The majority of patients with infectious mononucleosis have mild symptoms. However a few will complain of the following features:

• Once EBV is acquired it does not immediately cause any symptoms. The virus has to multiply and reach a certain threshold before it results in symptoms. The incubation period for EBV is about 4-6 weeks.
• Prodrome of general malaise, fatigue and headache may start 3-4 days prior to the actual sore throat and fever. The majority of symptomatic patients will complain of a prolonged history of fatigue and malaise.
• The fever in infectious mononucleosis is low grade but continuous. The sore throat is often the second complaint and may vary from moderate to severe. Complaints of muscle and joint pain is also rare, which is different from other viral infections like influenza where the muscle pain is moderate.
• Patients with infectious mononucleosis may also complain of a dry cough, lack of appetite and vague chest pain.
• The rare patient with CNS involvement may complain of a headache, visual disturbances and dizziness. The CNS features of infectious mononucleosis usually occur late.
• The physical exam in a patient with infectious mononucleosis depends on when the patient presents. Patients presenting early in the course of the infection may have a fever, skin rash, redden throat and localized cervical adenopathy.
• Those patients presenting late may present with splenomegaly, palatal petechiae, jaundice and abdominal pain if there is splenic rupture/enlargement. If the spleen is enlarged, the patient may complain of tenderness to palpation.
• Skin discoloration and icterus is sometime seen in patients with hepatosplenomegaly, and is slightly more common in elderly individuals.
• Examination of the oral cavity usually will shows a redden pharynx with signs of an inflammatory process. The pharyngitis may be exudative and often confused with group A streptococcal infection. The tonsils are usually enlarged and the upper airway passageway may appear narrowed. Petechiae on the soft palate are also common.
• Rarely some patients with infectious mononucleosis may present with generalized macular papular rash that is non pruritic and seen on the face and trunk. This rash is faint and often disappears within several days.
• Other rare observation may include bilateral periorbital edema, conjunctivitis or eyelid edema.
• The oral cavity should not be repeatedly examined or manipulated as it may irritate the swollen tonsil and result in sudden airway distress. This patient is best monitored in an intensive care setting and an intubation set and a tracheostomy set should be available at the bedside.

• Splenomegaly

  Clinical estimates of splenomegaly are fallible. Laboratory determinations, commonly by 2D ultrasonography, must take account of methodology, the formulae used in calculations and the individual's body size. [ncbi.nlm.nih.gov]

  Conclusions and Relevance In adolescent and adult patients presenting with sore throat, the presence of posterior cervical, inguinal or axillary adenopathy, palatine petechiae, splenomegaly, or atypical lymphocytosis is associated with an increased likelihood [doi.org]

  Symptomatic individuals typically first experience fever, malaise, and fatigue, which is later accompanied by acute pharyngitis, tonsillitis, lymphadenopathy, and/or splenomegaly lasting up to a month. [amboss.com]

  Other symptoms and signs include Splenomegaly Mild hepatomegaly and hepatic percussion tenderness Periorbital edema and palatal petechiae Less frequently maculopapular eruptions Rarely jaundice Splenomegaly, which occurs in about 50% of cases, is maximal [merck.com]

• Cervical Lymphadenopathy

  Physical examination findings of palatal petechiae, posterior cervical lymphadenopathy, axillary lymphadenopathy, and inguinal lymphadenopathy increase the likelihood of a positive heterophile antibody test result. [aafp.org]

  AIM: To depict the grey-scale and Doppler features of cervical lymphadenopathy due to infectious mononucleosis (IM) and to compare the findings with other benign conditions and lymphoma. [ncbi.nlm.nih.gov]

  Imaging is usually not necessary, but certain findings on imaging can be suggestive: CT splenomegaly possible splenic rupture splenic infarction has been reported 3 generalized lymphadenopathy, including cervical lymphadenopathy tonsillar enlargement [radiopaedia.org]

• Generalized Lymphadenopathy

  Imaging is usually not necessary, but certain findings on imaging can be suggestive: CT splenomegaly possible splenic rupture splenic infarction has been reported 3 generalized lymphadenopathy, including cervical lymphadenopathy tonsillar enlargement [radiopaedia.org]

  There is an increase in mononuclear white blood cells and other atypical lymphocytes, generalized lymphadenopathy, splenomegaly, and occasionally hepatomegaly with hepatitis. [fpnotebook.com]

  IM is generally a self-limiting disease with symptoms resolving in a few weeks. Pharmacologic therapy generally consists of supportive care with nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. [uspharmacist.com]

  It is particularly commonly seen in children and young adults, but may be encountered in all ages, including the very elderly. 4 Clinically, the lymphadenopathy is usually localized, but may be generalized. [doi.org]

• Posterior Cervical Adenopathy

  Characteristic clinical features of EBV IM include bilateral upper lid edema, exudative or nonexudative pharyngitis, bilateral posterior cervical adenopathy, and splenomegaly ± maculopapular rash. [ncbi.nlm.nih.gov]

  The likelihood of mononucleosis is reduced with the absence of any lymphadenopathy (summary sensitivity, 0.91; positive LR range, 0.23-0.44), whereas the likelihood increases with the presence of posterior cervical adenopathy (summary specificity, 0.87 [doi.org]

