ICD-10: B27.92

Infectious mononucleosis, commonly known as "mono," is primarily caused by the Epstein-Barr virus (EBV) and is characterized by symptoms such as fever, sore throat, swollen lymph nodes, and fatigue. The ICD-10 code B27.92 specifically refers to infectious mononucleosis that is unspecified and associated with meningitis, a serious condition involving inflammation of the protective membranes covering the brain and spinal cord.

Clinical Description of B27.92

Definition and Etiology

Infectious mononucleosis is typically caused by EBV, which is a member of the herpesvirus family. While the classic presentation of mono does not usually include meningitis, complications can arise, particularly in immunocompromised individuals or those with atypical presentations. Meningitis associated with infectious mononucleosis can be viral or, less commonly, bacterial, necessitating careful clinical evaluation and management.

Symptoms

Patients with B27.92 may present with a combination of the following symptoms:
- Classic Mono Symptoms: Fever, sore throat, fatigue, and lymphadenopathy.
- Neurological Symptoms: Headache, neck stiffness, photophobia, and altered mental status, which may indicate meningitis.
- Other Symptoms: Rash, splenomegaly, and hepatomegaly may also be present.

Diagnosis

Diagnosis of infectious mononucleosis with meningitis typically involves:
- Clinical Evaluation: Assessment of symptoms and medical history.
- Laboratory Tests:
- Heterophile antibody test (Monospot test) to confirm EBV infection.
- Complete blood count (CBC) showing atypical lymphocytes.
- Lumbar puncture may be performed to analyze cerebrospinal fluid (CSF) if meningitis is suspected, revealing lymphocytic pleocytosis in viral meningitis.

Treatment

Management of B27.92 focuses on supportive care, as there is no specific antiviral treatment for EBV. Treatment may include:
- Symptomatic Relief: Analgesics for pain and fever, hydration, and rest.
- Corticosteroids: In cases of severe symptoms or complications, such as significant swelling or neurological involvement.

Prognosis

The prognosis for patients with infectious mononucleosis with meningitis varies based on the severity of the symptoms and the underlying health of the patient. Most individuals recover fully with appropriate management, although some may experience prolonged fatigue.

Conclusion

ICD-10 code B27.92 captures a specific and serious manifestation of infectious mononucleosis, highlighting the importance of recognizing and managing potential complications such as meningitis. Clinicians should remain vigilant for neurological symptoms in patients presenting with classic signs of mono, ensuring timely diagnosis and treatment to mitigate risks associated with this condition.

Infectious mononucleosis, often referred to as "mono," is primarily caused by the Epstein-Barr virus (EBV) and is characterized by a range of clinical presentations, signs, symptoms, and patient characteristics. The ICD-10 code B27.92 specifically refers to infectious mononucleosis that is unspecified and associated with meningitis. Below is a detailed overview of the clinical aspects related to this condition.

Clinical Presentation

General Overview

Infectious mononucleosis typically presents with a constellation of symptoms that can vary in severity. When meningitis is involved, the clinical picture may include additional neurological signs.

Common Symptoms

1. Fever: A high fever is often one of the first symptoms, typically ranging from 101°F to 104°F (38.3°C to 40°C) [1].
2. Sore Throat: Severe pharyngitis is common, often accompanied by tonsillar enlargement and exudate [1].
3. Fatigue: Profound fatigue is a hallmark symptom, which can last for weeks or even months [1].
4. Lymphadenopathy: Swelling of lymph nodes, particularly in the neck and armpits, is frequently observed [1].
5. Rash: A rash may occur in some patients, often resembling a measles-like rash [1].

Symptoms Specific to Meningitis

When meningitis is present, additional symptoms may include:
- Headache: Often severe and persistent, indicating increased intracranial pressure [2].
- Stiff Neck: Nuchal rigidity is a classic sign of meningitis, making it painful for the patient to flex their neck [2].
- Photophobia: Sensitivity to light can occur, contributing to discomfort [2].
- Altered Mental Status: Patients may experience confusion, drowsiness, or other changes in consciousness [2].

