Domina Conceptos Médicos

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Mononucleosis

La mononucleosis infecciosa, también conocida como "la enfermedad del beso", es una infección viral muy contagiosa causada por el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de Epstein-Barr. Su nombre común deriva de su principal método de transmisión: el contagio con saliva Saliva The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptyalin. Salivary Glands: Anatomy infectada a través de los LOS Neisseria besos. Las manifestaciones clínicas de la mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as "the kissing disease," is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis infecciosa incluyen fiebre, faringoamigdalitis y linfadenopatía. El diagnóstico es clínico y se confirma mediante pruebas de anticuerpos heterófilos o pruebas de anticuerpos serológicos específicos. En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la actualidad no existe una terapia antiviral Antiviral Antivirals for Hepatitis B específica para esta enfermedad.

Last updated: Jan 28, 2023

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Descripción General

Definición

La mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis infecciosa es una enfermedad infecciosa viral más frecuentemente causada por el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de Epstein-Barr ( EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés) y se caracteriza por una tríada de fiebre, faringoamigdalitis y linfadenopatía.

Sinónimos

  • Síndrome de mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis
  • Enfermedad de Pfeiffer o fiebre glandular de Pfeiffer
  • “Mono” o “enfermedad del beso”

Epidemiología

  • Un 90%–95% de prevalencia a lo largo de la vida a nivel mundial
  • Ocurre con más frecuencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum primavera y otoño
  • Los LOS Neisseria niños y adolescentes de 15–19 años son los LOS Neisseria más afectados
  • Una causa común de faringitis viral, especialmente entre los LOS Neisseria adultos jóvenes de Estados Unidos
  • La infección clínica es 30 veces mayor en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria estadounidenses blancos que en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria negros.

Etiología

El EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus pertenece al AL Amyloidosis grupo de los LOS Neisseria herpesvirus humanos (HHV-4, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés).

Fisiopatología

Patogenicidad

El EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus tiene una especificidad de especie excepcionalmente alta:

  • Se replica casi exclusivamente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células epiteliales humanas de la orofaringe y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria linfocitos B
  • No se han obtenido muestras en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el medio ambiente, lo que sugiere que su principal reservorio es el ser humano

Transmisión

La enfermedad se transmite principalmente por contacto con secreciones corporales, sobre todo orofaríngeas.

  • Infección por contacto directo: especialmente frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños a través de los LOS Neisseria padres, compañeros de juego, etc ETC The electron transport chain (ETC) sends electrons through a series of proteins, which generate an electrochemical proton gradient that produces energy in the form of adenosine triphosphate (ATP). Electron Transport Chain (ETC).
  • Infección indirecta: al AL Amyloidosis tocar objetos contaminados (por ejemplo, un vaso).
  • Infección por contacto:
    • Especialmente frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adolescentes, por saliva Saliva The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptyalin. Salivary Glands: Anatomy infectada al AL Amyloidosis besarse y compartir bebidas.
    • Los LOS Neisseria besos parecen ser una vía más importante que el coito.
  • Rara vez se propaga a través de transfusiones de sangre y trasplante de órganos debido al AL Amyloidosis uso de pruebas de amplificación de ácidos nucleicos (NAAT) de alta sensibilidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el tejido del donante.
  • La transmisión vertical del VEB parece ser la excepción más que la regla.

