Infectious mono-nucleosis, also known as glandular fever, is a common viral infection caused by the Epstein-Barr virus.
Symptomatic patients usually present with a classic triad of symptoms, including fever, pharyngitis, and lymphadenopathy.
IMN is transmitted via contact of body secretions, mainly oropharyngeal, and rarely genital secretions.
It can also be transmitted via blood transfusion and organ transplant.
However, these modes of transmission are very rare.
Upon entry to the respiratory tract, Epstein-Barr virus primarily infects B lymphocytes in the oropharyngeal mucosa, resulting in humoral & cellular immune responses against the virus.
T-lymphocyte response is extremely important in controlling the proliferation of infected B lymphocytes.
If the T-lymphocyte response is ineffective, it can lead to uncontrolled B-cell proliferation, which is associated with B-cell malignancies such as Burkitt lymphoma, Hodgkin’s lymphoma, and non-Hodgkin’s lymphoma.
Most patients with IMN are asymptomatic, or they display only a few symptoms.
As already mentioned, symptomatic patients usually have a classic triad of symptoms, including fever, lymphadenopathy, and pharyngitis.
Lymphadenopathy is always bilateral.
Pharyngitis may be associated with tonsillar enlargement, and palatal petechiae may also occur.
Sometimes patients will also have uvular edema.
Virtually all patients with IMN will have fatigue and malaise.
Additional symptoms may include the following.
Bone & muscle pain.
Cough and chest pain.
Nausea and loss of appetite without vomiting.
And rash, which is generalized, maculo-papular, and non-itchy.
The rash tend to appear early in the course of the disease.
Some late signs of IMN include Hepatosplenomegaly and Jaundice.
Some uncommon manifestations of IMN include the following.
Optic neuritis.
Transverse myelitis.
Meningitis & encephalitis.
Cranial nerve palsies.
Pancreatitis.
Myositis.
And glomerulo-nephritis.
Diagnosis of IMN is confirmed by heterophile antibody test or through Epstein-Barr virus specific antibodies in the serum.
Heterophile antibodies are antibodies that produced against poorly defined antigens.
And they react to antigens from animal red blood cells.
For example, in Paul Bunnel test, sheep red blood cells agglutinate in the presence of heterophile antibodies.
And in the monospot test, horse red blood cells agglutinate in the presence of heterophile antibodies.
Both these tests can be used to diagnose IMN.
In patients who have a negative heterophile test, or patients with prolonged illness, Epstein-Barr virus specific antibody testing can be done.
Additionally, complete blood count is useful in ruling out other conditions with a same clinical presentation.
It will show lymphocytosis and mild thrombocytopenia.
Peripheral blood smear will show atypical lymphocytes.
And ESR will also be elevated.
Treatment of IMN is mainly supportive and includes bed rest, adequate hydration, nutritional optimization, and temperature control.
It is important to monitor the patients closely because massive tonsillar enlargement can cause airway obstruction.
In that case, steroids are indicated to reduce inflammation.

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