Signs

Physical Examination Findings

• Fever: Elevated body temperature upon examination.
• Lymphadenopathy: Enlarged lymph nodes, particularly posterior cervical nodes.
• Tonsillar Hypertrophy: Enlarged tonsils with possible exudate.
• Neurological Signs: In cases of meningitis, signs such as Kernig's sign (pain upon extending the knee when the hip is flexed) or Brudzinski's sign (involuntary lifting of the legs when the neck is flexed) may be present [2].

Patient Characteristics

Demographics

• Age: Infectious mononucleosis is most common in adolescents and young adults, typically between the ages of 15 and 24 [1].
• Sex: Both males and females are equally affected, although some studies suggest a slightly higher incidence in females [1].

Risk Factors

• Close Contact: The disease is often spread through saliva, making individuals in close contact (e.g., college students, military recruits) more susceptible [1].
• Immunocompromised Status: Patients with weakened immune systems may experience more severe symptoms and complications, including meningitis [2].

Conclusion

Infectious mononucleosis with meningitis (ICD-10 code B27.92) presents a unique clinical challenge due to the combination of typical mononucleosis symptoms and those associated with meningitis. Early recognition and management are crucial to prevent complications. If a patient presents with the classic symptoms of mononucleosis alongside neurological signs, prompt evaluation for meningitis is essential. Understanding the clinical presentation, signs, symptoms, and patient characteristics can aid healthcare providers in delivering effective care and improving patient outcomes.

References

1. ICD-10-CM TABULAR LIST of DISEASES and INJURIES.
2. Epstein-Barr virus infections of the nervous system.

Infectious mononucleosis, particularly when associated with meningitis, is classified under the ICD-10 code B27.92. This code is part of a broader classification system used for diagnosing and coding various diseases and conditions. Below are alternative names and related terms associated with this condition.

Alternative Names for Infectious Mononucleosis

1. Mono: A common abbreviation for infectious mononucleosis, often used in casual conversation.
2. Kissing Disease: This term arises from the common transmission of the Epstein-Barr virus (EBV), which causes mononucleosis, through saliva.
3. Glandular Fever: A term primarily used in some countries, particularly in the UK, to describe the same condition.

Related Terms

1. Epstein-Barr Virus (EBV): The virus responsible for most cases of infectious mononucleosis. It is a member of the herpes virus family.
2. Lymphadenopathy: Swelling of the lymph nodes, a common symptom of infectious mononucleosis.
3. Fever: A common symptom associated with infectious mononucleosis.
4. Fatigue: A hallmark symptom that can persist for weeks or months after the initial infection.
5. Meningitis: In the context of B27.92, this refers to the inflammation of the protective membranes covering the brain and spinal cord, which can occur alongside infectious mononucleosis.

Clinical Context

Infectious mononucleosis is characterized by symptoms such as fever, sore throat, swollen lymph nodes, and fatigue. When meningitis is present, it indicates a more severe complication that requires immediate medical attention. The unspecified nature of the code B27.92 suggests that the specific details of the meningitis (such as viral or bacterial) are not specified in the diagnosis.

Conclusion

Understanding the alternative names and related terms for ICD-10 code B27.92 can enhance communication among healthcare professionals and improve patient education. Recognizing these terms is essential for accurate diagnosis, treatment, and coding in medical records. If you have further questions or need more specific information, feel free to ask!

Infectious mononucleosis, commonly caused by the Epstein-Barr virus (EBV), can lead to various complications, including meningitis. The ICD-10 code B27.92 specifically refers to "Infectious mononucleosis, unspecified with meningitis." To diagnose this condition, healthcare providers typically follow a set of clinical criteria and diagnostic tests.

Clinical Criteria for Diagnosis

1. Symptoms and History:
   - Classic Symptoms: Patients often present with symptoms such as fever, sore throat, swollen lymph nodes, and fatigue. The presence of these symptoms is crucial for initial suspicion of infectious mononucleosis.
   - Neurological Symptoms: In cases where meningitis is suspected, additional symptoms may include headache, neck stiffness, photophobia, and altered mental status.

2. Physical Examination:
   - Lymphadenopathy: Examination may reveal swollen lymph nodes, particularly in the cervical region.
   - Splenomegaly: An enlarged spleen is a common finding in infectious mononucleosis.

