Infectious mononucleosis (glandular fever)

Notification requirement for infectious mononucleosis (glandular fever)

Notification is not required.

Primary school and children’s services centre exclusion for infectious mononucleosis (glandular fever)

Primary school and children’s services centres exclusion is not required.

Infectious agent of infectious mononucleosis (glandular fever)

Epstein–Barr virus (EBV) is the causative agent.

Identification of infectious mononucleosis (glandular fever)

Clinical features

Infectious mononucleosis (glandular fever) is an acute viral infection affecting mainly young adults. Clinical features include fever, generalised lymphadenopathy and a sore throat that is usually an exudative pharyngotonsillitis.

Splenomegaly occurs in 50 per cent of patients and jaundice in 4 per cent. In young children, the disease is mild or asymptomatic. The duration of symptoms varies from one to several weeks. A variety of uncommon complications have been described, and fatalities are exceedingly rare. A chronic form of the disease is suggested as one of the causes of chronic fatigue syndrome.

Human herpesvirus 6, cytomegalovirus, toxoplasmosis and acute HIV infection may cause a syndrome resembling glandular fever both clinically and haematologically.

Diagnosis

Diagnostic enzyme-linked immunosorbent assay (ELISA) IgG and IgM antibody testing can be conducted on serum. A full blood examination characteristically shows mononucleosis and a lymphocyte count of 50 per cent or more. Polymerase chain reaction (PCR) testing is available for cerebrospinal fluid or tissue specimens through the Victorian Infectious Diseases Reference Laboratory. Virus can also be isolated from throat swabs or nasopharyngeal aspirates.

ELISA IgG for nuclear antigen takes 2–3 months to become positive.

Incubation period of Epstein–Barr virus

The incubation period is 4–6 weeks.

Public health significance and occurrence of infectious mononucleosis (glandular fever)

Occurrence is worldwide and widespread in early childhood in developing countries. In developed countries, the age of infection is delayed until older childhood or young adulthood. The infection is most commonly seen in high-school and university students. Only 50 per cent of those infected will develop clinical disease.

EBV appears to play a causative role in:

• Burkitt’s lymphoma, which is a monoclonal tumour of B cells that is hyperendemic in highly malarious zones of the world
• nasopharyngeal carcinoma, particularly among groups from China and Taiwan
• hairy cell leukaemia
• post-transplant lymphoproliferative disorders.

Reservoir of Epstein–Barr virus

Humans are the reservoir.

Mode of transmission of Epstein–Barr virus

EBV is transmitted by person-to-person spread by the oropharyngeal route via saliva, classically by ‘tongue kissing’. Young children may be infected by saliva on the hands of attendants or on toys.

Period of communicability of infectious mononucleosis (glandular fever)

The period of communicability is prolonged. Pharyngeal excretion may persist for a year or more after infection. Twenty per cent or more of EBV antibody–positive healthy adults are long-term oropharyngeal carriers.

Susceptibility and resistance to infectious mononucleosis (glandular fever)

Everyone is susceptible to infection. Infection confers a high degree of resistance. Reactivation of EBV may occur in immunosuppressed individuals.

Control measures for infectious mononucleosis (glandular fever)

Preventive measures

No vaccine is available. Basic hygiene can help prevent many diseases, including glandular fever. Teach children not to share spoons, forks, cups, soft drink cans or sports water bottles. Adults should not share personal items such as glasses, cigarettes, lipstick or other items that may be covered in saliva.

Control of case

Isolation is not necessary. There is no treatment, and antibiotics are not indicated and may cause a rash, particularly amoxicillin. Avoidance of contact sports in the period following infection is advised because of the risk of splenic injury due to inflammation and swelling.

Control of contacts

Not applicable.

Control of environment

Not applicable.

Outbreak measures for infectious mononucleosis (glandular fever)

Not applicable.

Special settings

People with active EBV infection should not visit people receiving organ, including bone marrow, transplants.