infectious mononucleosis (epstein-barr virus) professor: ma lian
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INFECTIOUS INFECTIOUS MONONUCLEOSIMONONUCLEOSISS((epstein-barr epstein-barr virus)virus)
Professor: Ma lianProfessor: Ma lian
Typical featuresTypical features Prolong feverProlong fever Exudative Exudative
pharyngitispharyngitis Generalized Generalized
adenopathyadenopathy HepatosplenomegalHepatosplenomegal
yy Atypical Atypical
lymphocyteslymphocytes Heterophil Heterophil
antibodiesantibodies
General considerationsGeneral considerations
Infectious mononucleosis (mono) is a Infectious mononucleosis (mono) is a common acute infectious disease common acute infectious disease usually found in individuals between the usually found in individuals between the ages of 5 and 30. ages of 5 and 30.
PathogenyPathogeny Epstein-Barr virusEpstein-Barr virus (90%) (90%) CMV, HIV, HHV-6, toxoplasma gondiiCMV, HIV, HHV-6, toxoplasma gondii, ,
Hepatitis virusHepatitis virus etc (5-10%). etc (5-10%).
EBVEBV
Occur worldwideOccur worldwide Transmitted by Transmitted by
saliva and blood saliva and blood transfusiontransfusion
Related with the Related with the following diseasesfollowing diseases MonoMono Burkitt lymphomaBurkitt lymphoma Nasopharyngeal Nasopharyngeal
cancercancer
Clinical findingsClinical findings
Symptoms and signsSymptoms and signs Prolong fever(>39℃)Prolong fever(>39℃) Soft palate Soft palate petechiaepetechiae and and ExudativeExudative
pharyngitispharyngitis Generalized Generalized adenopathyadenopathy Splenomegaly and hepatomegalySplenomegaly and hepatomegaly RashRash (macular,scarlatiniform or urticarial) (macular,scarlatiniform or urticarial) eye edemaeye edema X-linked lymphoproliferative syndrome (XLP): X-linked lymphoproliferative syndrome (XLP):
occur in the children with primary occur in the children with primary immunodeficiency diseaseimmunodeficiency disease
Sore throatSore throat
Exudative pharyngitisExudative pharyngitisSoft palate petechiaeSoft palate petechiae
Generalized Generalized adenopathyadenopathy
usually in the neck, armpit, and throatusually in the neck, armpit, and throat
Rash Rash
Clinical findingsClinical findings
Laboratory findingsLaboratory findings Peripheral blood Peripheral blood
Atypical lymphocytes Atypical lymphocytes LeukopeniaLeukopenia
HeterophilHeterophil antibodies antibodies Anti-EBV antibodiesAnti-EBV antibodies aminotransferaseaminotransferase
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 diagnosisDifferantial diagnosis
Group A streptococcal infectionGroup A streptococcal infection RubellaRubella AdenovirusAdenovirus Hepatitis A or BHepatitis A or B ToxoplasmosisToxoplasmosis Drug reactionDrug reaction LeukemiaLeukemia CMV CMV mononucleosis mononucleosis HIV infectionHIV infection
ComplicationComplication CardiorespiratoryCardiorespiratory
Interstitial pneumonitisInterstitial pneumonitisMyocarditisMyocarditisPericarditisPericarditisPleuritisPleuritis
HematologicHematologicAutoimmune hemolytic anemiaAutoimmune hemolytic anemiaImmune granulocytopenia or thrombocytopeniaImmune granulocytopenia or thrombocytopeniaPancytopeniaPancytopenia
ComplicationComplication
HepaticHepaticCholestatic jaundice (severe hepatitis)Cholestatic jaundice (severe hepatitis)Massive hepatic necrosis and failureMassive hepatic necrosis and failure
NeurologicNeurologicCranial nerve palsiesCranial nerve palsiesGuillain-Barré syndromeGuillain-Barré syndromeMeningoencephalitisMeningoencephalitisTransverse myelitisTransverse myelitisOthersOthers
Infectious mononucleosis hepatitisMarked mononuclear cell
infiltration of the sinusoids without significant necrosis. H&E stain.
Infectious mononucleosis heapatitisHigh power of previous illustration showing the signs of high regenerative activity: binucleate cells and a mitotic figure. H&E stain.
TreatmentTreatment
No specific therapy exists for IM, No specific therapy exists for IM, but general support helpsbut general support helps rest and fluidsrest and fluids acetaminophen or aspirin for fever acetaminophen or aspirin for fever
and aches;and aches; lozenges, salt-water gargles, lozenges, salt-water gargles, viscous lidocaine hydrochloride for viscous lidocaine hydrochloride for
sore throat.sore throat.
TreamentTreament
Acyclovir, ganciclovir, and Acyclovir, ganciclovir, and foscarnetfoscarnet
IVIG IVIG α-interferonα-interferon Antibiotics and corticosteroids are Antibiotics and corticosteroids are
indicated only for complications. indicated only for complications. Patients with Patients with splenomegaly should splenomegaly should
advoid sport for 6-8 weeks.advoid sport for 6-8 weeks.