References:
- Global Infectious Diseases and Epidemiology Online Network: Infectious Diseases of the Philippines, 2013 eBook Edition, ISBN 978-1-61755-582-4, by Stephen Berger. Accessed here.
| Agent | VIRUS - DNA. Herpesviridae. Gammaherpesvirinae, Lymphocryptovirus: Human herpesvirus 4 (Epstein Barr virus) |
| Reservoir | Human |
| Vector | None |
| Vehicle | Saliva Blood transfusion |
| Incubation Period | 28 to 42 days |
| Diagnostic Tests | Serology Nucleic acid amplification |
| Typical Adult Therapy | Supportive |
| Typical Pediatric Therapy | As for adult |
| Clinical Hints | Exudative pharyngitis, symmetrical cervical lymphadenopathy, splenomegaly and hepatic dysfunction; atypical lymphocytes and positive serology appear after 10 to 14 days; acute illness resolves in 2 to 3 weeks, but malaise and weakness may persist for months. |
| Synonyms | EBV, EBV, Epstein-Barr, Febbre ghiandolare, Glandular fever, Infectious mononucleosis, Monocytic angina, Mononucleose, Mononucleosi, Mononucleosis - infectious, Mononukleose, Pfeiffer’s disease. |
Symptoms of Infectious Mononucleosis (IM) usually consist of fever, pharyngitis, and lymphadenopathy.
- Patients usually do not recall a history of possible exposure.
- A prodrome consisting of 1 to 2 weeks of fatigue, malaise, and myalgia is common; however, abrupt presentations may occur.
- A low-grade fever is usually present and lasts for 1 to 2 weeks, occasionally up to 5 weeks.
- CMV/EBV co-infection may be associated with prolonged illness.
Pharyngitis may be severe, particularly during the first week of illness.
- Tonsillitis may be present, and lymphadenopathy is almost universal, lasting for 1 to 2 weeks.
- Posterior cervical nodes are often affected, and generalized adenopathy may occur.
- Periorbital edema and palatal petechiae are often present.
- Splenomegaly is found in most cases, and hepatomegaly in 25%.
- Asymptomatic pericardial effusions are common.
- Patients often complain of headache.
- A morbilliform or papular erythematous eruption of the upper extremities or trunk is noted in 5% of cases.
- Lemmiere’s syndrome has been reported as a complication of infectious mononucleosis.
- Guillain-Barre syndrome and membranous glomerulonephritis have been reported following primary EBV infection.
It is of note that a macular erythematous rash may occur in patients treated with ampicillin, usually appearing 5 to 9 days following the first dose.
- This phenomenon should not be misinterpreted as a penicillin allergy.
- Erythema nodosum and erythema multiforme have been associated with IM, as have petechiae and jaundice.
- The presence of severe abdominal pain may herald splenic rupture. Other diseases ascribed to Epstein-Barr virus include nasopharyngeal carcinoma, Burkitt’s lymphoma (African type), post-transfusion lymphoproliferative disorder (PTLD), hemophagocytic lymphohistiocytosis and hemolytic anemia.
- Epstein-Barr virus infection, like many other infectious diseases, is occasionally followed by Guillain-Barre syndrome.
- Gianotti-Crosti syndrome may be the only presenting manifestation of Epstein-Barr virus infection. A false positive serological reaction toward Epstein-Barr virus has been associated with a variety of conditions, including rheumatoid arthritis, Hepatitis E, Hepatitis A and Parvovirus B19 infection.