Enfermedad

  • Desde la orofaringe, el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology se propaga por todo el cuerpo:
    • Infecta:
      • Epitelios CD21 CD21 Molecular sites on or in B-lymphocytes, follicular dendritic cells, lymphoid cells, and epithelial cells that recognize and combine with complement C3D. Human complement receptor 2 (CR2) serves as a receptor for both C3dg and the gp350/220 glycoprotein of Human Herpesvirus 4 and binds the monoclonal antibody OKB7, which blocks binding of both ligands to the receptor. Epstein-Barr Virus positivos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orofaringe y las glándulas salivales
      • Linfocitos B
    • A continuación, los LOS Neisseria linfocitos infectados se infiltran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum otros tejidos linfoides de todo el sistema linforreticular.
  • Se desencadena una respuesta de células T citotóxicas → hiperplasia linfoide que se manifiesta como:
    • Amigdalitis
    • Linfadenopatía
    • Hepatoesplenomegalia
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la infección primaria por VEB, hay una producción masiva de:
    • Anticuerpos contra el VEB
    • Anticuerpos contra antígenos no relacionados (anticuerpos heterófilos)
    • Otros anticuerpos (e.g., contra plaquetas → trombocitopenia)
  • Tras la respuesta inmunitaria inicial, el VEB permanece en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una serie de linfocitos infectados (latencia):
    • La excreción oral suele persistir durante 6 meses después de la enfermedad y puede continuar de forma intermitente durante décadas.
    • Se ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia descubierto que el estado de portador crónico está relacionado con la fatiga crónica.
    • Reactivación:
      • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria individuos inmunocompetentes, los LOS Neisseria síntomas serían mínimos o inexistentes.
      • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos inmunocomprometidos, se produce una infección sintomática por VEB y/o se desarrolla una neoplasia maligna relacionada con el VEB.
Ciclo de infección del EBV

El virus de Epstein-Barr puede infectar tanto a los linfocitos B como a las células epiteliales orofaríngeas. El EBV entra en los linfocitos B uniéndose al receptor celular CD21, lo que permite la fusión de la envoltura viral con la membrana celular. El ciclo lítico da lugar a la producción de viriones infecciosos tanto en los linfocitos B como en las células epiteliales orofaríngeas. En los linfocitos B, la replicación lítica normalmente solo tiene lugar después de la reactivación tras la latencia, mientras que la replicación lítica en las células epiteliales orofaríngeas suele seguir directamente a la entrada viral. Durante la replicación lítica, la ADN polimerasa viral se encarga de sintetizar el genoma viral. Esto contrasta con la latencia, en la que la ADN polimerasa de la célula huésped copia el genoma viral. Sin embargo, durante la latencia no hay producción de viriones, ya que solamente se expresa una parte de los genes del EBV.

Imagen por Lecturio.

Presentación Clínica

  • Periodo de incubación: 4–8 semanas
  • Estadio prodrómico: suele ser asintomático (especialmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños < 10 años, de los LOS Neisseria cuales solo el 10% son sintomáticos) pero puede incluir malestar, cefalea y fiebre baja
  • Los LOS Neisseria síntomas se presentan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adolescentes y adultos, y duran entre 2–4 semanas.

Tríada clásica de síntomas

  1. Fiebre
  2. Amigdalitis (amígdalas agrandadas y eritematosas que pueden estar cubiertas de exudado)/ faringitis
  3. Linfadenopatía cervical
    • Más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las cadenas cervicales posteriores y auriculares posteriores
    • Usualmente simétrica
Mononucleosis infecciosa

Faringitis que presenta una amigdalitis exudativa y una úvula agrandada en un adolescente 5 días después del inicio de la mononucleosis infecciosa

Imagen: “Infectious mononucleosis” por University of Minnesota Medical School, Minneapolis, MN, USA. Licencia: CC BY 4.0

Síntomas adicionales

  • Cefalea
  • Malestar general que puede progresar a fatiga persistente y severa
  • Petequias presentes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la unión entre el paladar duro y el blando
  • Halitosis Halitosis An offensive, foul breath odor resulting from a variety of causes such as poor oral hygiene, dental or oral infections, or the ingestion of certain foods. Oral Cancer: aliento fétido
  • Hepato-, espleno-, o hepatoesplenomegalia
  • Aumento de volumen generalizado de los LOS Neisseria ganglios linfáticos (ganglios sensibles, firmes y móviles)
  • Erupción maculopapular Maculopapular Dermatologic Examination (similar al AL Amyloidosis sarampión, presente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum aproximadamente el 5% de los LOS Neisseria casos)