  One clinical tip-off might be that the cervical adenopathy is invariably posterior, not only anterior, with infectious mononucleosis. [journals.lww.com]

• Axillary Lymphadenopathy

  Physical examination findings of palatal petechiae, posterior cervical lymphadenopathy, axillary lymphadenopathy, and inguinal lymphadenopathy increase the likelihood of a positive heterophile antibody test result. [aafp.org]

• Infectious Mononucleosis

  Diagnosing Infectious Mononucleosis Healthcare providers typically diagnose infectious mononucleosis based on symptoms. Laboratory tests are not usually needed to diagnose infectious mononucleosis. [cdc.gov]

  IgM antibodies to Epstein-Barr virus in infectious mononucleosis. Arch Gesamte Virusforsch. 1972; 37 (4):332–339. [ PubMed ] [ Google Scholar ] HOAGLAND RJ. The transmission of infectious mononucleosis. [ncbi.nlm.nih.gov]

  Last Reviewed: November 2011 Versión en español What is infectious mononucleosis? Infectious mononucleosis is a viral disease that affects certain blood cells. [health.state.ny.us]

• Fever

  The disease is characterized by fever, sore throat and fatigue. More information Glandular Fever Offering e-mail consultations by past sufferer who now works as nutritional therapist. Glandular Fever Find information about this disorder. [curlie.org]

  Glandular fever (also known as infectious mononucleosis) is a type of viral infection that can cause fever, sore throat, swollen lymph nodes (glands) and fatigue. Most cases of glandular fever are caused by the Epstein-Barr virus (EBV). [web.archive.org]

  Glandular fever mostly affects teenagers and young adults. [nhs.uk]

  Most patients have the triad of Fever Pharyngitis Adenopathy Fever usually peaks in the afternoon or early evening, with a temperature around 39.5 ° C, although it may reach 40.5 ° C. [merck.com]

  Identification of infectious mononucleosis (glandular fever) Clinical features Infectious mononucleosis (glandular fever) is an acute viral infection affecting mainly young adults. [www2.health.vic.gov.au]

• Fatigue

  Fatigue can sometimes persist for longer. In most people, fatigue will end after three months. It's estimated that 9-22% of people will experience symptoms of fatigue that last up to six months. [web.archive.org]

  NHS Choices: Glandular Fever Information on this viral infection that can cause fever, sore throat, swollen lymph nodes and fatigue. Includes causes, symptoms, diagnosis, risks, treatment and prevention. [curlie.org]

  Fatigue, myalgias, and need for sleep may persist for several months after the acute infection has resolved. [ncbi.nlm.nih.gov]

  Infectious mononucleosis is caused by Epstein-Barr virus (EBV, human herpesvirus type 4) and is characterized by fatigue, fever, pharyngitis, and lymphadenopathy. Fatigue may persist weeks or months. [merck.com]

  For some people, their liver or spleen or both may remain enlarged even after their fatigue ends. Most people get better in two to four weeks; however, some people may feel fatigued for several more weeks. [cdc.gov]

• Pain

  The evaluation of a febrile patient with acute abdominal pain represents a frequent yet possibly challenging situation in the emergency department (ED). [ncbi.nlm.nih.gov]

  On day 2 of admission, the patient developed a sharp, pleuritic, nonradiating chest pain on his left side, which was worsened by inspiration and relieved by leaning forward. He also complained of palpitations and diaphoresis. [cfp.ca]

  Doctors will: Tell you to rest for a week or two, when you’re feeling the most tired and weak Have you take acetaminophen or ibuprofen to help your fever and pain Have you take corticosteroids, if your tonsils are so swollen and painful that you're having [msdmanuals.com]

• Lymphadenopathy

  A 20-year-old man was hospitalized for the evaluation of lymphadenopathy and systemic symptoms. His symptoms developed at the eighth week of the infliximab treatment and he required hospitalization. [ncbi.nlm.nih.gov]

  Imaging is usually not necessary, but certain findings on imaging can be suggestive: CT splenomegaly possible splenic rupture splenic infarction has been reported 3 generalized lymphadenopathy, including cervical lymphadenopathy tonsillar enlargement [radiopaedia.org]

  Typical manifestations include fatigue (sometimes persisting weeks or months), fever, pharyngitis, splenomegaly, and lymphadenopathy. [merck.com]

  Physical examination findings of palatal petechiae, posterior cervical lymphadenopathy, axillary lymphadenopathy, and inguinal lymphadenopathy increase the likelihood of a positive heterophile antibody test result. [aafp.org]

• Sore Throat

  NHS Choices: Glandular Fever Information on this viral infection that can cause fever, sore throat, swollen lymph nodes and fatigue. Includes causes, symptoms, diagnosis, risks, treatment and prevention. [curlie.org]

  Symptoms are of limited value for the diagnosis of mononucleosis; sore throat and fatigue are sensitive (range, 0.81-0.83) but nonspecific. [ncbi.nlm.nih.gov]

  Sore Throat: Is It Mono? Having a sore throat can be a symptom of many conditions, and many people wonder if their own sore throat might be a sign of something more serious than the common cold. [medicinenet.com]

