Abstract Four atypical cases of presumed infectious mononucleosis (IM) encephalitis are presented. [pediatrics.aappublications.org]

Otorhinolaryngologic presentations of infectious mononucleosis. Pediatr Clin North Am 1981;28:1011–1016. This review focuses on ear, nose, and throat presentations of infectious mononucleosis. [medtextfree.wordpress.com]

Background: The purpose of this series is to present a classic case in a board-style examination question format. [jaoa.org]

If present, additional medical attention may be necessary until the condition improves or resolves. This may result in a hospitalization lasting days to weeks. [verywell.com]

Although uncommon, uvular edema has important diagnostic significance when present. [emedicine.medscape.com]

• Cervical Lymphadenopathy

  An eight year old white boy developed meningeal signs, intermittent coma, opisthotonos, extensor spasms, mild papilledema and hyperpyrexia two weeks after the onset of a sore throat and cervical lymphadenopathy. [pediatrics.aappublications.org]

  He presented with cervical lymphadenopathy and hepatosplenomegaly. [bmcmedimaging.biomedcentral.com]

  Cervical lymphadenopathies in children: A prospective clinical cohort study. Int J Pediatr Otorhinolaryngol. 2016;82:81-7. [hopkinsguides.com]

  Epstein-Barr Virus Primary EBV infection may be asymptomatic, present as a nonspecific febrile illness, or classically, as the infectious mononucleosis syndrome with cervical lymphadenopathy, exudative pharyngitis, and splenomegaly. [clinicalgate.com]

• Chronic Fatigue Syndrome

  "What Causes Prolonged Fatigue after Infectious Mononucleosis and Does It Tell Us Anything about Chronic Fatigue Syndrome?" J Infect Dis. 2007;196 (1):4-5. [verywell.com]

  References 1 Primary healthcare provision and Chronic Fatigue Syndrome: a survey of patients' and General Practitioners' beliefs., BMC Fam Pract, 2005, vol. 6 pg. 49 2 An empirical delineation of the heterogeneity of chronic unexplained fatigue., Pharmacogenomics [academic.oup.com]

  New research shows the first “robust” evidence that chronic fatigue syndrome (CFS) — medically known as myalgic encephalomyelitis (ME) — is a physical disorder that may be kick-started by an infection. [healthline.com]

  One of the disorders is Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. Researchers are unsure if EBV is the cause or result of the immune dysfunction associated with CFS/ME. [wellnessresources.com]

  EBV not an acknowledged cause of Chronic Fatigue Syndrome, but fatigue is common following infectious mononucleosis. Chronic active EBV (CAEBV, rare): pancytopenia, chronic LN, pneumonitis, abnormal LFTs > 8wks. [hopkinsguides.com]

• Malaise

  A 16-year-old, previously healthy girl presents with a several-day history of fever, sore throat, and malaise. She appears very tired and has a temperature of 39°C. [nejm.org]

  Mononucleosis, formally infectious mononucleosis or glandular fever, infection in humans, caused by the Epstein-Barr virus (EBV), whose most common symptoms are fever, general malaise, and sore throat. [britannica.com]

  This virus may be transmitted in urine and genital secretions. 5 Signs and symptoms Usually beginning 4 to 8 weeks after infection, common signs and symptoms of infectious mononucleosis include malaise, anorexia, fever, pharyngitis, periorbital edema, [journals.lww.com]

  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]

  Abstract Background A 12-year-old boy presented to a community hospital with fever, malaise and fatigue. A polymerase chain reaction test of the cerebrospinal fluid was positive for Epstein–Barr virus. [nature.com]

• Hodgkin Lymphoma

  They have established a link with many disorders including certain types of cancers such as Hodgkin’s lymphoma, a wide variety of B-cell lymphomas, some T-cell lymphomas, nose-throat cancer, and some gastric cancers. [wellnessresources.com]

  Nasopharyngeal cancer, Burkitt lymphoma (a type of non-Hodgkin lymphoma), and some types of Hodgkin's lymphoma are also associated with EBV. [emedicinehealth.com]

  Monomorphic PTLD: due to one cell type, and most common form of PTLD usually causing non-Hodgkin B-cell lymphoma but other types may occur. [hopkinsguides.com]

  Epstein-Barr virus-associated non-Hodgkin's lymphoma in HIV-infected patients. Leuk Lymphoma. 1995 Jan. 16(3-4):217-21. [Medline]. Herrod HG, Dow LW, Sullivan JL. [emedicine.medscape.com]

