1. COMMUNICABLE DISEASES
Infectious Mononucleosis
“Glandular Fever”
“Monocytic Angina”
Professor
Qayser Sahib Al Habeeb
Specialist in
Internal and Community Medicine
Department of Family and Community Medicine
College of Medicine - University of Duhok

2. Infectious Mononucleosis
“Glandular Fever” “Monocytic Angina”
An acute viral syndrome
“often” caused by
Epstein Barr Virus
that infects B-Lymphocytes

3. other viral infections ( CMV, HHV-6 , HIV-1 ) and Toxoplasmosis can
A variety of
other viral infections
( CMV, HHV-6 , HIV-1 )
and
Toxoplasmosis
can
produce a similar clinical syndrome

4. Viral Replication (Lytic infection) and
B-cells
are the site of
both;
Viral Replication (Lytic infection)
and
Viral Persistence (Latent infection)

5. with equal sex distribution
Cases
are usually sporadic
with equal sex distribution
In children
primary EBV infection is usually asymptomatic
whereas
in adolescents and adults glandular fever is the usual presentation

6. Occurrence:
--- In developing countries,
subclinical infection in childhood is virtually universal.
--- In developed countries,
infection may be delayed until adolescence or early adult life; most common in high school&university students
Under these circumstances
~ 50% of those infected will develop typical clinical disease.

7. I P : from 4 to 6 weeks
MOT : ● direct or indirect saliva contact i.e. close oral contact or
sharing eating utensils.
● recent evidence suggests that infection often results from spread during sexual intercourse.
● rarely follows blood transfusion.

8. Period of communicability:
--- At least few weeks.
--- EBV is not highly contagious and isolation of cases is unnecessary
--- Prolonged pharyngeal excretion may persist for a year or more
%– 20 % or more of EBV antibody positive healthy individuals are
“long term oro pharyngeal carriers”

9. It is currently believed that these healthy people, who nevertheless
secrete EBV particles,
are the primary reservoir for transmission of
EBV among humans

10. Immunity:
► Every one is susceptible to infection.
► Infection confers a high degree of resistance.
►Reactivation of EBV may occur in immunosuppressed individuals.

11. Pathology:
Infection local epithelial cells & B lymphocytes dissemination of infected B cells production of T cell response by atypical mononucleosis
lymphoid hyperplasia
with
lymphadenopathy
Spleenomegaly
&
hepatomegaly

12. a prodrome of fever, fatigue, and headache is followed by
Clinical Features:
a prodrome of fever, fatigue, and headache is
followed by
classical triad of
sore throat + fever + lymphadenopathy
with
full recovery
after 6-8 weeks in the vast majority of cases.

13. Pruritic maculopapular rash
Signs:
- Exudative tonsilitis and peritonsillar edema Petechae at junction of hard and soft palate,
- Cervical (especially posterior cervical), axillary
and inguinal lymph nodes (discrete non tender)
Splenomegaly 50%
hepatomegaly 15%
jaundice %
Pruritic maculopapular rash
90% after antibiotics

15. Exudative Pharyngitis in a Patient with Infectious Mononucleosis

17. Infectious mono, peripheral smear, high power showing reactive lymphocytes

20. Amoxicillin Rash
( (itchy macular

21. Complications
Rare and include
1- pharyngeal and tracheal obstruction
2- blood: hemolytic anemia & thrombocytopenia
3- meningoencephalitis,hepatitis, myocarditis,
pneumonitis, GB syndrome.
4- splenic rupture
5- chronic fatigue & depression
6- ≈ 10% of patients with IM suffer a chronic relapsing
syndrome.

22. Diagnosis:
● Leucocytosis with relative and absolute lymphocytosis
● Presence of atypical lymphocytes (activated T cells)
● mild ↑in (AST) in ≈ 90%

23. ● Positive heterophil antibody test :
paul bunnell test or
rapid monospot test used for diagnostic screening
( (+ve in 85%of acute cases
● heterophil –ve cases are confirmed by the gold standard test :
IgM Ab to Viral Capsid Antigen (VCA)

24. Differential Diagnosis:
Herpes virus 6,
cytomegalovirus or
toxoplasmosis
may cause
a syndrome resembling glandular fever, both
clinically and hematologically.

25. Treatment:
Symptomatic +
-- short course of steroid for tonsillopharyngeal edema…………… (airway obstruction)
-- avoid alcohol……… (worsens hepatitis)
-- avoid exercise………. (splenic rupture)

26. -- antibiotics are not indicated unless throat culture yields a ß-hemolytic streptococcus
-- avoid ampicillin & amoxicillin since they commonly cause an itchy macular rash.

27. Practically all cases make full recovery in few weeks to few months.
Prognosis:
Practically all cases make full recovery
in few weeks to few months.
Death is rare but may result from:
► respiratory obstruction
► hemorrhage;
(splenic rupture or thrombocytopenia)
► encephalitis.

28. with different malignancies has been documented e.g.
Association
with different malignancies has been documented
e.g.
burkitts lymphoma,
some forms of Hodgkins disease,
nasopharyngeal carcinoma
&
oral hairy leucoplakia (AIDS patients)

29. Preventive and control measures:
◙ There is no vaccine available.
◙ Basic hygiene can help prevent many diseases including glandular fever.
◙ Teach children not to share spoons, forks , cups, soft drink cans ……etc.
◙ Adults should not share personal items such as glasses, cigarettes, lipstick or other items that may be covered in saliva.
◙ Isolation is not necessary.
◙ There is no treatment and antibiotics are not indicated.

30. Thank you