1. INFECTIOUS MONONUCLEOSIS (epstein-barr virus) Professor: Ma lian

2. Typical features Prolong fever Prolong fever Exudative pharyngitis Exudative pharyngitis Generalized adenopathy Generalized adenopathy Hepatosplenomegaly Hepatosplenomegaly Atypical lymphocytes Atypical lymphocytes Heterophil antibodies Heterophil antibodies

3. General considerations Infectious mononucleosis (mono) is a common acute infectious disease usually found in individuals between the ages of 5 and 30. Infectious mononucleosis (mono) is a common acute infectious disease usually found in individuals between the ages of 5 and 30. Pathogeny Pathogeny Epstein-Barr virus (90%) Epstein-Barr virus (90%) Epstein-Barr virus Epstein-Barr virus CMV, HIV, HHV-6, toxoplasma gondii, Hepatitis virus etc (5-10%). CMV, HIV, HHV-6, toxoplasma gondii, Hepatitis virus etc (5-10%).

4. EBV Occur worldwide Occur worldwide Transmitted by saliva and blood transfusion Transmitted by saliva and blood transfusion Related with the following diseases Related with the following diseases Mono Mono Burkitt lymphoma Burkitt lymphoma Nasopharyngeal cancer Nasopharyngeal cancer

5. Clinical findings Symptoms and signs Symptoms and signs Prolong fever(>39 ℃ ) Prolong fever(>39 ℃ ) Soft palate petechiae and Exudative pharyngitis Soft palate petechiae and Exudative pharyngitis Soft palate petechiae Exudative pharyngitis Soft palate petechiae Exudative pharyngitis Generalized adenopathy Generalized adenopathy Generalized adenopathy Generalized adenopathy Splenomegaly and hepatomegaly Splenomegaly and hepatomegaly Rash (macular,scarlatiniform or urticarial) Rash (macular,scarlatiniform or urticarial) Rash eye edema eye edema X-linked lymphoproliferative syndrome (XLP): occur in the children with primary immunodeficiency disease X-linked lymphoproliferative syndrome (XLP): occur in the children with primary immunodeficiency disease

6. Sore throat Exudative pharyngitis Soft palate petechiae

7. Generalized adenopathy usually in the neck, armpit, and throat

8. Rash

9. Clinical findings Laboratory findings Laboratory findings Peripheral blood Peripheral blood Atypical lymphocytes Atypical lymphocytes Atypical lymphocytes Atypical lymphocytes Leukopenia Leukopenia Heterophil antibodies Heterophil antibodies Heterophil antibodies Heterophil antibodies Anti-EBV antibodies Anti-EBV antibodies aminotransferase aminotransferase

11. No clumping of the red bloods cells indicates the person's serum does not contains heterophile antibodies. The few clumps that are seen are red blood cells from the test reagent that did not separate during shaking of the reagent prior to placing it on the slide. Clumping of the red bloods cells indicates the person's serum contains heterophile antibodies.

12. Differantial diagnosis Group A streptococcal infection Group A streptococcal infection Rubella Rubella Adenovirus Adenovirus Hepatitis A or B Hepatitis A or B Toxoplasmosis Toxoplasmosis Drug reaction Drug reaction Leukemia Leukemia CMV mononucleosis CMV mononucleosis HIV infection HIV infection

13. Complication Cardiorespiratory Interstitial pneumonitis Myocarditis Pericarditis Pleuritis Cardiorespiratory Interstitial pneumonitis Myocarditis Pericarditis Pleuritis Hematologic Autoimmune hemolytic anemia Immune granulocytopenia or thrombocytopenia Pancytopenia Hematologic Autoimmune hemolytic anemia Immune granulocytopenia or thrombocytopenia Pancytopenia

14. Complication Hepatic Cholestatic jaundice (severe hepatitis) Massive hepatic necrosis and failure Hepatic Cholestatic jaundice (severe hepatitis) Massive hepatic necrosis and failure Neurologic Cranial nerve palsies Guillain-Barr é syndrome Meningoencephalitis Transverse myelitis Others Neurologic Cranial nerve palsies Guillain-Barr é syndrome Meningoencephalitis Transverse myelitis Others

15. Infectious mononucleosis hepatitis Marked mononuclear cell infiltration of the sinusoids without significant necrosis. H&E stain. Infectious mononucleosis heapatitis High power of previous illustration showing the signs of high regenerative activity: binucleate cells and a mitotic figure. H&E stain.

16. Treatment No specific therapy exists for IM, but general support helps No specific therapy exists for IM, but general support helps rest and fluids rest and fluids acetaminophen or aspirin for fever and aches; acetaminophen or aspirin for fever and aches; lozenges, salt-water gargles, lozenges, salt-water gargles, viscous lidocaine hydrochloride for sore throat. viscous lidocaine hydrochloride for sore throat.

17. Treament Acyclovir, ganciclovir, and foscarnet Acyclovir, ganciclovir, and foscarnet IVIG IVIG α-interferon α-interferon Antibiotics and corticosteroids are indicated only for complications. Antibiotics and corticosteroids are indicated only for complications. Patients with splenomegaly should advoid sport for 6-8 weeks. Patients with splenomegaly should advoid sport for 6-8 weeks.