Management of infectious mononucleosis

Infectious mononucleosis (IM) is a constellation of clinical features largely seen in adolescence and young adults. It is typified by pharyngitis, prominent cervical lymphadenopathy and high fevers. It therefore can be difficult to distinguish the disease from the far more common presentation of bacterial tonsillitis (BT). Epstein Barr Virus (EBV) causes IM in the majority of cases, and thus a distinguishing feature is an associated lymphocytosis, rather than the neutrophilia seen in BT. Along with the different aetiology and diagnostic pathways, there are a number of aspects of the disease that warrant further research. This thesis aims to investigate the epidemiology, diagnosis and management of the disease, as well as providing a review of a number of areas of controversy. IM is associated with a high lymphocyte count and recent publications have sought to exploit this as a screening tool. I examined 1000 laboratory results but found that the lymphocyte to white cell count alone was not sufficient to act as a screening tool in IM. IM tends to present as a more severe infection than BT, but there was no literature to collaborate what many physicians had noted. The admission rates to a tertiary hospital of both diseases were examined over a 20-year period. This allowed us to show that IM had a significantly longer hospital stay, providing evidence for the first time of the severity of the disease. As 90% of cases are viral in origin, antibiotics would unsurprisingly not usually have a role in the treatment of IM. However, the virally driven pharyngitis can lead to anaerobic overgrowth in the oral cavity contributing to the severity of the symptoms. carried out a randomised controlled trial to demonstrate a significant length of stay decrease in those treated with anaerobic antibiotics. Finally a comprehensive review of multiple controversial topics associated with IM was undertaken. I discussed subjects such as the association of IM with Multiple Sclerosis (MS), chronic fatigue, splenic rupture, and relationship with malignancies and treatment with steroids. Findings from this thesis may have important clinical implications in the epidemiology, diagnosis and management of infectious mononucleosis