Epsteinbarr virus adolescents and adults any infectious mononucleosis 80% cytomegalovirus adolescents and adults any heterophile antibodynegative mononucle osis 5 to 7%. Epsteinbarr virus ebv, the viral agent responsible for im, is a ubiquitous herpesvirus first described by epstein, achong, and barr in continuous cell lines derived from african burkitt lymphoma tissues. Epsteinbarr virus ebv is the most common cause of infectious mononucleosis, but other viruses can also cause this disease. Epsteinbarr virus infection results in a spectrum of diseases, with the host immune response playing a key role in shaping the clinical manifestations. Steroids are recommended for impending airway obstruction and hematological complications. After the fever is gone, the virus is still carried in the saliva for up to 6 months, but in small amounts. It manifests typically as fever, pharyngitis with petechiae, exudative pharyngitis, lymphadenopathy, hepatosplenomegaly, and atypical lymphocytosis. Serological response of the ebv antibodies in pediatric cases of infectious mononucleosis and in their contacts. A few cases are caused by a virus called cytomegalovirus cmv. Mono is usually a mild illness that goes away without treatment after several weeks. Rarely, infectious mononucleosis can cause life threatening airway obstruction from. Overall, mononucleosis is only slightly contagious from contacts. Between 1976 and 1982, 1 children aged 6 months to 16 years with documented epsteinbarr virusinduced infectious mononucleosis were studied prospectively, and in most instances serially.
Journal of pediatric infectious diseases volume 9, issue 4. In some cases, your childs doctor may also order tests to confirm a diagnosis, including a white blood cell count, heterophile antibody test or monospot test. The etiologic agent for infectious mononucleosis is epsteinbarr virus, although a. The spectrum of diseases is wide, ranging from asymptomatic to fatal infection. Frequently, symptoms include sore throat, malaise, fevers, lymphadenopathy, and abdominal pain. Epsteinbarr virus infectious mononucleosis in children. Ampicillin rash, a phenomenon unique to patients with epsteinbarr virus acute infectious mononucleosis aim treated with ampicillin, was.
Mononucleosis caused by epsteinbarr virus and cytomegalovirus in children. Infectious mononucleosis and other epsteinbarr viral infections. Epsteinbarr virus ebv, or human herpesvirus 4, is a gammaherpesvirus that infects more than 95% of the worlds population. Infectious mononucleosis in young children the american journal. Most people are infected by the virus as children, when the disease produces few or no symptoms. There is a plausible explanation for this lack of interest among pediatricians.
Common questions about infectious mononucleosis american. Infectious mononucleosis im is a common childhoodadolescent illness. Infectious mononucleosis im is characterized by a triad of fever, tonsillar pharyngitis, and lymphadenopathy. Initially, infectious mononucleosis can be diagnosed in an adolescent or adult on the basis of the typical symptomsfever, fatigue and malaise, swollen lymph nodes, and a sore throat. Infectious mononucleosis was recognized as a unique disease in the 1880s by nil filatov, a russian pediatrician, who called the syndrome idiopathic adenitis. Infectious mononucleosis mono is often called the kissing disease. Infectious mononucleosis in children symptoms and treatment. Convulsion as a presenting sign of infectious mononucleosis. Causes of infectious mononucleosis infectious mononucleosis is transmitted by exposure to saliva, so it can be spread by kissing, by sharing glasses or. Active immunization with live attenuated measles virus 2 dose schedule a. Most people become infected with ebv at some point in their lives. We have vast experience diagnosing and caring for common illnesses like infectious mononucleosis.
A handout on infectious mononucleosis, written by the author of this article, is provided on page 1289. Mononucleosis mono is an infectious disease caused most often by the epsteinbarr virus ebv. Epsteinebarr virusassociated infectious mononucleosis causing upper airway obstruction in a child with a history of adenoid hypertrophy. Professor, department of pediatrics, division of infectious disease, st. Pediatric infectious mononucleosis childrens national. Infectious mononucleosis at the united states military academy. Infectious mononucleosis im is a disease common among adolescents in the united states. Original article transient liver elastography profiles in. Infectious mononucleosis is the most common presentation of epsteinbarr virus ebv infection. We sought to establish the current incidence of rash associated with antibiotic.
Assistant professor, department of pediatrics, division of emergency medicine. Severe complications have been reported such as splenic rupture, acute upper airway obstruction, hepatitis, acute renal failure, and hematological and neurological complications. The infection is often asymptomatic, but some develop the clinical syndrome of infectious mononucleosis im. There are usually no complications, although it may take several weeks for. The virus that causes mono is transmitted through saliva, so you can get it through kissing, but you can also be exposed through a cough or sneeze, or by sharing a glass or food utensils with someone who has mono. Mononucleosis infectious infectious mononucleosis mon oh new klee oh siss, also known as mono, is an illness usually caused by the epsteinbarr virus ebv.