• Pharyngitis

  Pharyngitis may be severe, painful, and exudative and may resemble streptococcal pharyngitis. Adenopathy is usually symmetric and may involve any group of nodes, particularly the anterior and posterior cervical chains. [merck.com]

  Both cases involved young adults presenting with fever, pharyngitis, lymphadenopathy, hepatosplenomegaly, and atypical lymphocytosis confirmed by serologic tests, liver biopsy and electron microscopic study. [ncbi.nlm.nih.gov]

  Rapid test for group A β-hemolytic streptococcus To exclude streptococcal pharyngitis. Rapid test for group A β-hemolytic streptococcus To exclude streptococcal pharyngitis. [medicaljoyworks.com]

• Cough

  A 16-month-old boy was admitted because of cough that had lasted for 10 days. [ncbi.nlm.nih.gov]

  However, sneezes and coughs also can transmit the virus. To continue reading this article, you must login. Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School. [health.harvard.edu]

  Therefore, glandular fever can be spread through: kissing (it is often referred to as the kissing disease), exposure to coughs and sneezes, and sharing eating and drinking utensils, such as cups, glasses or unwashed forks and spoons. [web.archive.org]

  Causes of Infectious Mononucleosis Infectious mononucleosis is transmitted by exposure to saliva, so it can be spread by kissing, by sharing glasses or cutlery, and by droplets spread by coughing. Mono is usually caused by the Epstein-Barr virus. [doi.org]

• Tonsillar Hypertrophy

  Upper airway obstruction from tonsillar hypertrophy is rare. Fulminant disease course of immunocompromised people are rare. Splenic rupture is rare. Myocarditis and pericarditis are rare. [en.wikipedia.org]

• Abdominal Pain

  The evaluation of a febrile patient with acute abdominal pain represents a frequent yet possibly challenging situation in the emergency department (ED). [ncbi.nlm.nih.gov]

  In children younger than 4 years, the infection is most often asymptomatic, but they may present with atypical symptoms (eg, irritability, failure to thrive, abdominal pain due to mesenteric adenopathy or splenomegaly, upper respiratory infection [URI [emedicine.medscape.com]

• Nausea

  AB - A 19-year-old man was admitted to hospital due to fatigue, nausea, abdominal pain and faint. He was pale and icteric, awake with sufficient respiration and circulation. [pure.au.dk]

  Symptoms of infectious mononucleosis include fatigue, fever, nausea, sore throat, cough, body aches, rash, photophobia, swollen lymph nodes in neck and armpits, and rarely, splenomegaly (enlarged spleen) and hepatomegaly (enlarged liver). [u.osu.edu]

  Symptoms of hepatitis include: jaundice, a yellowing of the skin and eyes intolerance to alcohol loss of appetite nausea The symptoms of jaundice and hepatitis should disappear as the person recovers from glandular fever. [medicalnewstoday.com]

  […] typically include: Fever Headaches Muscle aches Unusual fatigue, such as the need for 12 to 16 hours of sleep daily These symptoms are followed very shortly by: Sore throat Enlarged lymph nodes Chills Joint aches Loss of appetite and slight weight loss Nausea [drugs.com]

  Balfour 2007a listed the adverse events in a summary format: abdominal pain, headache, nausea, vomiting, rash. [doi.org]

• Loss of Appetite

  Common symptoms of mono include Fatigue Fever Sore throat Swollen lymph nodes, especially in the neck Body aches Loss of appetite Rash is another common symptom. [jamanetwork.com]

  The most common symptoms include excessive fatigue, headache, loss of appetite, sore throat, swelling of the tonsils, enlarged lymph nodes (swollen glands) in the neck, underarms, and groin. [infoplease.com]

  The onset of illness can be abrupt, but often will appear gradually over several days, with chills, sweats and loss of appetite. How is it spread? The virus is spread from person to person through saliva. [hnhu.org]

  Symptoms of hepatitis include: jaundice, a yellowing of the skin and eyes intolerance to alcohol loss of appetite nausea The symptoms of jaundice and hepatitis should disappear as the person recovers from glandular fever. [medicalnewstoday.com]

  You could develop a fever, fatigue, sore throat, swollen lymph nodes, or other symptoms, like sore muscles and a loss of appetite. Mono can cause different combinations of symptoms in different people. [webmd.com]

• Vomiting

  […] include: Fever Headaches Muscle aches Unusual fatigue, such as the need for 12 to 16 hours of sleep daily These symptoms are followed very shortly by: Sore throat Enlarged lymph nodes Chills Joint aches Loss of appetite and slight weight loss Nausea and vomiting [drugs.com]

  People with mono hepatitis tend to be sicker, and may require hospitalization, especially if they experience vomiting and dehydration. [lexingtonclinic.com]

  One day later, a sudden deterioration with fever up to 40 ° C, strong tension headache, dizziness, nausea and a single vomiting episode occurred. [lecturio.com]

  Differential Diagnosis of Infectious Mononucleosis Diagnosis Key distinguishing features Acute human immunodeficiency virus infection Mucocutaneous lesions, rash, diarrhea, weight loss, nausea, vomiting Cytomegalovirus infection Paired IgG serology shows [aafp.org]

