Mononucleosis is commonly caused by Epstein Barr virus but can also be caused by other organisms like cytomegalovirus. It's classically known as the kissing disease due to its demographic of adolescent patients and its ability to be easily spread by saliva. Symptoms include characteristic weakness, malaise and a variety of potential complications including splenomegaly and lymphadenopathy.
Fever is a typical non-specific presentation of the illness.
The liver is commonly enlarged to some degree although hepatomegaly is often moderate compared to splenomegaly.
The spleen is enlarged in most cases and can be vulnerable to rupture although quite rare. Therefore, patients should be kept from heavy physical activity and contact sports for at least one month following initial infection or until splenomegaly has resolved.
Pharyngitis is a non-specific presentation of the viral illness and is often confused with strep throat.
Posterior cervical lymphadenopathy is the classic lymph node involvement pattern which can help differentiate this illness from others.
Atypical lymphocytes are lymphocytes that become large as a result of antigen stimulation. Atypical lymphocytes are common in infectious mononucleosis and can help identify disease.
Heterophile antibodies are positive in this disease which is the foundation of the Mono-spot test. It can take time to become positive because it takes time to create the antibodies. Therefore a negative test does not exclude the disease. The mono-spot test is classically positive in Epstein barr mononucleosis and negative in CMV mononucleosis.
Ampicillin is often given as treatment due to the similarity of clinical symptoms with strep pharyngitis. If a patient presents with a rash after taking ampicillin, suspect Epstein-barr mononucleosis.
Hodgkin's lymphoma is associated with 1 in 1,000 cases of mononucleosis.
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