At least one out of four teenagers and young adults who get infected. Sep 01, 2011 epsteinbarr virus infection results in a spectrum of diseases, with the host immune response playing a key role in shaping the clinical manifestations. Pediatric mononucleosis and epsteinbarr virus infection. A twoyearold black child was brought to the emergency depart ment ed by his mother with a chief complaint of neck swelling. Pdf azithromycininduced rash in infectious mononucleosis. We integrate basic pediatric care services with stateoftheart treatment to meet the challenges posed by pediatric infectious diseases. Patients are infectious at the onset of symptoms through the first day of rash.
Approximately 95% of adults worldwide are infected with epsteinbarr virus ebv. Mar 15, 2015 approximately 95% of adults worldwide are infected with epsteinbarr virus ebv. The infection is often asymptomatic, but some develop the clinical syndrome of infectious mononucleosis. Infectious mononucleosis is the prototype ebv infection and is characterized by fever, sore throat, cervical and generalized lymphadenopathy, hepatosplenomegaly, and somatic complaints of. Classic physical findings include fever, splenomegaly, pharyngitis, and lymphadenopathy. Severe complications from infectious mononucleosis after. Dexamethasone for the treatment of infectious mononucleosis. Infectious mononucleosis mono is an infection that causes sore throat, fever, swollen glands, and tiredness or fatigue.
Epsteinbarr virus infectious mononucleosis in children i. Infectious mononucleosis is usually diagnosed based on symptoms and a physical exam. Ebv is in the herpes virus family, and is also known as human herpes virus type 4. Dec 05, 2018 epsteinbarr virus ebv, or human herpesvirus 4, is a gammaherpesvirus that infects more than 95% of the worlds population. Feb 27, 2015 identification of ebv as the cause of infectious mononucleosis. We now know that the characteristic atypical lymphocytes, carefully described morphologically by downey and. Infectious mononucleosis, also called mono, is a contagious disease. Pediatric infectious disease services uc davis health. Infectious mononucleosis is most contagious while your child has a fever. Epsteinbarr virus infections red book 2015 red book. Fibrotouch examinations were carried out in 357 pediatric patients aged 1. American academy of pediatrics textbook of pediatric care, 2nd edition.
In a study of families that have a childhood index case of infectious mononucleosis, seroconversion occurred in 34. Infectious mononucleosis etiology bmj best practice. Infectious mononucleosis is spread primarily through saliva, which is how it got the name the kissing disease. Epstein barr virus ebv, also known as human herpes virus 4, is the etiologic agent in approximately 80% to 90% of im cases. Infectious mononucleosis im, mono, also known as glandular fever, is an infection usually caused by the epsteinbarr virus ebv. Pediatric annals infectious mononucleosis im is a familiar disorder to physicians who treat adolescents. It is most commonly caused by the epsteinbarr virus ebv. Infectious mononucleosis forest hills pediatric associates. Like all herpesviruses, ebv stays within the body once a person is infected. Cases of infectious mononucleosis with only one exception were ebv seropositive in acute andor convalescent sera. Louis university school of medicine and cardinal glennon childrens hospital, st.
Infectious mononucleosis is the name coined by sprunt and evans in 1920 1 for an acute infectious disease consisting of fever, cervical lymphadenopathy and pharyngitis accompanied by atypical large peripheral blood lymphocytes. The complete blood count may show an uncommon type of white blood cells atypical lymphocytes, which can suggest infectious mononucleosis. Physical examination is significant for splenomegaly, tonsillar exudate, and posterior auricular lymphadenopathy. Incidence of rash after amoxicillin treatment in children. Pathophysiology and clinical presentation correct diagnosis. Symptoms vary but may include swollen lymph glands, sore throat, and tiredness. I nfectious mononucleosis is a clinical syndrome caused by epsteinbarr virus ebv that is particularly common in adolescents and children. Infectious mononucleosis is a clini cal syndrome caused by epsteinbarr virus ebv that is particularly com mon in adolescents and children. See page 1201 for definitions of strengthofrecommendation labels. Infectious mononucleosis is sometimes called mono or the kissing disease. The most common manifestation of primary infection with this organism is acute infectious mononucleosis, a selflimited clinical syndrome that most frequently affects adolescents and young adults.