  Moreover, there was no history of fluid loss through diarrhoea or vomiting. High bilirubin levels are frequently seen in cirrhosis and liver failure, which, in its decompensated state, can lead to the hepatorenal syndrome (HRS). [ncbi.nlm.nih.gov]

• Palatal Petechiae

  Infectious mononucleosis should be suspected in patients 10 to 30 years of age who present with sore throat and significant fatigue, palatal petechiae, posterior cervical or auricular adenopathy, marked adenopathy, or inguinal adenopathy. [ncbi.nlm.nih.gov]

  It should be suspected in patients presenting with sore throat, fever, tonsillar enlargement, fatigue, lymphadenopathy, pharyngeal inflammation, and palatal petechiae. [aafp.org]

  Palatal petechiae Occur transiently and not in every patient. Palatal petechiae Occur transiently and not in every patient. Tonsillar enlargement Replication of the Epstein Barr Virus occur mainly in B lymphocytes. [medicaljoyworks.com]

  Splenomegaly (50% of cases), fever, fatigue, malaise Pharyngitis and/or tonsillitis (reddened, enlarged tonsils covered in pus); palatal petechiae Bilateral cervical lymphadenopathy (especially posterior) that may become generalized and can, in severe [amboss.com]

  Other symptoms and signs include Splenomegaly Mild hepatomegaly and hepatic percussion tenderness Periorbital edema and palatal petechiae Less frequently maculopapular eruptions Rarely jaundice Splenomegaly, which occurs in about 50% of cases, is maximal [merck.com]

• Exudative Pharyngitis

  Pharyngitis may be severe, painful, and exudative and may resemble streptococcal pharyngitis. Adenopathy is usually symmetric and may involve any group of nodes, particularly the anterior and posterior cervical chains. [merck.com]

  Differential diagnosis Exudative pharyngitis is commonly confused with group A streptococcal pharyngitis. [patient.info]

• Tonsillar Exudate

  exudates, fever, and absence of cough are less likely than with streptococcal pharyngitis or infectious mononucleosis Table 1. [aafp.org]

• Jaundice

  We report a case of infectious mononucleosis in a 72-year old jaundiced gentleman with ferritin level of 2438 that normalised on clinical improvement. [ncbi.nlm.nih.gov]

  Uncommon severe complications include encephalitis and other neurologic manifestations, splenic rupture, airway obstruction due to tonsillar enlargement, hemolytic anemia, thrombocytopenia, and jaundice. [merck.com]

  Jaundice. A yellowing of your skin and the whites of your eyes (jaundice) also occurs occasionally. [mayoclinic.com]

• Hepatosplenomegaly

  Both cases involved young adults presenting with fever, pharyngitis, lymphadenopathy, hepatosplenomegaly, and atypical lymphocytosis confirmed by serologic tests, liver biopsy and electron microscopic study. [ncbi.nlm.nih.gov]

  Young adults (15-24) are more likely to be symptomatic. fever tonsillitis lymphadenopathy and splenomegaly occasionally hepatosplenomegaly fatigue occasionally: rash Complications splenic rupture: may be spontaneous splenic infarction 3 It was originally [radiopaedia.org]

• Hepatomegaly

  The patient showed severe hepatomegaly incidentally, and dual positivity of Immunoglobulin (Ig) M to Epstein-Barr virus (EBV) viral capsid antigen (VCA) and cytomegalovirus (CMV). [ncbi.nlm.nih.gov]

  Hepatomegaly Hepatomegaly is found in some patients, it is associated with deranged liver functions and intra hepatic cholestasis. [medicaljoyworks.com]

  […] usually not necessary, but certain findings on imaging can be suggestive: CT splenomegaly possible splenic rupture splenic infarction has been reported 3 generalized lymphadenopathy, including cervical lymphadenopathy tonsillar enlargement possible hepatomegaly [radiopaedia.org]

  Symptoms of infectious mononucleosis include fatigue, fever, nausea, sore throat, cough, body aches, rash, photophobia, swollen lymph nodes in neck and armpits, and rarely, splenomegaly (enlarged spleen) and hepatomegaly (enlarged liver). [u.osu.edu]

• Myalgia

  Fatigue, myalgias, and need for sleep may persist for several months after the acute infection has resolved. [ncbi.nlm.nih.gov]

  Headache, myalgia Because of the action of cytokines. Headache, myalgia Because of the action of cytokines. Neck or groin lumps Due to associated cervical and inguinal lymphadenopathy. [medicaljoyworks.com]

  Elderly patients with Epstein-Barr virus infection usually present with nonspecific complaints (eg, fever, fatigue, malaise, myalgias). [emedicine.medscape.com]

• Photophobia

  Symptoms of infectious mononucleosis include fatigue, fever, nausea, sore throat, cough, body aches, rash, photophobia, swollen lymph nodes in neck and armpits, and rarely, splenomegaly (enlarged spleen) and hepatomegaly (enlarged liver). [u.osu.edu]

  Other symptoms include cough, chest pain and photophobia. Older adults and elderly patients often have few throat symptoms or signs and have little or no lymphadenopathy. [patient.info]