Síndrome de Hoagland:

  • Párpados superiores hinchados o edematosos: una manifestación única de la MI MI MI is ischemia and death of an area of myocardial tissue due to insufficient blood flow and oxygenation, usually from thrombus formation on a ruptured atherosclerotic plaque in the epicardial arteries. Clinical presentation is most commonly with chest pain, but women and patients with diabetes may have atypical symptoms. Myocardial Infarction aguda
  • Se desconoce la fisiopatología del signo de Hoagland, pero se cree que es el resultado de una infiltración linfocítica.

Síndromes neurológicos:

  • Peden aparecer 2–4 semanas después de la aparición de los LOS Neisseria síntomas iniciales
  • Puede incluir:
    • Síndrome de Guillain-Barré
    • Parálisis facial y de otros nervios craneales
    • Inflamación aséptica del cerebro, las meninges Meninges The brain and the spinal cord are enveloped by 3 overlapping layers of connective tissue called the meninges. The layers are, from the most external layer to the most internal layer, the dura mater, arachnoid mater, and pia mater. Between these layers are 3 potential spaces called the epidural, subdural, and subarachnoid spaces. Meninges: Anatomy y/o los LOS Neisseria nervios centrales y periféricos

Mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis crónica:

  • Rara, se debe a la replicación viral persistente (infección crónica, activa por EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus)
  • Presentación:
    • Fiebre crónica o recurrente
    • Fatiga
    • Pérdida de peso
    • Linfadenopatía
    • Citopenia
    • Neumonía intersticial
    • Hepatitis

Diagnóstico

El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria síntomas clínicos señalados anteriormente junto a las pruebas de confirmación.

  • Laboratorio:
    • Leucocitosis linfocítica absoluta y relativa (> 4 500/ml y > 50% de leucocitos) con > 10% de linfocitos T CD8+ reactivos, grandes y atípicos (“linfocitos atípicos”)
    • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types leve, neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia y trombocitopenia
    • ↑ Velocidad de eritrosedimentación
    • ↑ Proteína C reactiva
    • Leve ↑ transaminasas, fosfatasa alcalina y bilirrubina total
  • Prueba rápida para la mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis, prueba monospot o prueba de anticuerpos heterófilos:
    • Detecta los LOS Neisseria anticuerpos heterófilos producidos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum respuesta a la infección por EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus
    • Tiene una sensibilidad del 85% y una especificidad del 100%.
    • Si hay reactividad, no es necesario realizar más pruebas
  • Serología:
    • Detecta anticuerpos contra el EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus
    • La inmunoglobulina G positiva representa una infección pasada.
    • La inmunoglobulina M positiva representa una infección actual.
  • Histopatología de los LOS Neisseria ganglios linfáticos:
    • No es necesario para el diagnóstico
    • El cuadro de hiperplasia polimórfica de la pulpa es típico.
    • La propagación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria ganglios linfáticos y el rápido crecimiento de las células blásticas/ necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage están presentes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la muestra histológica.

Resumen

Si se sospecha de mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis infecciosa por los LOS Neisseria antecedentes y el examen físico, pedir un recuento de leucocitos con diferencial y una prueba de anticuerpos heterófilos.

  • Heterófilo +: no se necesitan más pruebas, se confirma el diagnóstico de mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis infecciosa
  • Heterófilo –: sugiere que el citomegalovirus (CMV) es una posible causa, pero el diagnóstico definitivo del EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus es la prueba serológica del antígeno de la cápside viral del EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus mediante la prueba de anticuerpos contra el EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus
Tríada clásica de la mononucleosis infecciosa

Algoritmo diagnóstico de la mononucleosis infecciosa

Imagen por Lecturio.

Tratamiento y Pronóstico

Actualmente no existe una terapia antiviral Antiviral Antivirals for Hepatitis B específica, por lo que el tratamiento es de soporte.

