|Herpes Varicella-Zoster (Shingles) Infection
|Chickenpox Varicella Infection
|Varicella Cerebral Vasculopathy
|Herpes Zoster Ophthalmicus (HZO) Shingles
|Rubella (German Measles)
|Epstein-Barr Virus infection
| Cytomegalovirus (CMV) infections
| CMV retinitis infections
90% of those with Infectious Mononucleosis develop a rash if given ampicillin or amoxicillin
- One of the causes of Glandular fever/Infectious Mononucleosis
- Infection is common and 90% of adults show evidence of infection.
- Similar clinical picture with CMV and toxoplasmosis
- Check for these as well as EBV especially in pregnancy / immunocompromised
- EBV is a gamma herpes virus
- Infection usually in young but may be delayed to adolescence even adulthood
- 50% of infections are clinical
- Saliva Aerosol/droplet spread - kissing classically
- Low contagion risk and isolation not required
Clinical: often subclinical
- Flu like illness, Headache, Malaise, Fever
- Large tonsils and pharyngitis and sore throat
- Generalised tender inguinal/axillarycervical lymphadenopathy
- Jaundice with abnormal LFT's due to a mild hepatitis
- Splenomegaly (liable to rupture)
- Erythema multiforme, petechial rashes, periorbital oedema
- Encephalitis is rarely seen. Clinical severity increases with age
- In pregnancy if heterophile antibodies are negative then check for CMV serology.
- It is important to recognise that CMV can produce an identical clinical picture.
- Active CMV infection during pregnancy can cause fetal abnormalities.
- Toxoplasma gondii can cause a similar clinical picture
Causes of Infectious Mononucleosis type picture
- Epstein Barr Virus infection, Cytomegalovirus infection
- Human Herpes Virus 6 infection, HIV-1 infection, Toxoplasmosis
Long term Complications
- Nasopharyngeal cancer, Burkitt's lymphoma
- Post transplant lymphoma, HIV related immunoblastic lymphomas
- Chronic fatigue syndrome
- Duncan's syndrome (X linked lymphoproliferative syndrome) due to SAP gene mutation
- Streptococcal sore throat (liver and spleen and inguinal/axillary nodes usually normal)
- Cytomegalovirus infection
- Toxoplasmosis infection
- Viral hepatitis
- HIV seroconversion
- FBC: mononuclear lymphocytosis with atypical lymphocytes, low platelets, neutropenia
- LFT: raised ALT and even a raised Bilirubin
- Atypical (CD8 +ve) T lymphocytes are common and can cause some worry about ALL
- Positive mono spot (Horse red blood cells) or Paul-Bunnell (Sheep RBCS) due to heterophile antibodies which agglutinate red blood cells in the second week of the illness. May be initially negative and so can be repeated.
- Serology: Anti IgM EBV early antigen (EA) titre and negative IgG EBV will confirm acute infectious mononucleosis
- Viral PCR in peripheral blood
Causes of Atypical lymphocytosis
- Epstein Barr Virus, Acute retroviral syndrome with HIV
- Viral hepatitis, Mumps, Rubella
- Supportive, fatigue is common and can be debilitating. Full recovery can take 6 weeks. There is no role for antivirals against EBV.
- Aspirin can help reduce fever and sore throat. Tonsils may be very swollen and even cause airway problems which may need help
- Patients should be advised against contact sports until splenic enlargement has resolved as there is a risk of splenic rupture.
- Avoid Amoxil and Ampicillin as they cause a widespread macular papular rash. If seen is a useful diagnostic test but really best avoided.
- A beta-haemolytic streptococcal pharyngitis superinfection should be treated with IV Benzylpenicillin or Erythromycin
- Prednisolone 30-60 mg od for 5 days can lessen the severity of the severe pharyngeal oedema and symptoms, may be used in meningitis/encephalitis or if thrombocytopenia or haemolysis are present