• Skin Rash

  OBJECTIVE: To provide an extensive review of case reports, epidemiological data, and the underlying mechanism of antibiotic-induced skin rash in patients with concurrent infectious mononucleosis (IM). [ncbi.nlm.nih.gov]

  rash 42.1% (16) 35% (64) 30% (45) 33.3% (52) 30.3% (72) Skin rash in patients treated with antibiotics 55.6% (15/27) 45% (54/121) 33.3% (42/126) 37.7% (49/130) 32.9% (57/173) Skin rash in patients without antibiotics 9% (1/11) 16% (10/63) 13% (3/24) [omicsonline.org]

  They may find: Swollen lymph nodes in the front and back of your neck Swollen tonsils with a whitish-yellow covering Swollen liver or spleen Skin rash Blood tests will be done, including: White blood cell (WBC) count: will be higher than normal if you [medlineplus.gov]

• Petechiae

  In adolescent and adult patients presenting with sore throat, the presence of posterior cervical, inguinal or axillary adenopathy, palatine petechiae, splenomegaly, or atypical lymphocytosis is associated with an increased likelihood of mononucleosis. [ncbi.nlm.nih.gov]

  […] whereas the likelihood increases with the presence of posterior cervical adenopathy (summary specificity, 0.87; positive LR, 3.1 [95% CI, 1.6-5.9]), inguinal or axillary adenopathy (specificity range, 0.82-0.91; positive LR range, 3.0-3.1), palatine petechiae [doi.org]

  It should be suspected in patients presenting with sore throat, fever, tonsillar enlargement, fatigue, lymphadenopathy, pharyngeal inflammation, and palatal petechiae. [aafp.org]

  Fatigue and malaise may persist for several months after the acute infection has resolved. [ 6 ] Sore throat; tonsillar enlargement is common, classically exudative and may be massive; palatal petechiae and uvular oedema. [patient.info]

• Urticaria

  We describe a patient who developed generalized anhidrosis and cholinergic urticaria accompanied by heat intolerance after infectious mononucleosis infection. [ncbi.nlm.nih.gov]

  Skin signs of EBV infection There are a variety of uncommon skin conditions associated with EBV infection, including: Infantile papular acrodermatitis (Gianotti-Crosti syndrome) Erythema multiforme Erythema nodosum Urticaria including cold urticaria Urticarial [dermnetnz.org]

  Ampicillin and urticaria. Br Med J. 1969 Mar 29; 1 (5647):846–847. [ PMC free article ] [ PubMed ] [ Google Scholar ] Sarkany I. Clinical and laboratory aspects of drug allergy. [pubmedcentral.nih.gov]

  Less common clinical symptoms were also described such as erythema multiforme-like and herpetiform lesions, urticaria, petechiae, transient cold urticaria, immune-related thrombocytopenic purpura, erythema nodosum or pedunculated papule on the tongue. [omicsonline.org]

• Yellow Discoloration of the Skin

  Symptoms may include fever, swollen lymph glands in the neck, armpits, and groin, constant fatigue, sore throat, enlarged spleen, and jaundice, a yellow discoloration of the skin. Treatment includes rest and plenty of liquids. [hopkinsmedicine.org]

  discoloring of the skin and whites of the eyes due to abnormally high levels of bilirubin (bile pigmentation) in the bloodstream Once a person has had mononucleosis, the virus remains dormant in the throat and blood cells for the rest of that person's [urmc.rochester.edu]

• Pruritic Rash

  Fine macular non-pruritic rash, which rapidly disappears. Transient bilateral upper lid oedema. Lymphadenopathy, especially neck glands. Nausea and anorexia. [patient.info]

• Headache

  Common symptoms include: fever swollen lymph glands in the neck, armpits and groin extreme fatigue sore throat, which can make swallowing difficult swollen spleen or liver headache or body aches The symptoms usually last for about two to four weeks, but [childrenshospital.org]

  Although oral antibiotics or acetaminophen alone did not improve the deteriorating symptoms, including fever, headache and general fatigue, nonsteroidal anti-inflammatory drugs (NSAIDs), such as tiaramide or loxoprofen, completely improved the symptoms [ncbi.nlm.nih.gov]

  The most common symptoms of mono include: Fever Headache Extreme tiredness (fatigue) Swollen lymph glands in the neck, armpits, and groin Headaches and body aches Sore throat because of enlarged tonsils (tonsillitis). [stanfordchildrens.org]

  Symptoms Mono may begin slowly with fatigue, a general ill feeling, headache, and sore throat. The sore throat slowly gets worse. Your tonsils become swollen and develop a whitish-yellow covering. [mountsinai.org]

  Headache, myalgia Because of the action of cytokines. Headache, myalgia Because of the action of cytokines. Neck or groin lumps Due to associated cervical and inguinal lymphadenopathy. [medicaljoyworks.com]

• Guillain-Barré Syndrome

  The value of plasmapheresis in acute inflammatory demyelinating polyradiculopathy (Guillain—Barré syndrome) is well established. 2, 3 Variants of Guillain—Barré syndrome have been described in which cranial-nerve involvement is foremost; the most striking [nejm.org]

  CNS complications can include meningitis, encephalitis, hemiplegia, psychosis, cranial nerve palsies, Guillain-Barré syndrome, transverse myelitis, and peripheral neuritis. [emedicine.medscape.com]