  • El tratamiento sintomático incluye:
    • Reposo de la actividad física durante 3 (deportes sin contacto) a 4 (deportes de contacto) semanas tras la aparición de los LOS Neisseria síntomas iniciales para evitar la rotura esplénica
    • Antipiréticos y analgésicos (e.g., paracetamol paracetamol Acetaminophen is an over-the-counter nonopioid analgesic and antipyretic medication and the most commonly used analgesic worldwide. Despite the widespread use of acetaminophen, its mechanism of action is not entirely understood. Acetaminophen, antiinflamatorios no esteroideos)
    • Adecuada ingesta de líquidos y nutrientes
  • La administración de penicilina y aminopenicilinas puede desencadenar la formación de erupciones.

Pronóstico

  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum general, es frecuente una resolución favorable y se desarrolla una inmunidad duradera.
  • La evolución de la enfermedad es más grave en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las personas con inmunodeficiencias (incluidos los LOS Neisseria receptores de trasplantes).
  • Las infecciones crónicas son extremadamente raras.
  • Latencia del virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células B → mayor riesgo de recurrencia y linfoma de células B en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria inmunodeprimidos (e.g., aquellos con VIH).
Erupción por Amoxicilina

Erupción por amoxicilina en pacientes con mononucleosis infecciosa

Imagen: “Amoxicillin rash in a patient with infectious mononucleosis (patient 4)” por Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary. Licencia: CC BY 4.0

Complicaciones

Sobreinfección bacteriana
Muchos pacientes desarrollan una faringitis estreptocócica secundaria.

Cardíacas

  • Miocarditis: enfermedad inflamatoria del músculo cardiaco, que surge principalmente debido a la infección con virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology cardiotrópicos (comúnmente asociados con el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology Coxsackie, pero también se observa con el VEB).
  • Arritmias (bradiarritmias y taquiarritmias) o pericarditis Pericarditis Pericarditis is an inflammation of the pericardium, often with fluid accumulation. It can be caused by infection (often viral), myocardial infarction, drugs, malignancies, metabolic disorders, autoimmune disorders, or trauma. Acute, subacute, and chronic forms exist. Pericarditis (inflamación del pericardio): pueden observarse junto con la miocarditis.

Dermatológicas

  • Erupción asociada a la ampicilina
  • Leucoplasia vellosa oral: desencadenada por el EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus; da lugar a parches blancos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la lengua que pueden tener un aspecto velloso

Hematológicas

  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica:
    • Tipo de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types causada por la destrucción prematura de los LOS Neisseria glóbulos rojos.
    • La anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica autoinmune fría es una complicación poco frecuente que puede estar asociada al AL Amyloidosis VEB.
  • Trombocitopenia y/o neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia: complicación relacionada con la producción de anticuerpos contra plaquetas y/o neutrófilos durante la infección por VEB.

Hepáticas

  • Síndrome de Reye: trastorno poco frecuente caracterizado por encefalopatía e insuficiencia hepática tras la recuperación de una infección vírica (afecta principalmente a niños).
  • Hepatitis vírica leve: infección que causa inflamación y lesiones hepáticas
  • Necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage hepática fulminante: lesión grave del hígado asociada a encefalopatía e INR prolongado ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un individuo sin enfermedad hepática subyacente)

Esplénicas

  • Esplenomegalia
  • Rotura esplénica:
    • Ocurre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum < 0,5% de los LOS Neisseria casos; más frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum varones
    • Se presenta con:
      • Dolor Dolor Inflammation abdominal brusco
      • Dolor Dolor Inflammation referido en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el hombro
      • Compromiso hemodinámico
    • Requiere cirugía inmediata.
    • Evitar deportes de contacto y levantar objetos pesados puede reducir el riesgo.