  Postural orthostatic tachycardia syndrome Chronic fatigue syndrome Cancers associated with the Epstein-Barr virus include: Burkitt's lymphoma, Hodgkin's lymphoma and lymphomas in general as well as nasopharyngeal and gastric carcinoma. [56] Once the acute [en.wikipedia.org]

• Streptococcal Pharyngitis

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

  Pharyngitis Pharyngitis is one of the cardinal manifestations of EBV infectious mononucleosis. Exudative pharyngitis may resemble streptococcal pharyngitis. [emedicine.medscape.com]

  Dramatic illness with dysphagia and “touching tonsils” should make the clinician consider streptococcal pharyngitis, even if the diagnosis of infectious mononucleosis has been confirmed. [medtextfree.wordpress.com]

  Ddx mononucleosis syndrome: includes Group A Streptococcal pharyngitis, acute CMV, acute HIV, toxoplasmosis, influenza, viral hepatitis, rubella, drug reactions. [hopkinsguides.com]

  pharyngitis (because of the symptoms of fever, pharyngitis and adenopathy ) and are given antibiotics such as ampicillin or amoxicillin as treatment. [ citation needed ] Other conditions from which to distinguish infectious mononucleosis include leukemia [en.wikipedia.org]

• Chills

  Sore throat, including white patches in the back of the throat Swollen lymph glands in the back of the neck, groin, and armpit Fatigue In addition to these classic symptoms, some children may also have one or more of the following signs and symptoms: Chills [healthychildren.org]

  Initial symptoms within the first three days may include chills, loss of appetite, and feelings of lack of energy or malaise. [onhealth.com]

  Loss of appetite, fatigue, chills, headache, bloating, sore muscles, body aches, weakness, and sweats are common. Dizziness is reported in some patients. [emedicinehealth.com]

  The initial symptoms of mono are a general lack of energy or malaise, fatigue, a loss of appetite, and chills. These initial symptoms can last from one to three days before the more intense symptoms of the illness begin. [medicinenet.com]

  The most common symptoms of mono are: Fever, which may range from 101°F (38.3°C) to 104°F (40°C), and chills. Sore throat, often with white patches on the tonsils (which may look like strep throat ). [northshore.org]

• Sore Throat

  Infectious mononucleosis is characterized by swollen lymph glands, fever, sore throat, and extreme fatigue. It’s often spread through contact with infected saliva from the mouth. [hopkinsmedicine.org]

  Gargle with salt water or use throat lozenges to soothe your sore throat. This is okay for children as long as they are old enough. [northshore.org]

  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]

  Painful, sore throat -- one of the most uncomfortable symptoms of mono -- is typically the worst during the first 5 to 7 days of the infection. Sore throat resolves and gets much better in the subsequent 7 to 10 days. [onhealth.com]

  Symptoms may include fever; swollen lymph glands in the neck, armpits, and groin; constant fatigue; sore throat; enlarged spleen; and liver inflammation. [massgeneral.org]

• Pharyngitis

  This virus may be transmitted in urine and genital secretions. 5 Signs and symptoms Usually beginning 4 to 8 weeks after infection, common signs and symptoms of infectious mononucleosis include malaise, anorexia, fever, pharyngitis, periorbital edema, [journals.lww.com]

  Pharyngitis Pharyngitis is one of the cardinal manifestations of EBV infectious mononucleosis. Exudative pharyngitis may resemble streptococcal pharyngitis. [emedicine.medscape.com]

  A 16-year-old girl is seen with fatigue, fever, pharyngitis, and lymphadenopathy. [jaoa.org]

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

  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. [msdmanuals.com]

• Dysphagia

  Dramatic illness with dysphagia and “touching tonsils” should make the clinician consider streptococcal pharyngitis, even if the diagnosis of infectious mononucleosis has been confirmed. [medtextfree.wordpress.com]

• Jaundice

  Physical examination showed jaundice and hepatomegaly. Neurological examination showed diplopia and obtundation (mild confusion). [gastrohep.com]

  Examination pearl: In adults with jaundice and no signs of sepsis, hepatitis, or malignancy, think of infectious mononucleosis. 1 Cohen JI. Epstein-Barr virus infection. N Engl J Med. 2000; 343 :481-492. 2 Cohen JL. [jaoa.org]

  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]

