Infectious mononucleosis - Revision history

Urinetrouble: /* Diagnosis */ added sensitivity and specificity of monospot test

2023-03-04T21:31:38Z

Diagnosis: added sensitivity and specificity of monospot test

← Older revision		Revision as of 21:31, 4 March 2023
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	===Diagnosis===		===Diagnosis===
	*Heterophile antibody (monospot) test		*Heterophile antibody (monospot) test
			**Sensitivity of 87% and specificity of 91% <ref>Sylvester JE, Buchanan BK, Silva TW. Infectious Mononucleosis: Rapid Evidence Review. Am Fam Physician. 2023 Jan;107(1):71-78. PMID: 36689975.</ref>
	**Up to 25% of patients in 1st week of symptoms may have false negative test<ref>Pitetti RD, Laus, S, and Wadowsky, RM. Clinical evaluation of a quantitative real time polymerase chain reaction assay for diagnosis of primary Epstein-Barr virus infection in children. Pediatr Infect Dis J. 2003; 22:736–739.</ref>		**Up to 25% of patients in 1st week of symptoms may have false negative test<ref>Pitetti RD, Laus, S, and Wadowsky, RM. Clinical evaluation of a quantitative real time polymerase chain reaction assay for diagnosis of primary Epstein-Barr virus infection in children. Pediatr Infect Dis J. 2003; 22:736–739.</ref>
	**10% of adult patients with EBV infection will be persistently negative		**10% of adult patients with EBV infection will be persistently negative

SMReel: /* Clinical Features */

2022-10-04T15:34:56Z

Clinical Features

← Older revision		Revision as of 15:34, 4 October 2022
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	***Red macular or maculopapular morbilliform [[rash]] of trunk & upper arms		***Red macular or maculopapular morbilliform [[rash]] of trunk & upper arms
	***Occasionally involves face, thigh and legs, periorbital & eyelid edema in 50% of cases		***Occasionally involves face, thigh and legs, periorbital & eyelid edema in 50% of cases
			***Most often mono is diagnosed based on other signs <ref>Sara Bode; Contagious Exanthematous Diseases. ''Quick References 2022''; 10.1542/aap.ppcqr.396150</ref>
	*Previously treated as [[strep pharyngitis]]		*Previously treated as [[strep pharyngitis]]
	**Morbilliform [[rash]] can develop<ref>Luzuriaga K and Sullivan JL. Infectious mononucleosis. N Engl J Med. 2010; 362:1993-2000.</ref>		**Morbilliform [[rash]] can develop<ref>Luzuriaga K and Sullivan JL. Infectious mononucleosis. N Engl J Med. 2010; 362:1993-2000.</ref>

Elcatracho: /* Background */

2021-02-21T02:31:47Z

Background

← Older revision		Revision as of 02:31, 21 February 2021
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	==Background==		==Background==
	*Caused by Epstein-Barr virus		*Caused by Epstein-Barr virus
	**[[CMV]] and HHV-6 may cause mononucleosis-like illnesses		**[[CMV]] and [[HHV-6]] may cause mononucleosis-like illnesses
	*Infects B lymphocytes which causes dissemination		*Infects B lymphocytes which causes dissemination
	**T lymphocytes fight infection		**T lymphocytes fight infection

Elcatracho: /* Background */

2021-02-01T19:15:08Z

Background

← Older revision		Revision as of 19:15, 1 February 2021
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	*Caused by Epstein-Barr virus		*Caused by Epstein-Barr virus
	**[[CMV]] and HHV-6 may cause mononucleosis-like illnesses		**[[CMV]] and HHV-6 may cause mononucleosis-like illnesses
			*Infects B lymphocytes which causes dissemination
			**T lymphocytes fight infection
			**In patients with decreased T cell function, can lead to continued proliferation and [[lymphoma\|neoplastic transformation]]

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Evaluation */

2020-09-09T21:20:22Z

Evaluation

← Older revision		Revision as of 21:20, 9 September 2020
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	[[File:SplenomegalyandsubcaphematomaMarked.png\|thumb\|Splenomegaly due to mononucleosis resulting in a subcapsular hematoma]]		[[File:SplenomegalyandsubcaphematomaMarked.png\|thumb\|Splenomegaly due to mononucleosis resulting in a subcapsular hematoma]]
	===Work-up===		===Work-up===
	*Heterophile antibody (monospot) test		*Heterophile antibody (monospot) test vs EBV IgM Assay
	*CBC		*CBC
	**Lymphocytosis (≥50% lymphocytes)		**Lymphocytosis (≥50% lymphocytes)