Respiratorias

  • Obstrucción de las vías respiratorias y dificultad para respirar debido a la inflamación de las amígdalas (tratar con esteroides)
  • Neumonitis intersticial
  • Neumonía

Inmunológicas y oncológicas

  • Disminución de la inmunidad celular
  • Síndromes linfoproliferativos
  • Linfomas de Burkitt y no Hodgkin:
    • Asociados a la infección por EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus.
    • El linfoma de Burkitt endémico se da principalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum África; la enfermedad suele afectar a los LOS Neisseria huesos de la mandíbula y la cara.
    • El linfoma de Burkitt esporádico se presenta con masas abdominales o afectación de la médula ósea.
  • Linfomas de Hodgkin: cáncer que se origina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria linfocitos y que se manifiesta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum forma de ganglios linfáticos no dolorosos y agrandados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuello, bajo el brazo o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la ingle

Neurológicas

  • Encefalitis: inflamación del cerebro, causada generalmente por una infección viral
  • Síndrome de Guillain-Barré: una polineuropatía autoinmune (debilidad de las extremidades, neuropatías craneales, cambios sensoriales) que se produce después de una infección.
  • Otras complicaciones:
    • Parálisis de Bell (parálisis del nervio facial)
    • Neuritis óptica
    • Mielitis transversa
    • Linfoma primario del SNC

Renales

  • Glomerulonefritis: la inflamación postinfecciosa de los LOS Neisseria glomérulos se asocia ocasionalmente al AL Amyloidosis VEB.
  • Nefritis intersticial:
    • Inflamación del intersticio renal.
    • Suele estar inducida por la ingesta de fármacos, pero también se observa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum infecciones bacterianas, víricas y fúngicas.

Diagnóstico Diferencial

Las siguientes condiciones son diagnósticos diferenciales para la mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis infecciosa:

  • Infección por CMV: un virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de ADN de doble cadena que se propaga por secreciones como la saliva Saliva The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptyalin. Salivary Glands: Anatomy, la orina y la sangre. La infección por CMV suele ser asintomática en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria huéspedes inmunocompetentes, pero causa una enfermedad grave en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria pacientes inmunocomprometidos.
  • Infección por VIH: está causada por un virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de ARN monocatenario de la familia Retroviridae Retroviridae The human immunodeficiency virus (HIV) is a species of Lentivirus, a genus of the family Retroviridae, which causes HIV infections and acquired immunodeficiency syndrome (AIDS). The virus has high genetic variability and is divided into 2 major types, HIV type 1 (HIV-1) and HIV type 2 (HIV-2). The human immunodeficiency virus is a single-stranded, positive-sense, enveloped RNA virus, which targets and destroys WBCs, leading to frequent opportunistic infections and, eventually, death. Human Immunodeficiency Virus (HIV) y se transmite a través del intercambio de fluidos corporales, como el semen y la sangre. La infección por el VIH provoca un deterioro del sistema inmunitario, que comienza con síntomas constitucionales (linfadenopatía) y avanza hacia las enfermedades características del SIDA (infecciones oportunistas).
  • Infección estreptocócica: bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology grampositiva conocida por su característico crecimiento en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cadena; puede causar endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis, meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis, conjuntivitis bacteriana y fascitis necrosante
  • Toxoplasmosis Toxoplasmosis Toxoplasmosis is an infectious disease caused by Toxoplasma gondii, an obligate intracellular protozoan parasite. Felines are the definitive host, but transmission to humans can occur through contact with cat feces or the consumption of contaminated foods. The clinical presentation and complications depend on the host’s immune status. Toxoplasma/Toxoplasmosis: enfermedad infecciosa causada por Toxoplasma Toxoplasma Toxoplasmosis is an infectious disease caused by Toxoplasma gondii, an obligate intracellular protozoan parasite. Felines are the definitive host, but transmission to humans can occur through contact with cat feces or the consumption of contaminated foods. The clinical presentation and complications depend on the host’s immune status. Toxoplasma/Toxoplasmosis gondii, que es un parásito intracelular obligado que vive en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el intestino felino (huésped definitivo). Los LOS Neisseria seres humanos pueden infectarse a través del consumo de carne cruda o de alimentos contaminados por heces de gato.
  • Virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la parainfluenza: virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de ARN con envoltura que pueden causar infecciones de las vías respiratorias superiores e inferiores y crup, que suelen presentarse como mialgias/artralgias repentinas con fiebre y amigdalitis
  • Difteria: infección bacteriana grave causada por Corynebacterium diphtheriae Corynebacterium diphtheriae Diphtheria is an infectious disease caused by corynebacterium diphtheriae that most often results in respiratory disease with membranous inflammation of the pharynx, sore throat, fever, swollen glands, and weakness. The hallmark sign is a sheet of thick, gray material covering the back of the throat. Diphtheria que afecta a las membranas mucosas de la nariz y la garganta, provocando dolor Dolor Inflammation de garganta, fiebre, inflamación de los LOS Neisseria ganglios y debilidad
  • Herpesvirus humano (HHV): síndrome similar a la mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis infecciosa que se asocia a la seroconversión del HHV-6 HHV-6 Human herpesvirus (HHV)-6 and HHV-7 are similar double-stranded DNA viruses belonging to the Herpesviridae family. Human herpesviruses are ubiquitous and infections are commonly contracted during childhood. Human Herpesvirus 6 and 7 en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adultos. Aunque se trata de una afección poco frecuente, los LOS Neisseria síntomas se asocian a linfadenopatía anterior y posterior.

