Glandular Fever-Like Syndromes

• Glandular fever (infectious mononucleosis) refers to the clinical illness caused by EBV.
• Other infections can cause illnesses that are clinically indistinguishable from glandular fever.
  • These are collectively referred to as 'Glandular Fever-Like Syndromes' and are caused by:
    • HIV (at the time of seroconversion).
    • CMV.
    • Toxoplasmosis.
• Clinical features in all these infections are non-specific.
• The severity of symptoms varies from patient to patient.
  • There may be little more than a mild flu-like illness.
  • Others experience an extremely debilitating illness with high morbidity.
• During the acute phase symptoms may include:
  • Sore throat.
  • Fever.
  • Lymphadenopathy (tender, enlarged lymph nodes).
  • General malaise.
  • Headache.
  • Muscle aching.
  • Erythematous rash involving the trunk.
• Most of the symptoms subside in a few weeks:
  • But, lymphadenopathy and general malaise do persist for several months in some patients.
• Care must be taken to reach the correct diagnosis, or management may be inappropriate.
  • Investigations for each infection are included in the pages for each of the causative organisms..

Toxoplasmosis

• Toxoplasmosis is caused by Toxoplasma gondii.
  • This is a parasite with a complicated lifecycle:
    • The cat is the definitive host.
    • Cysts excreted in cat faeces can remain viable in soil for months.
    • Humans and animals (e.g. pigs and sheep) can become infected.
• Human infection occurs via either ingestion of:
  • Tissue cysts in raw or inadequately cooked meat.
  • Sporocysts on unwashed fruit or vegetables contaminated with cat faeces.
• The prevalence of previous toxoplasmosis in U.K. populations is low (around 15% of women of child-bearing age) compared to developing countries.
• Infection is usually asymptomatic, although can be associated with Glandular Fever-Like Syndrome symptoms.
• Congenital toxoplasmosis infection may occur if primary maternal toxoplasmosis infection occurs during the early stages of pregnancy:
  • Severe congenital abnormalilties can include hearing loss, mental retardation and cerebral palsy.
  • Similar congenital abnormalities may also follow infection with either Rubella, CMV or HSV infection (ToRCH syndrome, where T is Toxoplasmosis).
• Serology is used to establish a diagnosis of toxoplasmosis.
• Not all cases require active intervention with anti-parasite drugs.

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