Pathophysiology
INFECTIOUS MONONUCLEOSIS
Treatment
Clinical Manifestations
incubation period is 30-50 days
3-5 days: Flu like sx-headache, malasie, joint pain, fatigue--> within this time frame, other individuals may present as asymptomatic
Mono is usually dx with the presence of fever, sore throat, cervical lymphadenopathy, and fatigue
Progression of mono: generalized lymphadenopath, splenomegaly and hepatomegaly (occurs in 25-75% of individuals)
Splenomegaly: splenic rupture may occur due to mild trauma, occurs in 90% of males with mono during days 4-21 of sx onset.
Splenic rupture is most common cause of death related to mono.
Rare fatalities due to IM:
-hepatic failure
-associated bacterial infection
-viral myocarditis
Other organ system involvement
Fulminant hepatitis with jaundice and anemia, ecephalitis, Guillain-Barre syndrome, Bell palsy
Eyes: eyelid and periorbital edema, dry eyes, kertitis, uveitis, conjunctivitis
Pulmonary (rare): pneumonia and respiratory failure possible in immumnocompromised individuals.
Reye's syndrome: causes swelling of liver and brain, usually occurs in children with EBV infection.
IM is self limiting:
-recovery is a few weeks
-severe complications occur only 5% of cases
-residual fatigue can last 1-2 mo after all other sx have resolved
virus replicates
invasion of B lymphocytes
infected B lymphocyte circulation throughout body in blood and throughout the reticular endothelial system (spleen, liver, lymphatic system)
cellular-mediated and antibody-mediated response
fever is caused by cytokines released by host immune system
lymphocytosis is caused by an increasing number of circulating activated B and T lymphocytes (Downey Cells)
ineffective immune response can result in development of B cell Lymphoma
pharyngitis is cause by virus-infected B lymphocyte proliferation within the oropharynx