• Cerebellar Ataxia

  Infectious mononucleosis (IM) complicated with a neurological manifestation, including acute cerebellar ataxia, Guillain-Barre syndrome, meningitis, encephalitis, cranial nerve palsies, optic neuritis or transverse myelitis, has been rarely reported; [ncbi.nlm.nih.gov]

  EBV can also cause many other diseases and conditions, including but not limited to: Viral meningitis Encephalitis Transverse myelitis Optic neuritis Paralysis of facial muscles or on one side of the body Acute Cerebellar Ataxia Guillain-Barre syndrome [americanpregnancy.org]

  "Post-infectious acute cerebellar ataxia in children". Clinical Pediatrics. 42 (7): 581–4. doi:10.1177/000992280304200702. PMID 14552515. ^ Toussirot E, Roudier J (October 2008). "Epstein-Barr virus in autoimmune diseases". Best Practice & Research. [en.wikipedia.org]

  Severe chronic active Epstein-Barr virus infection accompanied by virus-associated hemophagocytic syndrome, cerebellar ataxia and encephalitis. Psychiatry Clin Neurosci. 1998 Aug. 52(4):449-52. [Medline]. Ziegler JL, Drew WL, Miner RC, et al. [emedicine.medscape.com]

• Peripheral Neuropathy

  Neurologic complications are rare but may include encephalitis, seizures, Guillain-Barré syndrome, peripheral neuropathy, viral meningitis, myelitis, cranial nerve palsies, and psychosis. [merck.com]

  A diagnosis of acute symmetrical sensorimotor peripheral neuropathy (Guillain-Barré syndrome) was made. The results of CSF cultures were negative. [dx.doi.org]

• Cranial Nerve Involvement

  The value of plasmapheresis in acute inflammatory demyelinating polyradiculopathy (Guillain—Barré syndrome) is well established. 2, 3 Variants of Guillain—Barré syndrome have been described in which cranial-nerve involvement is foremost; the most striking [nejm.org]

The diagnosis of infectious mononucleosis may be suspected on clinical presentation, but confirmation requires some type of laboratory study. Over the years several tests have been developed to identify antibodies to EBV in serum [6] [7].

The test most commonly performed is the latex agglutination assay which identifies heterophile antibodies (Monospot test). These antibodies often peak 14 to 40 days after an infection and may be detectable in blood for 12 months, albeit at low levels. It is important to be aware that the Monospot test may be negative when performed right after the infection but the test does start to become positive over the next several weeks. There are some patients who will have a negative Monospot test and yet manifest symptoms of mononucleosis, these individuals should be considered as having heterophile-negative infectious mononucleosis after further examination. It is also important to note that falsely positive Monospot tests may occur in people with rubella, toxoplasmosis and certain malignancies like lymphoma and leukemia.

Other blood work

Patients with suspected infectious mononucleosis may require other blood tests that are not specific for mononucleosis but can help eliminate other causes. Blood work often done includes:

• Complete blood count (CBC) and white cell count. Leukocytosis is a common feature of infectious mononucleosis and absence of this should suggest an alternative diagnosis. Lymphocytosis and thrombocytopenia alone are not confirmative for infectious mononucleosis because such a finding can be seen with many other noninfectious causes (malignancies) and viral infections. Anemia is not a common presentation of infectious mononucleosis and hence, if present, should suggest an alternate diagnosis.
• Erythrocyte sedimentation rate (ESR) is often elevated in patients with infectious mononucleosis but is usually within normal limits in patients with group A streptococcal pharyngitis. However, ESR alone is a very nonspecific finding as it may be elevated in many other disorders, besides infections.
• Blood smear may reveal lymphocytosis.
• Liver function tests may reveal increase in serum transaminases, but such elevations can also be seen in patient with viral hepatitis.
• Throat culture is rarely done in patients with infectious mononucleosis as the yield for group A streptococci is very low. Even presence of group A streptococci from the throat is not diagnostic because of colonization.

Other studies

• Patients with neurological symptoms may have CNS involvement and some type of imaging study is recommended. A CT scan or an MRI should be performed to rule out other causes.
• Patients who present with neurological signs and symptoms with infectious mononucleosis should also undergo a lumbar puncture. The fluid obtained should be sent for culture, biochemistry and serological studies.
• If the patient has seizures or any seizure like activity, an EEG may help rule out other causes of encephalitis.
• In the rare patient in whom the diagnosis is not clear, a lymph node biopsy may be required. Because aspiration of a lymph node has very low yield a small open biopsy is required. Enough tissue must be obtained to rule out a lymphoma. If infectious mononucleosis is the cause, the history will reveal predominantly lymphocytic infiltration in the peripheral regions of the lymph node.