  Intense jaundice in infectious mononucleosis. Mayo Clin Proc 1973;48:857–862. This represents a clinical report of the association of severe jaundice with infectious mononucleosis. Hemolysis plus hepatitis is the likely explanation. [medtextfree.wordpress.com]

  In addition, involvement of the liver, as shown by chemical tests, is almost universally present, although severe disease of the liver with jaundice is rare. [britannica.com]

• Hepatomegaly

  Physical examination showed jaundice and hepatomegaly. Neurological examination showed diplopia and obtundation (mild confusion). [gastrohep.com]

  There is an increase in mononuclear white blood cells and other atypical lymphocytes, generalized lymphadenopathy, splenomegaly, and occasionally hepatomegaly with hepatitis. [icd10data.com]

  […] weeks after infection, common signs and symptoms of infectious mononucleosis include malaise, anorexia, fever, pharyngitis, periorbital edema, and lymphadenopathy (which often involves the posterior cervical chain). 2 It may also be associated with hepatomegaly [journals.lww.com]

  Later signs include: Mild hepatomegaly and splenomegaly (splenic enlargement returns to normal or near normal usually within three weeks after the clinical presentation) with tenderness over the spleen. [patient.info]

• Confusion

  Your fever would continue to elevate, you would be confused, vomiting and very sensitive to light, have memory loss and extreme weakness. You would not be getting better. Mono can make you very very ill and it does take a while to get over. [drugs.com]

  When present, this more severe infection might cause additional symptoms, including: Confusion Intense headache Profound drowsiness Coma These complications occur very rarely. [verywell.com]

  Symptoms in mild cases of encephalitis usually include: fever headache poor appetite loss of energy a general sick feeling Serious cases of encephalitis can cause: a high fever severe headache nausea and vomiting stiff neck confusion personality changes [kidshealth.org]

  Neurological examination showed diplopia and obtundation (mild confusion). [gastrohep.com]

  Anicteric hepatitis is most likely to be confused with EBV infectious mononucleosis in elderly individuals who present with hepatitis. [emedicine.medscape.com]

• Neuralgia

  Whether these agents significantly decrease the incidence, duration, or severity of postherpetic neuralgia is uncertain. [clinicalgate.com]

  B0111Varicella encephalitis and encephalomyelitis B0181Varicella keratitis B0189Other varicella complications B019Varicella without complication B020Zoster encephalitis B021Zoster meningitis B0221Postherpetic geniculate ganglionitis B0222Postherpetic trigeminal neuralgia [cms.gov]

Limbic encephalitis is almost always associated with an underlying malignancy [9], but our patient did not have any known underlying malignancy and subsequent workup for malignancy was negative. [ijcasereportsandimages.com]

Infectious Mononucleosis Workup. Available online at http://emedicine.medscape.com/article/222040-workup. Accessed June 13, 2016. (Mar 2015) Womack, J. and Jimenez, M. American Association of Family Physicians. [labtestsonline.org]

• Enlargement of the Liver

  Other tissues presented no significant gross features related to the primary disease except for (1) rather consistent enlargement of the liver, (2) infrequent icterus, and (3) occasional cutaneous rash. [bloodjournal.org]

  This serious infection may lead to liver failure, decreases in the blood cells, or cancer and is often fatal. The incubation period of infectious mononucleosis ranges from 30 to 50 days. [healthychildren.org]

  Symptoms may include fever; swollen lymph glands in the neck, armpits, and groin; constant fatigue; sore throat; enlarged spleen; and liver inflammation. [massgeneral.org]

  Mono can be associated with an enlarged spleen and liver inflammation (hepatitis). One should avoid contact sports during active mono illness and during recovery because of the possibility that the spleen can rupture. [onhealth.com]

  Some people with mono become overly sensitive to light and about half develop enlargement of the spleen, usually two to three weeks after they first become sick. Mild enlargement of the liver may also occur. [encyclopedia.com]

Once we've approved your claim, you'll get the private treatment you need. 3 And we’ll pay for treatment After you've been treated, send us your invoices. [aviva.co.uk]

Before there can be effective treatments for CFS, there must be a better understanding of CFS so it can be diagnosed earlier. [healthline.com]

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you. Know why a new medicine or treatment is prescribed, and how it will help you. [massgeneral.org]

The prognosis in children has been uniformly favorable with little or no neurologic residuals. [pediatrics.aappublications.org]

