Difference between revisions of "Infectious mononucleosis"

(sn of monospot)
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*Heterophile antibody (monospot) test
 
*Heterophile antibody (monospot) test
 
**Up to 25% of pts in 1st week of symptoms may have false negative test
 
**Up to 25% of pts in 1st week of symptoms may have false negative test
**10% of pts w/ EBV infection will be persistently negative
+
**10% of adult pts w/ EBV infection will be persistently negative
 +
**Up to 50% of pediatric pts will be persistently negative<ref>Papesch M and Watkins R. Epstein-Barr virus infectious mononucleosis. Clin Otolaryngol Allied Sci. 2001; 26(1):3-8.</ref>
 
*Amoxicillin reaction
 
*Amoxicillin reaction
 
**Amoxicillin in pt w/ EBV will cause maculopapular rash in most
 
**Amoxicillin in pt w/ EBV will cause maculopapular rash in most

Revision as of 17:35, 4 June 2015

Background

  • Caused by Epstein-Barr virus
    • CMV and HHV-6 may cause mononucleosis-like illnesses

Clinical Features

  • Triad of:
    • Fever
    • Pharyngitis
    • Lymphadenopathy
  • Symptoms
    • abrupt or insidious, ha, fever & malaise common w/ st & lad to follow
    • Rash in 10-15% usu btwn 4th-6th day of illness
      • red macular or maculopapular morbilliform rash of trunk & upper arms
      • occ involves face, thigh & legs, periorbital & eyelid edema in 50% of cases
  • Previously treated at strep throat
    • Morbilliform rash can develop[1]
      • 95% of patients on amoxicillin or ampicillin
      • 40-60% with other beta-lactams

Diagnosis

  • Heterophile antibody (monospot) test
    • Up to 25% of pts in 1st week of symptoms may have false negative test
    • 10% of adult pts w/ EBV infection will be persistently negative
    • Up to 50% of pediatric pts will be persistently negative[2]
  • Amoxicillin reaction
    • Amoxicillin in pt w/ EBV will cause maculopapular rash in most
  • Definitive testing for suspected Mono during pregnancy (to r/o other pathology)
    • Send for: Epstein Barr virus, cytomegalovirus, and HIV

Differential Diagnosis

Acute Sore Throat

Bacterial infections

Viral infections

Noninfectious

Other

Pediatric Rash

Treatment

  • Supportive

Source

  1. Luzuriaga K and Sullivan JL. Infectious mononucleosis. N Engl J Med. 2010; 362:1993-2000.
  2. Papesch M and Watkins R. Epstein-Barr virus infectious mononucleosis. Clin Otolaryngol Allied Sci. 2001; 26(1):3-8.
  3. Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.