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EPSTEIN–BARR MONONUCLEOSIS (EBM)
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EBM (infectious mononucleosis, glandular fever) is a febrile illness caused by the herpes (Epstein–Barr) virus. It can mimic diseases such as HIV primary infection, streptococcal tonsillitis, cytomegalovirus, toxoplasmosis, viral hepatitis and acute lymphatic leukaemia.
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It may occur at any age but usually between 10–35 yrs, commonest in 15–25 yr olds. Affects >95% of the population worldwide.
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DxT: sore throat + fever + lymphadenopathy ± rash (also malaise, anorexia)
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WCC—absolute lymphocytosis
Blood film—atypical lymphocytes
+ve Paul–Bunnell test/monospot test
EBV specific viral capsule antigen (IgM, IgG) antibodies (most reliable)
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Prognosis EBM usually runs an uncomplicated course over 6–8 wks. Major symptoms subside within 2–3 wks. Patients should be advised to take about 4 wks off work.
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Common complications are antibiotic-induced skin rash, hepatitis, depression, prolonged debility.
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Supportive measures (no specific treatment)
Rest (the best treatment) during the acute stage, preferably at home and indoors
NSAIDs or paracetamol to relieve discomfort
Gargle soluble aspirin or 30% glucose to soothe the throat
Advise against: alcohol, fatty foods, continued activity, esp. contact sports
Corticosteroids reserved for various complications (e.g. neurological)
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Be cautious of giving penicillins, esp. ampi/amoxicillin in misdiagnosed cases of EBM tonsillitis. It may precipitate a severe rash.
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Post-EBM malaise Some young adults remain debilitated and depressed for some months. Lassitude and malaise may extend up to a year or so.