. Autoimmune hemolytic anemia - rare. Spontaneous resolution. Rarely thrombocytopenia with bleeding. Splenic rupture 2. Neurological - Encephalitis wi

mononucleosis though in smaller numbers appear in viral hepatitis, serum sickness, Hodgkin's disease, rubella, brucellosis, toxoplasma, cytomegalovirus or adenovirus infection. Complications - 1. Autoimmune hemolytic anemia - rare. Spontaneous resolution. Rarely thrombocytopenia with bleeding. Splenic rupture 2. Neurological - Encephalitis with predominant cerebellar features, viral meningitis, Guillain-Barre syndrome. Bell's palsy, transverse myelitis. 3. Other complications - (a) Cardiac - Nonspecific ECG changes, pericarditis, myocarditis. (b) Pulmonary - Pneumonitis. Other syndromes associated with EBV 1. Chronic EBV disease - Severe persistent illness associated with EBV is rare, but following have been described - Immunodeficiency and disseminated viral infection including hepatitis, pneumonitis, splenomegaly and pancytopenia. High litres of anti-VCA IgG and anti-EA. 2. Malignancy - EBV has been associated with Burkitfs lymphoma and nasopharyngeal carcinoma. In immunosuppressed patients (e g transplant recipients, individuals infected with HIV), EBV is also associated with development of polygonal B-cell lymphomas, which may respond to acyclovir or withdrawal of immunosuppressive drugs 3 Oral hairy leukoplakia - in patients with HIV infection. It responds to acyclovir but signifies a poor prognosis Management - is mainly symptomatic. Initial period of bed rest for 2-3 weeks. Gargles with soluble aspirin helpful for relieving sore throat. Antibiotics such as erythromydn if secondary infection. Ampicillin should be avoided as it produces a rash. Corticosteroids if severe pharyngitis, airway obstruction, severe thrombocytopenic purpura or acute hemolytic anaemia, and polyneuritis. AGENTS CAUSING IM-LIKE SYNDROMES: Cyt o me galo virus mononucleosis - EPIDEMIOLOGY -Asymptomatic infection is common in children. Virus is excreted in body fluids such as saliva, urine, semen and cervical secretions. Infection is commonly acquired from asymptomatic excretors through close contact. Kissing is an important mode of transmission in young adults. Virus is also transmitted by blood transfusion and tissue or organ transplants. CLINICAL FEATURES - CMV is associated with disease in three specific circumstances (a) Heterophile antibody-negative IM - Tonsillitis and cervical lymphadenopathy are unusual, and atypical lymphocytosis less marked than in EBV infection. (b) Congenital infection - from primary infection during pregnancy. Jaundice, hepatosplenomegaly and petechial rash may be present at birth, together with multiple congenital abnormalities such as microcephaly, intracerebral calcification and chorioretinitis. Infection is commonly fatal, and infants who survive may be severely handicapped mentally and physically Sensorineural deafness may be the only manifestation of congenital infection. (c) Immunosuppression -Reactivation of latent CMV infection occurs in immunocompromised patients and may be asymptomatic or cause only fever and mononucleosis. More severe disease with pneumonitis, hepatitis, enteritis and retinitis. DIAGNOSIS - (a) Antibody tests - Both IgM and IgG antibodies to CMV can be detected early However seroconversion from no antibody to IgG positive is more diagnostic. (b) Virus detection - by electron microscopy, serological detection of viral antigen in mucosal cells, or by culture of urine, blood or secretions. TREATMENT - Antiviral agent ganciclovir controls most manifestations except pneumonitis.