The prognosis seems to be good when treated early. Keywords: Ebstein-Barr virus, encephalitis, positive EBV specific PCR on CSF, glucocorticoids, immunoglobulins. [thieme-connect.com]

Prognosis Usually asymptomatic or of short duration and self-limiting. [patient.info]

What Is the Prognosis? Most cases of infectious mononucleosis clear up in 1 to 3 weeks (although symptoms, particularly fatigue, can last for several additional weeks in some children). [healthychildren.org]

What Is the Prognosis for an Epstein-Barr Virus Infection? The prognosis for Epstein-Barr virus infection is good. Almost all people infected with EBV recover completely in about one to three months. [emedicinehealth.com]

To establish an etiologic diagnosis, Paul-Bunnell-Davidsohn heterophil titers (PBD), antibody titers to the antigens of the Epstein-Barr virus (EBV), and oropharyngeal excretion of EBV were determined. [pediatrics.aappublications.org]

In search of encephalitis etiologies: diagnostic challenges in the California Encephalitis Project, 1998-2000. Clin Infect Dis. 2003; 36(6): 731-42. PubMed Hunt G. Meningitis and encephalitis in adolescents. [arupconsult.com]

If necessary for confirmation of disease presence (ie, elevated liver enzymes of unknown etiology), the EBV-IgM (and/or CMV-IgM) test is the “gold standard.” [jaoa.org]

Diagnosis of EBV encephalitis can be challenging as clinical features are varied and overlap considerably with other etiologies of encephalitis. [ijcasereportsandimages.com]

It therefore seems that EBV infection, when it presents as IM, is a significant risk factor for CFS in adults, with the level of risk consistent with it playing some etiological role. [academic.oup.com]

Mady Hornig director of translational research at the Center for Infection and Immunity and associate professor of epidemiology at Columbia's Mailman School, said in a press release. [healthline.com]

The changing epidemiology of infectious mononucleosis? J Infect. 2002;45(2):107-9. [hopkinsguides.com]

However, approximately 10% of those with IM are not acutely infected with EBV and many of these have symptoms attributable to cytomegalovirus (CMV) infection. [ 1 ] IM is particularly common in adolescents and children. [ 2 ] Epidemiology Clinical infection [patient.info]

Bacterial cultures were negative for Mycobacterium tuberculosis and other pathogens which are epidemiologically relevant in our geographic area (e.i. Rickettsia conorii, Brucella spp ). [bmcmedimaging.biomedcentral.com]

This test is most useful as an epidemiologic tool and cannot define acute disease. Hematologic Manifestations Up to 3% of patients with infectious mononucleosis manifest hematologic abnormalities that can involve any primary marrow component. [medtextfree.wordpress.com]

Gene expression may perhaps help us identify pathways involved in the pathophysiology of complex syndromes such as CFS. [academic.oup.com]

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management. Neurotherapeutics. 2016; 13(3): 493-508. PubMed George BP, Schneider EB, Venkatesan A. [arupconsult.com]

Essentials of Pathophysiology: Concepts of Altered Health States. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008. 4. Centers for Disease Control and Prevention. Epstein-Barr virus and infectious mononucleosis. 5. [journals.lww.com]

View Article PubMed Google Scholar Maghzi AH, Marta M, Bosca I, Etemadifar M, Dobson R, Maggiore C, Giovannoni G, Meier UC: Viral pathophysiology of multiple sclerosis: A role for Epstein-Barr virus infection?. [bmcmedimaging.biomedcentral.com]

Some studies indicate that a person can spread the infection for many months, possibly up to a year and a half. [31] Pathophysiology [ edit ] The virus replicates first within epithelial cells in the pharynx (which causes pharyngitis, or sore throat), [en.wikipedia.org]

Can Encephalitis Be Prevented? The best way to prevent encephalitis is to avoid getting infected with the viruses or other germs that can cause it. Regular hand washing will help limit the spread of some of these germs. [kidshealth.org]

Prevention It is difficult to prevent the spread of this virus because people who have been infected can spread the virus for the rest of their lives. [healthychildren.org]

Is it possible to prevent mono? Since mono is spread from person to person, avoiding close personal contact with infected individuals and practicing excellent hygienic practices can help prevent transmission of the virus. [medicinenet.com]

Encourage patients to drink plenty of water to prevent dehydration. Isolation isn't necessary, but advise them to avoid intimate contact with others. [journals.lww.com]