Rossdonaldson1: /* Evaluation */

2020-09-09T21:19:35Z

Evaluation

← Older revision		Revision as of 21:19, 9 September 2020
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	[[File:SplenomegalyandsubcaphematomaMarked.png\|thumb\|Splenomegaly due to mononucleosis resulting in a subcapsular hematoma]]		[[File:SplenomegalyandsubcaphematomaMarked.png\|thumb\|Splenomegaly due to mononucleosis resulting in a subcapsular hematoma]]
	===Work-up===		===Work-up===
			*Heterophile antibody (monospot) test
	*CBC		*CBC
	**Lymphocytosis (≥50% lymphocytes)		**Lymphocytosis (≥50% lymphocytes)
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	*[[LFTs]]		*[[LFTs]]
	**Elevations in AST and ALT is expected up to 5x		**Elevations in AST and ALT is expected up to 5x
			*Suspected mononucleosis during pregnancy (also need to rule out other pathology):
			**[[Epstein-Barr virus]], [[cytomegalovirus]], and [[HIV]]

			===Diagnosis===
	*Heterophile antibody (monospot) test		*Heterophile antibody (monospot) test
	**Up to 25% of patients in 1st week of symptoms may have false negative test<ref>Pitetti RD, Laus, S, and Wadowsky, RM. Clinical evaluation of a quantitative real time polymerase chain reaction assay for diagnosis of primary Epstein-Barr virus infection in children. Pediatr Infect Dis J. 2003; 22:736–739.</ref>		**Up to 25% of patients in 1st week of symptoms may have false negative test<ref>Pitetti RD, Laus, S, and Wadowsky, RM. Clinical evaluation of a quantitative real time polymerase chain reaction assay for diagnosis of primary Epstein-Barr virus infection in children. Pediatr Infect Dis J. 2003; 22:736–739.</ref>
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	*EBV IgM Assay		*EBV IgM Assay
	**Carries 97% sensitivity and 94% specificity at symptom onset<ref>Bruu, AL, et al. Evaluation of 12 commercial tests for detection of Epstein-Barr virus-specific and heterophile antibodies. Clin Diagn Lab Immunol. 2000; 7:451–456.</ref>		**Carries 97% sensitivity and 94% specificity at symptom onset<ref>Bruu, AL, et al. Evaluation of 12 commercial tests for detection of Epstein-Barr virus-specific and heterophile antibodies. Clin Diagn Lab Immunol. 2000; 7:451–456.</ref>
	*Suspected mononucleosis during pregnancy (also need to rule out other pathology):
	**[[Epstein-Barr virus]], [[cytomegalovirus]], and [[HIV]]

	~~===Diagnosis===~~

	==Management==		==Management==

Rossdonaldson1: /* Evaluation */

2020-09-09T21:17:42Z

Evaluation

← Older revision		Revision as of 21:17, 9 September 2020
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	==Evaluation==		==Evaluation==
			[[File:SplenomegalyandsubcaphematomaMarked.png\|thumb\|Splenomegaly due to mononucleosis resulting in a subcapsular hematoma]]
	===Work-up===		===Work-up===
	*CBC		*CBC
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	*Suspected mononucleosis during pregnancy (also need to rule out other pathology):		*Suspected mononucleosis during pregnancy (also need to rule out other pathology):
	**[[Epstein-Barr virus]], [[cytomegalovirus]], and [[HIV]]		**[[Epstein-Barr virus]], [[cytomegalovirus]], and [[HIV]]

			===Diagnosis===

	==Management==		==Management==

Rossdonaldson1: /* Clinical Features */

2020-09-09T21:11:12Z

Clinical Features

← Older revision		Revision as of 21:11, 9 September 2020
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	[[File:2549px-Lymphadanopathy.jpg\|thumb\|Neck lymphadenopathy associated with infectious mononucleosis.]]		[[File:2549px-Lymphadanopathy.jpg\|thumb\|Neck lymphadenopathy associated with infectious mononucleosis.]]
	[[File:Mononucleosis.jpg\|thumb\|Exudative pharyngitis in a person with infectious mononucleosis.]]		[[File:Mononucleosis.jpg\|thumb\|Exudative pharyngitis in a person with infectious mononucleosis.]]
			[[File:Cross Reaction Rash.jpg\|thumb\|Rash from using penicillin while infected with mono.]]
	*Triad of:		*Triad of:
	**[[Fever]]		**[[Fever]]

Rossdonaldson1: /* Clinical Features */

2020-09-09T21:10:20Z

Clinical Features

← Older revision		Revision as of 21:10, 9 September 2020
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	==Clinical Features==		==Clinical Features==
	[[File:2549px-Lymphadanopathy.jpg\|thumb\|Neck lymphadenopathy associated with infectious mononucleosis.]]		[[File:2549px-Lymphadanopathy.jpg\|thumb\|Neck lymphadenopathy associated with infectious mononucleosis.]]
			[[File:Mononucleosis.jpg\|thumb\|Exudative pharyngitis in a person with infectious mononucleosis.]]
	*Triad of:		*Triad of:
	**[[Fever]]		**[[Fever]]

Rossdonaldson1: /* Clinical Features */

2020-09-09T21:08:36Z

Clinical Features

← Older revision		Revision as of 21:08, 9 September 2020
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	==Clinical Features==		==Clinical Features==
			[[File:2549px-Lymphadanopathy.jpg\|thumb\|Neck lymphadenopathy associated with infectious mononucleosis.]]
	*Triad of:		*Triad of:
	**[[Fever]]		**[[Fever]]