3. Laboratory Tests:
   - Heterophile Antibody Test: The Monospot test is often used to detect heterophile antibodies, which are typically present in infectious mononucleosis.
   - EBV-Specific Antibodies: Testing for specific antibodies (e.g., VCA-IgM, VCA-IgG, and EA-D) can confirm an active EBV infection.
   - Complete Blood Count (CBC): A CBC may show atypical lymphocytes and elevated white blood cell counts, which support the diagnosis.

4. Cerebrospinal Fluid (CSF) Analysis:
   - If meningitis is suspected, a lumbar puncture may be performed to analyze the CSF. Findings may include:

   • Elevated white blood cell count, often with a lymphocytic predominance.
   • Presence of viral particles or specific antibodies against EBV in the CSF.

5. Imaging Studies:
   - While not routinely used for diagnosis, imaging studies such as MRI or CT scans may be employed to rule out other causes of neurological symptoms.

Conclusion

The diagnosis of infectious mononucleosis with meningitis (ICD-10 code B27.92) involves a combination of clinical evaluation, laboratory testing, and, when necessary, CSF analysis. The presence of classic symptoms, along with supportive laboratory findings, is essential for confirming the diagnosis. If meningitis is suspected, further investigation through CSF analysis is critical to ensure appropriate management and treatment.

Infectious mononucleosis, often caused by the Epstein-Barr virus (EBV), is characterized by symptoms such as fever, sore throat, and lymphadenopathy. When it is associated with meningitis, as indicated by the ICD-10 code B27.92, the treatment approach becomes more complex due to the involvement of the central nervous system. Below, we explore the standard treatment approaches for this condition.

Understanding Infectious Mononucleosis with Meningitis

Overview of Infectious Mononucleosis

Infectious mononucleosis is primarily viral and is most commonly associated with EBV. The condition typically resolves on its own, but complications can arise, particularly when the infection affects the meninges, leading to viral meningitis. Symptoms of meningitis may include severe headache, neck stiffness, photophobia, and altered mental status.

Diagnosis

Diagnosis of infectious mononucleosis with meningitis involves:
- Clinical Evaluation: Assessment of symptoms and physical examination.
- Laboratory Tests: Blood tests to detect heterophile antibodies (Monospot test) and specific EBV antibodies. Lumbar puncture may be performed to analyze cerebrospinal fluid (CSF) for signs of viral infection.

Standard Treatment Approaches

Supportive Care

The cornerstone of treatment for infectious mononucleosis, including cases with meningitis, is supportive care:
- Hydration: Ensuring adequate fluid intake to prevent dehydration.
- Rest: Encouraging plenty of rest to aid recovery.
- Pain Management: Use of analgesics such as acetaminophen or ibuprofen to relieve fever and discomfort.

Corticosteroids

In cases where there is significant neurological involvement or severe symptoms, corticosteroids may be indicated:
- Indications: Corticosteroids can help reduce inflammation and swelling in the central nervous system, particularly if there is a risk of complications such as increased intracranial pressure.
- Dosage and Administration: The specific dosage and duration depend on the severity of symptoms and the clinical judgment of the healthcare provider.

Antiviral Therapy

While antiviral medications are not routinely used for EBV infections, they may be considered in severe cases or when there is a risk of complications:
- Acyclovir: This antiviral may be used in cases of severe viral meningitis, although its efficacy specifically for EBV-related meningitis is limited.

Monitoring and Follow-Up

Patients diagnosed with infectious mononucleosis with meningitis require careful monitoring:
- Neurological Assessment: Regular evaluation of neurological status to detect any deterioration.
- Follow-Up Appointments: Scheduling follow-up visits to monitor recovery and manage any lingering symptoms.

Conclusion

Infectious mononucleosis with meningitis, classified under ICD-10 code B27.92, necessitates a comprehensive treatment approach focused on supportive care, potential use of corticosteroids, and careful monitoring. While most patients recover fully with appropriate management, it is crucial to remain vigilant for complications that may arise during the course of the illness. If symptoms worsen or new symptoms develop, immediate medical attention is essential to ensure optimal outcomes.