Our childrens hiv clinic is recognized as a provider of diagnostic, therapeutic and support. Dexamethasone for the treatment of sore throat in children with suspected infectious mononucleosis. An unexpected finding was the large number of young children, less than 4 years old, with this disease. Ampicillin rash, a phenomenon unique to patients with epsteinbarr virus acute infectious mononucleosis aim treated with ampicillin, was first reported in the 1960s. It was initially described as drusenfieber or glandular fever in 1889, but the term infectious mononucleosis was later used in 1920 to describe six college students with a febrile illness characterized by absolute lymphocytosis and atypical mononuclear cells in. In young adults, the disease often results in fever, sore throat, enlarged lymph nodes in the neck, and tiredness. Many people who get mono do not even know they have it. Clinical and laboratory characteristics of infectious mononucleosis. This rapidly changing field requires specialized, innovative approaches to both common infections and more serious infectious diseases. Most adults in the united states have been exposed to the epsteinbarr virus, which is a very common virus. Yi jiang department of hematology, childrens hospital of shanghai, shanghai jiao tong university, shanghai, china. A retrospective study was conducted on all children from 0 to 15 years with igm against viral capsid of ebv positive or indeterminate during a 22 month period. Pathophysiology and clinical presentation correct diagnosis infectious mononucleosis is a highly contagious viral disease caused by the epsteinbarr virus ebv. Incidence of rash after amoxicillin treatment in children with infectious mononucleosis article pdf available in pediatrics 15 april 20 with 934 reads how we measure reads.
Pmc free article hallee tj, evans as, niederman jc, brooks cm, voegtly j h. It is common among teenagers and young adults, especially college students. Infectious mononucleosis im was first described in the russian medical literature in 1885. The pediatric specialists at the division of adolescent medicine at boston children s hospital provide comprehensive primary care to patients ages 10 to 23. It is caused most often by the epsteinbarr virus ebv, which is in the herpesvirus family of organisms. The skin lesions are nonspecific and the mechanisms causing them are. Infectious mononucleosis, or mono, is an infection usually caused by the epsteinbarr virus. Jun 06, 1970 the ebv antibodies were measured in 378 sera from a group of 129 pediatric and older cases of infectious mononucleosis and from 117 family and social contacts. The virus spreads through saliva, which is why its sometimes called kissing disease. Definition diagnostic findings severe sore throat swollen lymph nodes in the neck, armpits, and groin fever for 7 to 14 days enlarge spleen in 50% of children blood smear showing many atypical unusual lymphocytes positive blood test for mononucleosis. Epsteinbarr virusassociated infectious mononucleosis causing. The american pediatric literature has singularly few discussions on infectious mononucleosis, or glandular fever, though numerous authors in other fields have referred to the condition as primarily an infection of childhood.
Infectious mononucleosis in children is a polyethological disease caused by viruses from the herpesviridae family, which occurs with fever, angina, polyadenitis, enlargement of the liver and spleen, and the appearance of atypical mononuclear cells in the peripheral blood. The journal provides an indepth update on new subjects and current comprehensive coverage of the latest techniques in diagnosis and treatment of childhood infectious diseases. Neurologic manifestations of infectious mononucleosis in the adult are well documented. Chief of pediatrics, harrison medical center, bremerton, wa school health liaison washington chapter, american academy of pediatrics medical consultant to south kitsap school district. Pediatric infectious disease services treating common and uncommon diseases in children 150192 216 specialized clinical programs uc davis childrens hospital is the only pediatric hiv provider in sacramento county. However, steroids are commonly used in uncomplicated cases of im, with insufficient evidence on the efficacy of steroids for symptom control. It is also known as mononucleosis, mono, glandular fever, or the kissing disease.
Infectious mononucleosis boston childrens hospital. Pdf incidence of rash after amoxicillin treatment in. Hepatic fibrosis was assessed by liver stiffness measurement lsm and liver ste. Infectious mononucleosis is either caused by the epsteinbarr virus ebv or the cytomegalovirus, both of whom are members of the herpes simplex virus family. Antibioticinduced skin eruption in the setting of infectious mononucleosis is a common and welldocumented clinical scenario. Children with infectious mononucleosis, in particular the very young, tended to have more rashes. As a pediatrician, one of us hhb has seen numerous cases in children younger than 12 years old. Infectious mononucleosis american academy of pediatrics. Openurl1crossref2pubmed3web of science4 pharyngeal pain from infectious mononucleosis im can be severe and may persist. Peripheral hemophagocytosis in infectious mononucleosis. Serological response of the ebv antibodies in pediatric cases. Children with infectious mononucleosis, in particular the very young, tended to have more. While not nearly as contagious as influenza and other respiratory infections, studies indicate that the majority of college students develop antibodies to ebv by the time they graduate, indicating infection at some point.