Gå direkt till huvudinnehållet

Mononukleos

Senast reviderad:
Sakkunnig:
Definition:
Viralt syndrom med feber, halsinfektion och svullna lymfkörtlar, nästan alltid förorsakat av Epstein-Barr-virus (EBV). Kallas även körtelfeber.
Förekomst:
Vanlig orsak till halsont bland barn och ungdomar (särskilt i åldrarna 16–20 år), men ovanligare hos vuxna efter 25 års ålder.
Symtom:
Ofta asymtomatiskt hos yngre. Halssmärtor och feber.
Kliniska fynd:
Typisk sjukdomsbild är feber, kraftigt svullna tonsiller med tjocka gråvita beläggningar och förstorade lymfkörtlar, framförallt på halsen. Ibland förstorad lever och mjälte.
Diagnostik:
Lymfocytos i akutfasen. Antikroppar kan påvisas i snabbtest efter 1–2 veckor. Diagnosen kan bekräftas med serologi.
Behandling:
Symtomlindrande behandling och vila. I undantagsfall behövs inläggning med intravenös vätskebehandling.
  1. Ebell MH, Call M, Shinholser J, et al. Does This Patient Have Infectious Mononucleosis?: The Rational Clinical Examination Systematic Review. JAMA 2016. pmid:27115266 PubMed  
  2. Sylvester JE, Buchanan BK, Silva TW. Infectious Mononucleosis: Rapid Evidence Review. Am Fam Physician. 2023 Jan;107(1):71-78. PMID: 36689975 PubMed  
  3. Womack J, Jimenez M. Common questions about infectious mononucleosis. Am Fam Physician. 2015 Mar 15;91(6):372-6. PMID: 25822555 PubMed  
  4. Balfour HH Jr, Holman CJ, Hokanson KM, et al. A prospective clinical study of Epstein-Barr virus and host interactions during acute infectious mononucleosis. J Infect Dis 2005; 192: 1503. PubMed  
  5. Aronson M, Auwaerter P. Infectious mononucleosis. UpToDate, last updated Mar 19, 2021. UpToDate  
  6. Ng S-B, Khoury JD. Epstein-Barr virus in lymphoproliferative processes. Adv Anat Pathol 2009; 16: 40-55. PMID: 19098466 PubMed  
  7. Sullivan JL. Virology of Epstein-Barr virus. UpToDate. Last updated Mar 05, 2021. UpToDate  
  8. Fafi-Kremer, S, Morand, P, Brion, JP, et al. Long-term shedding of infectious epstein-barr virus after infectious mononucleosis. J Infect Dis 2005; 191: 985. PMID: 15717276 PubMed  
  9. Ho-Yen DO, Martin KW. The relationship between atypical lymphocytosis and serological tests in infectious mononucleosis. J Infect 1981; 3: 324-31. PMID: 6309974 PubMed  
  10. Dommerby H, Stanferup SE, Stangerup M. Hancke S. Hepatosplenomegaly in infectious mononucleosis, assessed by ultrasound scanning. J Laryngol Otol. 1986;100:573-579. PubMed  
  11. Rea TD, Russo JE, Katon W, Ahley RL, Buchwald DS. Prospective study of the natural history of infectious mononucleosis caused by Epstein-Barr virus. J Am Board Fam Pract. 2001;14:234-242. PubMed  
  12. Brigden ML, Au S, Thompson S, Brigden S, Doyle P, Tsaparas Y. Infectious mononucleosis in an outpatient population: diagnostic utility of 2 automated hematology analyzers and the sensitivity and specificity of Hoagland's criteria in heterophile-positive patients. Arch Pathol Lab Med 1999; 123: 875-81. PubMed  
  13. Downey H, McKinlay CA. Acute lymphadenosis compared with acute lymphatic leukemia. Arch Intern Med 1923; 32: 82-112. PubMed  
  14. Rezk E, Nofal YH, Hamzeh A, et al. Steroids for symptom control in infectious mononucleosis. Cochrane Database Syst Rev. 2015; 8;11: CD004402. Epub ahead of print.. pmid:26558642 PubMed  
  15. De Paor M, O'Brien K, Fahey T, Smith SM. Antiviral agents for infectious mononucleosis (glandular fever). Cochrane Database Syst Rev. 2016 Dec 8;12(12):CD011487. doi: 10.1002/14651858.CD011487.pub2. PMID: 27933614 PubMed  
  16. Hurt C, Tammaro D. Diagnostic evaluation of mononucleosis-like illnesses. Am J Med 2007; 120: 911e1-8. PMID: 17904463 PubMed  
  17. Axelrod P, Finestone AJ. Infectious mononucleosis in older adults. Am Fam Physician 1990; 42: 1599-606. American Family Physician  
  18. Doja A, Bitnun A, Ford Jones EL, et al. Pediatric Epstein-Barr virus-associated encephalitis: 10-year review. J Child Neurol. 2006;21:384-391. PubMed  
  19. Pedersen M, Asprusten TT, Godang K, et al. Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: A prospective cohort study. Brain Behav Immun. 2019;75:94-100. PubMed  
  20. Katz BZ, Reuter C, Lupovitch Y, et al. A Validated Scale for Assessing the Severity of Acute Infectious Mononucleosis. J Pediatr 2019; 209:130. PubMed  
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet