Infectious mononucleosis (glandular fever)
Victorian statutory requirement
Notification and school exclusion are not required.
Infectious agent
Epstein-Barr virus (EBV) is the causative agent.
Identification
Clinical features
EBV is an acute viral infection affecting mainly young adults. Clinical features include fever, generalised lymphadenopathy and a sore throat that usually is an exudative pharyngotonsillitis.
Splenomegaly occurs in 50% of patients ;patients and jaundice in 4%. 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 the chronic fatigue syndrome.
Herpes virus 6, cytomegalovirus or toxoplasmosis may cause a syndrome resembling glandular fever, both both clinically and haematologically.
Method of diagnosis
Diagnostic ELISA IgG and IgM antibody testing can be conducted on sera. A full blood examination characteristically shows mononucleosis and a lymphocyte count of 50% or more. PCR testing is available foravailable for CSF or tissue specimens through VIDRL. Virus can also be isolatedbe isolated from throatfrom throat swabs or nasopharyngealor nasopharyngeal aspirates.
ELISA IgG for nuclear antigen,antigen takes two to three months to become positive.
Incubation period
The incubation period is from four to six weeks.
Public health significance & occurrence
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 and is most commonly seen in high school and university students. Only 50% of those infected will develop clinical disease.
Epstein-Barr virus appears to play a causative rolecausative role in:
- Burkett’s lymphoma which is a monoclonal tumor of B cells hyperendemic in highly malarious zones of the world
- nasopharyngeal carcinoma, particularly among groups from China and Taiwan
- hairy cell leukemia.
Reservoir
Humans.
Mode of transmission
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
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 & resistance
Everyone is susceptible to infection. Infection confers a high degree of resistance. Reactivation of EBV may occur in immunosuppressed individuals.
Control measures
Preventive measures
There is no vaccine 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.
Control of contacts
Not applicable.
Control of environment
Not applicable.
Special settings
People with active EBV infection should not visit people receiving organ transplants including bone marrow.
Outbreak measures
Not applicable.
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