Sections

Pediatric Mononucleosis and Epstein-Barr Virus Infection

Sections Pediatric Mononucleosis and Epstein-Barr Virus Infection
Overview
Presentation
DDx
Workup
Treatment
Guidelines
Medication
Follow-up
References

Medication

Medication Summary

Acute infectious mononucleosis is treated symptomatically. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat fever and discomfort. Corticosteroids do not significantly alter the course of infectious mononucleosis. Although they ameliorate symptoms, corticosteroids should not be used in the treatment of uncomplicated disease. They are used in patients with significant upper airway obstruction due to tonsillar or lymph node hypertrophy and in patients with severe thrombocytopenia or hemolytic anemia.

Numerous drugs inhibit Epstein-Barr virus (EBV) replication in vitro. Nonetheless, antiviral agents are not beneficial in patients with uncomplicated infectious mononucleosis. However, antiviral agents are used in the treatment of patients with interstitial pneumonitis, X-linked lymphoproliferative syndrome, PTLD, HLH, and other lymphoproliferative disorders.^{[58, 59, 60, 61]}Intravenous immunoglobulin may be considered to modulate immune function in the presence of disease complications due to autoantibodies.

New therapies, including the use of interferon alpha and the infusion of donor T cells or Epstein-Barr virus–specific cytotoxic T cells, are being studied.

Class Summary

Corticosteroids are potent anti-inflammatory drugs that also modify the immune response. They are used to decrease the size of tonsils and upper airway lymph nodes in the presence of airway compromise and possible upper airway obstruction. They may be useful to treat severe thrombocytopenia or hemolytic anemia. Whether prednisone should be used for myocarditis, pericarditis, or CNS system involvement is unclear.

Prednisone (Deltasone, Liquid Prep, Meticorten, Orasone, Prednicen-M, Sterapred)

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Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

Class Summary

Numerous drugs inhibit Epstein-Barr virus replication in vitro. These include acyclovir, desciclovir, ganciclovir, interferon-alfa, interferon-gamma, adenine arabinoside, and phosphonoacetic acid. Acyclovir, which inhibits viral shedding from the oropharynx, is the only antiviral drug used to treat infectious mononucleosis in placebo-controlled clinical trials. However, the clinical course is not significantly affected in patients with uncomplicated infectious mononucleosis.

Foscarnet (Foscavir)

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Foscarnet, a pyrophosphate analog, has been reported to be active against acyclovir- or ganciclovir-resistant herpes family viruses, including HSV, CMV, VZV, and EBV. Most of the data regarding its use in severe EBV infection are from isolated case reports, but they are generally positive.

Acyclovir (Zovirax)

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Strains of HSV1 are most sensitive, followed by HSV2. Acyclovir also is sensitive to other herpesviruses, including, in descending order, varicella zoster, EBV, and CMV.

Class Summary

Intravenous immunoglobulin is used to modulate immune function in the presence of autoantibodies. It has been used successfully in the treatment of immune thrombocytopenia associated with infectious mononucleosis.

Intravenous immunoglobulin (Gammagard S/D, Gammar-P, Polygam)

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Intravenous immunoglobulin neutralizes circulating myelin antibodies through antiidiotypic antibodies; it down-regulates proinflammatory cytokines, including INF-gamma; blocks Fc receptors on macrophages; suppresses inducer T and B cells and augments suppressor T cells; blocks the complement cascade; promotes remyelination; and may increase CSF IgG (10%).

Follow-up

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Media Gallery

Infectious mononucleosis. Antibody response to Epstein-Barr virus. Adapted with permission from Johnson DH, Cunha BA. Epstein-Barr virus serology. Infect Dis Pract. 1995;19:26-27.

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Author

Jaya Sureshbabu, MBBS, MRCPCH(UK), MRCPI(Paeds), MRCPS(Glasg), DCH(Glasg) Consultant Neonatologist and Pediatrian, Sree Gokulam Medical College and Research Foundation, India

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD Minnesota American Legion and Auxiliary Heart Research Foundation Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics, Novavax, Regeneron, Diassess, Actelion<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur.

Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab) Assistant Professor of Pediatrics, Co-Director of Antimicrobial Stewardship, Medical Director, Division of Pediatric Infectious Diseases and Immunology, Connecticut Children's Medical Center

Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab) is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics

Disclosure: Received research grant from: Cubist<br/>Received income in an amount equal to or greater than $250 from: Horizon Pharmaceuticals, Shire<br/>Medico legal consulting for: Various.

Acknowledgements

Rosemary Johann-Liang, MD Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration

Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Sections Pediatric Mononucleosis and Epstein-Barr Virus Infection
Overview
Presentation
DDx
Workup
Treatment
Guidelines
Medication
Follow-up
References

Pediatric Mononucleosis and Epstein-Barr Virus Infection Medication

Medication Summary

Glucocorticoids

Class Summary

Prednisone (Deltasone, Liquid Prep, Meticorten, Orasone, Prednicen-M, Sterapred)

Prednisone (Deltasone, Liquid Prep, Meticorten, Orasone, Prednicen-M, Sterapred)

Antiviral Agents

Class Summary

Foscarnet (Foscavir)

Foscarnet (Foscavir)

Acyclovir (Zovirax)

Acyclovir (Zovirax)

Immunoglobulins

Class Summary

Intravenous immunoglobulin (Gammagard S/D, Gammar-P, Polygam)

Intravenous immunoglobulin (Gammagard S/D, Gammar-P, Polygam)

Pediatric Mononucleosis and Epstein-Barr Virus Infection Medication

Medication Summary

Glucocorticoids

Class Summary

Prednisone (Deltasone, Liquid Prep, Meticorten, Orasone, Prednicen-M, Sterapred)

Prednisone (Deltasone, Liquid Prep, Meticorten, Orasone, Prednicen-M, Sterapred)

Antiviral Agents

Class Summary

Foscarnet (Foscavir)

Foscarnet (Foscavir)

Acyclovir (Zovirax)

Acyclovir (Zovirax)

Immunoglobulins

Class Summary

Intravenous immunoglobulin (Gammagard S/D, Gammar-P, Polygam)

Intravenous immunoglobulin (Gammagard S/D, Gammar-P, Polygam)

References

Tables

Contributor Information and Disclosures

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