Infectious mononucleosis (also known as glandular fever) is the term for infection with Epstein-Barr virus (EBV). The infection classically occurs in teenagers and young adults, hence its other name kissing disease. It is usually a clinical diagnosis, with confirmation by serum testing, but may have suggestive findings on imaging.
Exposure to Epstein-Barr virus, but often a subclinical infection, especially in children. Young adults (15-24) are more likely to be symptomatic.
- lymphadenopathy and splenomegaly
- occasionally hepatosplenomegaly
- occasionally: rash
It was originally called "mononucleosis" after abnormal mononuclear cells were found in patients with the clinical syndrome.
Epstein-Barr virus is in the herpesvirus class. It is thought to be spread primarily through a person-to-person route through salivary secretions. The Epstein-Barr virus infects B-cells in the lymphoid tissue. Like other herpes viruses, it becomes a lifelong chronic infection with periodic shedding of virus.
Elevated transaminases are occasionally seen.
Diagnosis is usually through serum lab work which shows lymphocytosis and a positive heterophile antibody test. Imaging is usually not necessary, but certain findings on imaging can be suggestive:
- possible splenic rupture
- splenic infarction has been reported 3
- generalized lymphadenopathy, including cervical lymphadenopathy
- tonsillar enlargement
- possible hepatomegaly
Treatment and prognosis
Symptomatic therapy is usually sufficient. Athletes are encouraged to discontinue sports during the acute phase (<3-4 weeks) to lower the risk of splenic rupture 2.
Imaging differential diagnoses include:
- 1. Evans AS, Niederman JC, Cenabre LC et-al. A prospective evaluation of heterophile and Epstein-Barr virus-specific IgM antibody tests in clinical and subclinical infectious mononucleosis: Specificity and sensitivity of the tests and persistence of antibody. J. Infect. Dis. 1976;132 (5): 546-54. Pubmed citation
- 2. Kinderknecht JJ. Infectious mononucleosis and the spleen. Curr Sports Med Rep. 2003;1 (2): 116-20. Pubmed citation
- 3. Trevenzoli M, Sattin A, Sgarabotto D et-al. Splenic infarct during infectious mononucleosis. Scand. J. Infect. Dis. 2002;33 (7): 550-1. Pubmed citation
- 4. Luzuriaga K, Sullivan JL. Infectious mononucleosis. (2010) The New England journal of medicine. 362 (21): 1993-2000. doi:10.1056/NEJMcp1001116 - Pubmed