-6, toxoplasma gondii, Hepatitis virus etc (5-10%). EBV Occur worldwide Transmitted by saliva and blood transfusion Related with the following diseases Mono Burkitt lymphoma Nasopharyngeal cancer Clinical findings Symptoms and signs Prolong fever(>39℃) Soft palate petechiae and Exudative pharyngitis Generalized adenopathy Splenomegaly and hepatomegaly Rash (macular,scarlatiniform or urticarial) eye edema X-linked lymphoproliferative syndrome (XLP): occur in the children with primary immunodeficiency disease Sore throat Soft palate petechiae Exudative pharyngitis Generalized adenopathy usually in the neck, armpit, and throat Rash Clinical findings Laboratory findings Peripheral blood Atypical lymphocytes Leukopenia Heterophil antibodies Anti-EBV antibodies aminotransferase No clumping of the red bloods cells indicates the person's serum does not contains heterophile antibodies. The few clumps that are seen are red blood cells from the test reagent that did not separate during shaking of the reagent prior to placing it on the slide. Clumping of the red bloods cells indicates the person's serum contains heterophile antibodies. Differantial diagnosis Group A streptococcal infection Rubella Adenovirus Hepatitis A or B Toxoplasmosis Drug reaction Leukemia CMV mononucleosis HIV infection Complication Cardiorespiratory Hematologic Interstitial pneumonitis Myocarditis Pericarditis Pleuritis Autoimmune hemolytic anemia Immune granulocytopenia or thrombocytopenia Pancytopenia Complication Hepatic Cholestatic jaundice (severe hepatitis) Massive hepatic necrosis and failure Neurologic Cranial nerve palsies Guillain-Barré syndrome Meningoencephalitis Transverse myelitis Others Infectious mononucleosis hepatitis Marked mononuclear cell infiltration of the sinusoids without significant necrosis. H&E stain. Infectious mononucleosis heapatitis High power of previous illustration showing the signs of high regenerative activity: binucleate cells and a mitotic figure. H&E stain. Treatment No specific therapy exists for IM, but general support helps rest and fluids acetaminophen or aspirin for fever and aches; lozenges, salt-water gargles, viscous lidocaine hydrochloride for sore throat. Treament Acyclovir, ganciclovir, and foscarnet IVIG α-interferon Antibiotics and corticosteroids are indicated only for complications. Patients with splenomegaly should advoid sport for 6-8 weeks.