• Thrombocytopenia

  They include Granulocytopenia Thrombocytopenia Hemolytic anemia Transient mild granulocytopenia or thrombocytopenia occurs in about 50% of patients; severe cases, associated with bacterial infection or bleeding, occur less frequently. [merck.com]

  Corticosteroids may have a role in hastening resolution of some complications, especially upper airway obstruction and possibly immune-mediated anemia and thrombocytopenia, but should be used judiciously. [oadoi.org]

• Lymphocytosis

  An atypical lymphocytosis of at least 20 percent or atypical lymphocytosis of at least 10 percent plus lymphocytosis of at least 50 percent strongly supports the diagnosis, as does a positive heterophile antibody test. [ncbi.nlm.nih.gov]

  Characterized by the classic triad of fever, pharyngitis, and lymphadenopathy, along with atypical lymphocytosis. Often subclinical in young children. [us.bestpractice.bmj.com]

  The presence of atypical lymphocytosis significantly increases the likelihood of mononucleosis (summary LR, 11.4 [95% CI, 2.7-35] for atypical lymphocytes ≥10%, 26 [95% CI, 9.6-68] for those with 20%, and 50 [95% CI, 38-64] for those with 40%). [doi.org]

• Monocytosis

  전염성 단핵구증 Infectious mononucleosis [현재위치]: 홈>임상의학>감염병학>바이러스 질환>전염성단핵구증(infectious mononucleosis) 검사 Positive EBV titers(IgG or IgM) (100%) Relative and absolute lymphocytosis(70%) Atypical monocytosis(90%) Elevated Liver function test(90%) Positive heterophil [clinicclinic2.cafe24.com]

  For excessive monocyte counts more generally, see monocytosis. [en.wikipedia.org]

• Neutropenia

  A mild transient neutropenia occurring during the first weeks of acute infection is a common finding however in rare cases a more profound neutropenia and agranulocytosis may occur up to 6weeks following the onset of initial symptoms. [ncbi.nlm.nih.gov]

  (infectious mononucleosis) 검사 Positive EBV titers(IgG or IgM) (100%) Relative and absolute lymphocytosis(70%) Atypical monocytosis(90%) Elevated Liver function test(90%) Positive heterophil antibodies(90%) Thrombocytopenia(50%) Relative and absolute neutropenia [clinicclinic2.cafe24.com]

  Pfeiffer‘s glandular fever in lab Significant lab results for infectious mononucleosis are: Absolute und relative leukocytosis (> 4000/ml and > 50% of leukocytes) with > 10% atypical large T-cells ( Pfeiffer cells, fibrocytes) Mild anemia, neutropenia [lecturio.com]

  In the more severe cases, corticosteroids may be tried to hasten recovery.1 Mild neutropenia is common, but neutrophils below 1,000 cells/mm3 are present in 3% of cases, lasting from a few days to two weeks.16 Fatigue: The first two to four weeks of illness [uspharmacist.com]

  PubMed Google Scholar Wood MJ: Viral infections in neutropenia-current problems and chemotherapeutic control. J Antimicrob Chemother. 1998, 41: 81-93. 10.1093/jac/41.suppl_4.81. [dx.doi.org]

• Leukopenia

  Leukopenia and thrombocytopenia are not uncommon. The syndrome of IM may also be attributable to other infectious diseases, eg, cytomegalovirus (CMV), human herpes virus-6 (HHV-6), or Toxoplasma gondii. [ncbi.nlm.nih.gov]

• Leukocytosis

  Sprunt, Frank Alexander Evans (1889-1956): Mononuclear leukocytosis in reaction to acute infection (infectious mononucleosis). Bulletin of the Johns Hopkins Hospital, Baltimore, 1920, 31: 410-417. [whonamedit.com]

  Laboratory findings often prove critical to the screening of atypical infectious mononucleosis, which is consistent with the observation that infectious mononucleosis was originally described as “mononuclear leukocytosis” in children [15]. [academic.oup.com]

  Pfeiffer‘s glandular fever in lab Significant lab results for infectious mononucleosis are: Absolute und relative leukocytosis (> 4000/ml and > 50% of leukocytes) with > 10% atypical large T-cells ( Pfeiffer cells, fibrocytes) Mild anemia, neutropenia [lecturio.com]

  Leukocytosis is a common feature of infectious mononucleosis and absence of this should suggest an alternative diagnosis. [symptoma.com]

  Mononuclear leukocytosis in reaction to acute infection (infectious mononucleosis). Bulletin of the Johns Hopkins Hospital. Baltimore, 1920;31:410-417. ^ "Historical Timeline | Yale School of Public Health". publichealth.yale.edu. [en.wikipedia.org]

The majority of patients with infectious mononucleosis are managed as outpatients. The few patients who are ill looking and have enlarged tonsils, should be admitted for observation. There is a potential for airway compromise and hence, these patients should be admitted for close monitoring of the respiratory status for a period of 24 to 48 hours. If tonsillar enlargement is moderate to severe, an ENT consult should be made. In addition, anesthesia must also be notified about such an admission, in case there is a need for emergent intubation. At the bedside, an emergency tracheostomy must be available. All healthcare workers should be told to avoid oral cavity examination to prevent irritation of the tonsils that can potentially aggravate the respiratory distress. Admitted patients should have an intravenous line and oxygen if the saturation is below 94% at room air. If wheezing is present, bronchodilator therapy may be required. The decision to administer steroids rests on the severity. Some physicians do administer a short course of IV steroids to decrease the inflammation.

Surgery is required when patients present with rupture of the spleen. The diagnosis is often made with a CT scan. Attempts to salvage the spleen are often undertaken but if preservation is not possible, a splenectomy is performed.

