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Infectious

Mononucleosis

Kristine Gem Velonta | Johannah Celeste Solon

Infectious mononucleosis
Infectious mononucleosis, or "mono", is an infection usually caused by
the Epstein-Barr virus.
the

also called human herpesvirus 4 (HHV-4), is a virus of the herpes family, and is one of
most common viruses in humans.

EBV is transmitted via intimate contact with body secretions, primarily


oropharyngeal secretions.
Thepartofthepharynxbetweenthesoftpalateandtheepiglottis.

EBV infects the B cells in the oropharyngeal epithelium.


The organism may also be shed from the uterine cervix, implicating the
role of genital transmission in some cases.
On rare occasion, EBV is spread via blood transfusion.

Signs and Symptoms


Most patients with Epstein-Barr virus (EBV) infectious
mononucleosis are asymptomatic and, therefore, have
few if any symptoms.
Symptoms usually start 4 to 6 weeks after you are
exposed to the virus.
The incubation period of EBV infectious mononucleosis is
1-2 months.
Virtually all patients with EBV infectious mononucleosis
report fatigue and prolonged malaise
feeling of
general discomfort or uneasiness, of being "out of sorts",
often the first indication of
an infection or
other disease.

A sore throat is second only to fatigue and malaise as a


presenting symptom.
Fever is usually present and is low grade, but chills are
relatively uncommon.
Various other symptoms have been described in patients
with EBV infectious mononucleosis, including cough,
ocular muscle pain, chest pain, and photophobia.

How is it spread:
The Epstein-Barr virus (EBV) can be found in saliva and mucus
(and sometimes tears). EBV is not spread by casual contact. You
can live in the same house with a person who has mono and
never become infected with the virus. But a person who has a
weakened immune system may be at higher risk for mono. It's
possible that people who have had mono can spread the virus
even though they no longer have symptoms.
The virus is transmitted primarily by repeated contact with
oropharyngeal secretions, and is primarily transmitted by adults
3050 days or by children 1014 days following infection.

How is it spread:
EBV lives and grows in the nose and throat. Any fluid that comes from these parts of
the body, including saliva, tears, or mucus, can be infected with the virus. The virus
(EBV) is spread when people come in contact with infected fluids.
EBV can be spread through intimate contact or sharing of saliva. (A brief kiss on the
lips is not likely to spread EBV. It is spread when saliva from an infected person gets
into another person's mouth.)
You can get EBV if you share a drinking glass or eating utensils with an infected
person (through sharing saliva).
In rare cases, someone can get an infection after receiving blood from a person who
is infected with EBV.
Most people get infected with EBV at some point in their lives but never get mono
symptoms. EBV "sleeps" (is dormant) in the body. It can become active from time to
time and spread to others. When it reactivates, most people do not have symptoms.
Many healthy people carry the virus and spread it every now and then throughout
their lives. Lifetime carriers of EBV are the most common source of EBV infection.

You are at risk if:


Are age 15 to 24, especially if you are in close contact with many
people. In the United States, college students, nurses, and
people in the military are most likely to get mono.
Have intimate contact with a person who has mono or an active
EBV infection. (A brief kiss on the lips is not likely to spread EBV.
It is spread when saliva from an infected person gets into another
person's mouth.)
Share drinking glasses, eating utensils, dishes, or a toothbrush
with an infected person. A person does not have to have
symptoms of mono to spread EBV.

Diagnosis
Diagnosis
of
infectious
mononucleosis
involves
identifying atypical lymphocytes in peripheral blood
smears.
During acute EBV disease, the number of lymphocytes
increases to 5060% of the total leukocytes in the
peripheral blood (a count of 20,00050,000/ml), of which
10% are atypical lymphocytes (95% are T lymphocytes,
5% are B lymphocytes), or Downey cells.
The presence of atypical lymphocytes is probably the
earliest indication of EBV infection, but is not specific for
EBV infection.
Modest leukocytosis is seen, and an elevated erythrocyte
sedimentation rate (ESR) is also frequently reported.

