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Acute Infectious Mononucleosis A047

Document
Last amended 
23 May 2019
Current RMA Instruments
Reasonable Hypothesis SOP
3 of 2012
Balance of Probabilities SOP
4 of 2012
Changes from previous Instruments

SOP Bulletin 156

ICD Coding
  • ICD-9-CM Codes: 075
  • ICD-10-AM Codes: B27.0
Brief description

Acute infectious mononucleosis, also known as glandular fever, is an acute illness due to Epstein-Barr virus infection.  It is characterised by fever, tonsilar pharyngitis, fatigue, enlarged lymph nodes and an elevated lymphocyte count on blood testing.  It is most common in adolescents and young adults.

Confirming the diagnosisIs 

Epstein-Barr virus infection is very common and often asymptomatic.  Evidence of past infection can be found in 90% or more of older adults. Aysmptomatic infection is not a disease (for DVA purposes) and is not covered by the SOP.

A diagnosis of acute infectious mononucleosis requires both a clinical illness consitent with the condition and laboratory evidence of recently acquired Epstein-Barr virus infection.  Laboratory evidence can include a heterophile antibody (monospot) test or serology testing for EBV-specific antibodies.  The diagnosis can be made by a general practitioner.

The relevant medical specialist is an infectious diseases physician.

Additional diagnoses covered by SOP
  • Glandular fever (but see conditions not covered)
  • Acute infectious mononucleosis - resolved 
  • Symptomatic Epstein-Barr virus infection
Conditions not covered by SOP
  • Asymptomatic Epstein-Barr virus infection - N.I.F.
  • Chronic fatigue syndrome*
  • Glandular fever due to cytomegalovirus infection#
  • Infectious mononucleosis type illness due to other viral infection (e.g. cytomegalovirus)#

* Another SOP applies

#  Non-SOP condition

Clinical onset

Clinical onset will be based on the time of onset of relevant symptoms, for all illness subsequently confirmed to be due to Epstein-Barr virus infection. 

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  Most cases fully resolve within a few weeks and require only supportive therapy.  Avoidance of strenuous activity for several weeks may be recommended (to allow recovery from fatigue and avoid risk of splenic rupture).  Disease modifying therapy is not available.  Fatigue may persist in a small minority of cases.  Chronic fatigue may develop in a small percentage, in which case the chronic fatigue syndrome SOP may apply.