Patients who are stable and have no airway compromise can resume a regular diet. In general, patients with infectious mononucleosis are told to refrain from physical activity for at least 3 to 4 weeks to ensure that splenic rupture does not occur. Those patients admitted for observation are only discharged when the tonsillar swelling has subsided and the patient is able to tolerate a diet. Following discharge patients need to be monitored to ensure that there is resolution of the symptoms. Patients should be warned that prolonged fatigue may occur [8] [9].

For the majority of patients with infectious mononucleosis, the prognosis is excellent.

• Both central nervous system (CNS) involvement and airway obstruction are rare events and only anecdotal case reports exist. When managed appropriately these individuals have an excellent prognosis.
• Those patients who have an enlarged spleen have a risk of rupture and should avoid all physical activity until the gland size returns to normal. Splenic rupture has been reported in the literature but is not a common complication. Even if spleen rupture occurs, the prognosis is good if the patient is able to get to an emergency room and undergo surgery. All patients who have the spleen removed are at risk for the postsplenectomy sepsis. These patients need to be monitored closely.
• Patients with neurological signs also fully recover. However, a few patients with infectious mononucleosis may develop prolonged fatigue that may last a few months or even years.
• Death following infectious mononucleosis is very rare and even when it occurs is due to comorbidity like a malignancy.
• In patients who are immunocompromised, liver infection with EBV can lead to necrosis and death.
• There are also reports suggesting that patients who undergo solid organ transplants may be at risk for developing a lymphoproliferative disorder induced by EBV. Other EBV associated malignancies reported in the literature include nasopharyngeal cancer, Burkitt lymphoma and leiomyosarcoma which may occur in immunocompromised individuals.

The cause of infectious mononucleosis is acquisition of EBV from an infected individual. Individuals with infectious mononucleosis develop oral and nasal secretions that persist for many months after the symptoms have subsided. These secretions tend to have a high concentration of the virus. Individuals at highest risk for acquiring infectious mononucleosis are those who have immunosuppression from malignancies, chemotherapeutic agents, human immunodeficiency virus (HIV) infection or congenitally acquired immune deficiency syndromes. Children who develop Burkitt lymphoma which is also caused by EBV, are also at risk for development of infectious mononucleosis.

Infectious mononucleosis is a global viral infection that is known to occur in people of all ages but is most common in teenagers and adolescents. Studies show that seroconversion is quite common before the age of five, but not all individuals develop clinical disease. However, teenagers and young adults who seroconvert often develop infectious mononucleosis.

The viral infection occurs in all races and in both genders. Because the infection is mild in many cases, most people do not come to medical attention. Hence exact numbers of people with infectious mononucleosis remains unknown, but the numbers are high.

EBV is acquired after a person comes into contact with body secretions from an infected individual. Patients with infectious mononucleosis often develop profuse oral and nasal secretions with a high concentration of the virus. The virus is also known to be shed from the epithelial lining of the cervix, which suggests that it may be contracted during unprotected sex. There are also reports of EBV present in donated blood from patients with infectious mononucleosis, thus suggesting that it can be acquired via a blood transfusion [4].

Once EBV enters the systemic circulation, it has an affinity for the reticular endothelial system such as the lymph nodes, liver and spleen. Here the virus induces an immune response with proliferation of B and T lymphocytes [5]. It is this cellular response that governs the clinical expression of symptoms after EBV infection. If the cellular response is intense, the virus will be killed and only a mild infection is seen. In immunocompromised people the virus is freely able to divide and hence produces a marked systemic response. The fever seen in infectious mononucleosis is due to the release of various cytokines that occurs as a result of lymphocytes attacking the EBV. The pharyngitis occurs because of infiltration and proliferation of the infected B lymphocytes in the lymphatic tissue in the pharynx.

The only way to prevent infectious mononucleosis is to avoid close contact with people who are already infected. This means avoiding contact with all body fluids, especially oral and nasal secretions since they harbor high concentrations of the virus. Washing hands frequently is also recommended. One needs to avoid using all personal care items from an infected person. Patients with infectious mononucleosis should avoid physical activity for 3 to 4 weeks to prevent splenic rupture.

Infectious mononucleosis is a common viral infection known to cause fever, pharyngitis and localized adenopathy. The disorder is caused by the Epstein Barr virus (EBV), which is acquired after contact with an infected individual. Blood work usually reveals presence of lymphocytosis and the diagnosis is confirmed with the Monospot test. The infection is common globally and often presents in teenagers and young adolescents. In the majority of cases, infectious mononucleosis presents with mild symptoms that are often mistaken for the common cold or streptococcal pharyngitis. The symptoms in children are mild whereas the symptoms in adults tend to be quite pronounced [1] [2] [3].

Infectious mononucleosis is a viral infection of the throat that presents with fever and swelling of the lymph nodes. While the infection is mild in most people, it can sometimes cause breathing difficulties, which requires admission to the hospital. Some patients may require a tube down the throat for a few days so that they can breathe. The virus can also cause enlargement of the spleen, which in some cases ruptures [10]. This often requires emergent surgery. Overall, the outcome of most patients with infectious mononucleosis is excellent. A few patients may develop prolonged fatigue for a few months or even years.

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