As mentioned, EBV is a B-lymphocyte mitogen (chemical substance that encourages acellto


commencecell)

that causes many different types of B lymphocytes to produce antibodies


(immunoglobulin).
Some plasma cells induced to multiply and produce immunoglobulin will produce
immunoglobulin M (IgM), which does not react with EBV-specific antigens but recognizes
antigenic determinants on sheep, horse, and cattle erythrocytes.
The IgM antibodies are called heterophile antibodies because they react with something
other than EBV viral proteins.
The EBV heterophile antibody titers are highest during the first 4 weeks of disease, and the
heterophile antibody tests are frequently used to detect the antibodies that react with
sheep, horse, or cattle erythrocytes rather than EBV proteins.
False-negative reactions occur in 10% of adults and 50% of children.
About 6090% of adults are positive for heterophile antibodies when tested during the first
2 weeks of the illness.
Most children younger than age 2 are negative for the heterophile antibodies. If heterophile
antibodies cannot be detected, the diagnosis of infectious mononucleosis can be obtained
by testing blood for EBV-specific antibodies (Table L-15).

Clinical Laboratory Findings in Acute


Infectious Mononucleosis

Epstein-Barr virus test


The Epstein-Barr virus test is a blood test used to
identify an EBV infection. The test detects the presence
of antibodies, which are proteins that your bodys
immune system releases in response to a harmful
substance, called an antigen. Specifically, the EBV test
is used to detect antibodies to EBV antigens. The test
can detect both a current infection and one that
occurred in the past.

An abnormal result means that the test has detected EBV antibodies. This means
that you are currently infected with EBV or have been infected with the virus in the
past. Your doctor can tell the difference between a past and a current infection
based on the presence or absence of antibodies that fight three specific antigens.
The three antibodies the test looks for are viral capsid antigen (VCA) IgG, VCA IgM,
and Epstein-Barr nuclear antigen (EBNA).
The presence of VCA IgG antibodies indicates that an EBV infection has occurred at
some time (recently or in the past).
The presence of VCA IgM antibodies and the absence of antibodies to EBNA means
that the infection has occurred recently.
The presence of antibodies to EBNA means that that infection occurred sometime
in the past. Antibodies to EBNA develop six to eight weeks after primary infection
and are present for life.
As with any test, false positive and false negative results do occur. The CDC found
that false negative results occur in 10 to 15 percent of patients. However, false
negatives occur primarily in tests of children younger than 10

Table L-15. Serology Specific for EBV


EBV Antibody Responses
Anti-VCA

Stage of EBV
Heterophile
Disease
Antibody

IgM

IgG

Anti-EBNA

Acute EBV
mononucleosi
s

+ or -

Past EBV
infection

EBV, Epstein-Barr virus; EBNA, EBV nuclear antigen; VCA, viral capsid
antigen; anti-VCA IgM, immunoglobulin M antibody to viral capsid
antigen; anti-VCA IgG, immunoglobulin G antibody to viral capsid
antigen.

Specific SerologicTest
A specific serologic test is routinely used to detect the presence of an infectious
mononucleosis heterophile antibody in serum or plasma.
The antibody may be present in detectable levels as early as the 4th day and practically
always by the 21st day of illness, and may persist for several months.
Test reported as positive or negative; no titration is done since no correlation exists
between the height of heterophile antibody titer and the severity of the disease.

1. Collection
1 red top tube
1 lavender top tube will also be accepted
2. Order Priority
STAT
3. Performed
In the Laboratory Department- Serology area
24 hours / 7 days
4. Turn around time -

thetimeit takes someone to

something

< 45 minutes from time of receipt

receive, deal with, and return

Treatment
Infectious mononucleosis is a self-limiting infection; therefore the physician
focusses on treating the patients symptoms
Acetaminophen is suggested to help alleviate her neck pain and headache.
Hot fluids and soup are recommended to soothe her sore throat and keep
her nourished.
Bed rest is recommended to allow her immune system to effectively
eliminate the virus
The physician predicts the symptoms to subside within the next few days as the
course of illness is approximately two weeks. A full recovery is expected to be
made within 2 months. During this time, the physician recommends the patient to
limit the amount of intimate contact with her boyfriend to prevent the spread of
the infection

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