Referencias

  1. Aronson, M., Auwaerter, P. (2021) Infectious mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis. UpToDate. Retrieved June 25, 2022, from https://www.uptodate.com/contents/infectious-mononucleosis
  2. Cohen J.I. (2022). Epstein-Barr virus Epstein-Barr Virus Epstein-Barr virus (EBV) is a linear, double-stranded DNA virus belonging to the Herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease, including infectious mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis. Loscalzo, J., Fauci, A., Kasper, D., Hauser, S., Longo, D., Jameson, J. (Eds.), Harrison’s principles of internal medicine, 21st edition. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=3095&sectionid=265424751
  3. Centers for Disease Control and Prevention. (2024). About infectious mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis (mono). Retrieved June 17, 2025, from https://www.cdc.gov/epstein-barr/about/mononucleosis.html
  4. Taga, K., Taga, H., Tosato, G. (2001). Diagnosis of atypical cases of infectious mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis. Clinical Infectious Diseases 33(1):83–88. https://doi.org/10.1086/320889
  5. Roberts, J.R. (2001). Infectious mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis. Emergency Medicine News 23(3):6–10. https://journals.lww.com/em-news/fulltext/2001/04000/infectious_mononucleosis__epidemiology_and.9.aspx
  6. Omori, M. (2019). Infectious mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis (IM) in emergency medicine. Medscape. Retrieved June 25, 2022, from https://emedicine.medscape.com/article/784513-overview
  7. Otsuka, Y., Kishida, M. (2022). Hoagland sign: bilateral upper eyelid oedema. BMJ Case Reports 15(6):e250857. https://doi.org/10.1136/bcr-2022-250857
  8. Louppides, S., Kakoullis, L., Parpas, G., Panos, G. (2019). Upper eyelid oedema in a patient with pharyngitis Pharyngitis Pharyngitis is an inflammation of the back of the throat (pharynx). Pharyngitis is usually caused by an upper respiratory tract infection, which is viral in most cases. It typically results in a sore throat and fever. Other symptoms may include a runny nose, cough, headache, and hoarseness. Pharyngitis/exudative tonsillitis Tonsillitis Tonsillitis is inflammation of the pharynx or pharyngeal tonsils, and therefore is also called pharyngitis. An infectious etiology in the setting of tonsillitis is referred to as infectious pharyngitis, which is caused by viruses (most common), bacteria, or fungi. Tonsillitis and malaise Malaise Tick-borne Encephalitis Virus: Hoagland sign in infectious mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis. BMJ Case Reports 12(12):e233719. https://doi.org/10.1136/bcr-2019-233719
  9. Taylor, G. (2003). Cytomegalovirus Cytomegalovirus CMV is a ubiquitous double-stranded DNA virus belonging to the Herpesviridae family. CMV infections can be transmitted in bodily fluids, such as blood, saliva, urine, semen, and breast milk. The initial infection is usually asymptomatic in the immunocompetent host, or it can present with symptoms of mononucleosis. Cytomegalovirus. American Family Physician 67(3):519–524. https://www.aafp.org/pubs/afp/issues/2003/0201/p519.html
