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Infectious Mononucleosis, Epstein-Barr Virus Infections

Dennis E. Hughes, DO, FAAFP, FACEP Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Epstein-Barr virus (EBV) is a member of the herpes virus family: human herpes virus 4 (1)

    • Two subtypes: ST1 predominates in Western Hemisphere, Southeast Asia; ST1 and ST2 equally p...

DIAGNOSIS

HISTORY

  • May begin abruptly or insidiously

  • Syndrome of fatigue, malaise, and sore throat

  • In adults, temperature may rise to 103°F (39.4°C) and gradually fall over a variable period of 7 to 10 da...

TREATMENT

  • Treatment is mostly supportive.

  • NSAIDs or acetaminophen

  • During acute stage, limit activity for 4 weeks to reduce potential complications (e.g., splenic rupture).

  • Transplant recipients who devel...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

ALERT

Rupture of the spleen may be fatal if not recognized; it requires blood transfusions, treatment for shock, and splenectomy. Occurrence is estimated at 0.1%.

 

Patient Monitoring

REFERENCES

1
Stanfield BA, Luftig MA. Recent advances in understanding Epstein-Barr virus. F1000Res.  2017;6:386. doi:12688/f1000research.1059.1.1. [View Abstract on OvidMedline]
2
Williams-Harmon ...

ADDITIONAL READING

  • Grimm JM, Schmeling DO, Dunmire SK, et al. Prospective studies of infectious mononucleosis in university students. Clin Transl Immunology.  2016;5(8):e94. [View Abstract on Ov...

CODES

ICD10

  • B27.00 Gammaherpesviral mononucleosis without complication

  • B27.09 Gammaherpesviral mononucleosis with other complications

  • B27.01 Gammaherpesviral mononucleosis with polyneuropathy

  • B27.02 Gamma...

CLINICAL PEARLS

  • 98% of patients with acute IM manifest with a combination of fever, sore throat, cervical node enlargement, and tonsillar hypertrophy.

  • False-negative monospot (heterophile antibody) is ...

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