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1: Introduction
• Definition: Acute, self-limiting lymphoproliferative disorder
• First described by Sprunt & Evans in 1920
• Etiology: Epstein-Barr virus (EBV) in ~90% cases
• Transmission: Saliva (“kissing disease”), blood, organ transplantation

Slide 2: Epidemiology
• Peak incidence: 15–25 years
• Rare in children less than 4 years
• Slight female predominance
• High prevalence in developed countries

Slide 3: Etiopathogenesis
• EBV infects oropharyngeal epithelial cells → spreads to B-lymphocytes
• EBV binds CD21 receptor on B-cells
• T-cell mediated immune response → lymphocytosis
• Results in lymphoid tissue hyperplasia

Slide 4: Clinical Features

Triad of Classical Symptoms
1. Fever (usually low to moderate grade)
2. Pharyngitis (membranous tonsillitis)
3. Lymphadenopathy (especially posterior cervical)

Other features
• Splenomegaly (50%)
• Hepatomegaly & jaundice (~10%)
• Fatigue, malaise, myalgia
• Maculopapular rash (esp. after ampicillin/amoxicillin)

Slide 5: Hoagland’s Criteria Diagnostic Importance)

Proposed by R.J. Hoagland in 1952
Suggestive of infectious mononucleosis if more than or equal to 2 present:

•more than 50lymphocytes in peripheral smear
•more 10% atypical lymphocytes
• Positive heterophile antibody test (Monospot test)
• Presence of clinical triad: fever, pharyngitis, lymphadenopathy

Slide 6: Hoagland’s Sign
• Definition: Bilateral upper eyelid edema seen in early stages
• Mechanism: Periorbital lymphatic obstruction
• Seen in ~50% cases
• Usually appears before other signs and resolves spontaneously

(Include a clinical photograph of Hoagland’s sign)

Slide 7: Investigations

Blood Tests
• CBC:
• Lymphocytosis (mote than50%)
• Atypical lymphocytes (more 10%)
• LFT: Mild elevation of transaminases

Serology
• Heterophile antibody test (Monospot) → positive in 80-90% cases
• EBV-specific antibodies (VCA-IgM, VCA-IgG, EBNA)

Slide 8: Complications
• Splenic rupture (rare but life-threatening)
• Airway obstruction due to massive tonsillar hypertrophy
• Secondary bacterial infections
• Neurological: meningitis, encephalitis, Bell’s palsy
• Hematological: hemolytic anemia, thrombocytopenia

Slide 9: Management
• Supportive care: bed rest, hydration, analgesics, antipyretics
• Steroids: only if severe tonsillar hypertrophy causing obstruction
• Avoid ampicillin/amoxicillin → rash in ~90% cases
• Avoid contact sports for at least 3 weeks (risk of splenic rupture)
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