  10.  Friel, T. (2022) Epidemiology, clinical manifestations, and treatment of cytomegalovirus Cytomegalovirus CMV is a ubiquitous double-stranded DNA virus belonging to the Herpesviridae family. CMV infections can be transmitted in bodily fluids, such as blood, saliva, urine, semen, and breast milk. The initial infection is usually asymptomatic in the immunocompetent host, or it can present with symptoms of mononucleosis. Cytomegalovirus infection in immunocompetent adults. UpToDate. Retrieved June 25, 2022, from https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-treatment-of-cytomegalovirus-infection-in-immunocompetent-adults
  11.  Asgari, M.M., Begos, D.G. (1997). Spontaneous splenic rupture Splenic rupture Splenic rupture is a medical emergency that carries a significant risk of hypovolemic shock and death. Injury to the spleen accounts for nearly half of all injuries to intra-abdominal organs. The most common reason for a rupture of the spleen is blunt abdominal trauma, specifically, motor vehicle accidents. Rupture of the Spleen in infectious mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis: a review. Yale Journal of Biology and Medicine 70(2):175–182. 
  12.  Lennon, P., Crotty, M., Fenton, J. (2015). Infectious mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis. BMJ 350:h1825. doi: https://doi.org/10.1136/bmj.h1825
  13. Styczynski, J., van der Velden, W., Fox, C.P., Engelhard, D., de la Camara, R., Cordonnier, C., Ljungman, P., & Sixth European Conference on Infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease in Leukemia, a joint venture of the Infectious Diseases Working Party of the European Society of Blood and Marrow Transplantation (EBMT-IDWP), the Infectious Diseases Group of the European Organization for Research Research Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. Conflict of Interest and Treatment of Cancer (EORTC-IDG), the International Immunocompromised immunocompromised A human or animal whose immunologic mechanism is deficient because of an immunodeficiency disorder or other disease or as the result of the administration of immunosuppressive drugs or radiation. Gastroenteritis Host Society (ICHS) and the European Leukemia Net (ELN). (2016). Management of Epstein-Barr virus Epstein-Barr Virus Epstein-Barr virus (EBV) is a linear, double-stranded DNA virus belonging to the Herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease and post-transplant lymphoproliferative disorders Lymphoproliferative disorders Disorders characterized by proliferation of lymphoid tissue, general or unspecified. Lymphocytosis in patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship after allogeneic hematopoietic stem cell transplantation Hematopoietic stem cell transplantation Transfer of hematopoietic stem cells from bone marrow or blood between individuals within the same species (homologous transplantation) or transfer within the same individual (autologous transplantation). Hematopoietic stem cell transplantation has been used as an alternative to bone marrow transplantation in the treatment of a variety of neoplasms. Organ Transplantation: Sixth European Conference on Infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease in Leukemia (ECIL-6) guidelines. Haematologica 101(7):803–811. https://doi.org/10.3324/haematol.2016.144428
  14. Ebell, M.H. (2004). Epstein-Barr virus Epstein-Barr Virus Epstein-Barr virus (EBV) is a linear, double-stranded DNA virus belonging to the Herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus infectious mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis. American Family Physician 70(7):1279–1287. https://www.aafp.org/pubs/afp/issues/2004/1001/p1279.html

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