Infectious Mononucleosis: Epidemiological Consequences of Diagnostic Errors

Introduction: Infectious mononucleosis is a viral disease, the clinical picture of which includes fever, tonsillitis, lymphadenopathy, hepatomegaly, and splenomegaly. A significant proportion of cases of infectious mononucleosis remains unrecognized for various reasons. The presence of hidden sources of infection prevents adequate evaluation of the epidemic situation and promotes the spread of pathogens, including within organized groups of children and adults. Objective: To characterize the causes of errors in diagnosing infectious mononucleosis and their epidemiological consequences on the example of non-infectious disease hospitals.

Materials and methods: We reviewed 60 scientific publications indexed in international (Web of Science, Scopus, PubMed) and domestic (RSCI) databases in 2012–2022 and selected using the following keywords and phrases: infectious mononucleosis, diagnosis of infectious mononucleosis, and errors in the diagnosis of infectious mononucleosis. The limited number of studies devoted to epidemiology of Epstein-Barr virus infection, both in Russia and abroad, did not allow us to select only those papers that were included in the RSCI core collection or published in Q1–Q2 journals.

Results: The main cause of errors in diagnosis of infectious mononucleosis is a great variety of clinical manifestations related to various etiological agents, as well as age and immunological status of the patient. Poor awareness of the clinical picture and laboratory diagnostics of infectious mononucleosis among healthcare professionals can be yet another reason. Wrong assessment of the epidemic situation, unidentified and unaccounted-for sources of infection among the population, introduction and spread of pathogens in noninfectious disease clinics. We have established the possibility of etiological agents of infectious mononucleosis to use almost all known mechanisms of transmission, of which airborne and artificial ones are the most prevalent in hospitals. The absence of preventive measures aimed at the source of infection and susceptible individuals determines actions that can interrupt mechanisms of transmission as the only realistic way of combatting the spread of pathogens of infectious mononucleosis.

Conclusion: Misdiagnosis of infectious mononucleosis can cause serious epidemiological consequences, including the nosocomial spread of pathogens.

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