Infectious mononucleosis: Difference between revisions
Neil.m.young (talk | contribs) (sn of monospot) |
No edit summary |
||
Line 17: | Line 17: | ||
***95% of patients on amoxicillin or ampicillin | ***95% of patients on amoxicillin or ampicillin | ||
***40-60% with other beta-lactams | ***40-60% with other beta-lactams | ||
==Differential Diagnosis== | |||
{{Throat pain DDX}} | |||
{{Peds Rash DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
===Work-up=== | |||
*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 adult 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> | **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 | |||
===Evaluation=== | |||
*Clinical features in conjunction with positive monospot. | |||
*Amoxicillin reaction is helpful in diagnosis | |||
**Amoxicillin in pt w/ EBV will cause maculopapular rash in most | **Amoxicillin in pt w/ EBV will cause maculopapular rash in most | ||
* | *Suspected mononucleosis during pregnancy (also need to r/o other pathology): | ||
** | **Epstein Barr Virus, Cytomegalovirus, and HIV | ||
== | ==Management== | ||
* | *Supportive | ||
*Avoid contact sports | |||
==Disposition== | |||
*Discharge | |||
==References== | |||
<references/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Peds]] | [[Category:Peds]] |
Revision as of 11:55, 22 August 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
- Morbilliform rash can develop[1]
Differential Diagnosis
Acute Sore Throat
Bacterial infections
- Streptococcal pharyngitis (Strep Throat)
- Neisseria gonorrhoeae
- Diphtheria (C. diptheriae)
- Bacterial Tracheitis
Viral infections
- Infectious mononucleosis (EBV)
- Patients with peritonsillar abscess have a 20% incidence of mononucleosis [2]
- Laryngitis
- Acute Bronchitis
- Rhinovirus
- Coronavirus
- Adenovirus
- Herpesvirus
- Influenza virus
- Coxsackie virus
- HIV (Acute Retroviral Syndrome)
Noninfectious
Other
- Deep neck space infection
- Peritonsillar Abscess (PTA)
- Epiglottitis
- Kawasaki disease
- Penetrating injury
- Caustic ingestion
- Lemierre's syndrome
- Peritonsillar cellulitis
- Lymphoma
- Internal carotid artery aneurysm
- Oral Thrush
- Parotitis
- Post-tonsillectomy hemorrhage
- Vincent's angina
- Acute necrotizing ulcerative gingivitis
Pediatric Rash
- Atopic dermatitis
- Bed bugs
- Contact dermatitis
- Drug rash
- Erythema infectiosum (Fifth disease)
- Hand-foot-and-mouth disease
- Henoch-schonlein purpura (HSP)
- Herpangina
- Herpes simplex virus (HSV)
- Infectious mononucleosis
- Meningitis
- Measles
- Molluscum contagiosum
- Roseola infantum
- Rubella (German measles)
- Scabies
- Scarlet fever
- Smallpox
- Varicella (Chickenpox)
Diagnosis
Work-up
- 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[3]
Evaluation
- Clinical features in conjunction with positive monospot.
- Amoxicillin reaction is helpful in diagnosis
- Amoxicillin in pt w/ EBV will cause maculopapular rash in most
- Suspected mononucleosis during pregnancy (also need to r/o other pathology):
- Epstein Barr Virus, Cytomegalovirus, and HIV
Management
- Supportive
- Avoid contact sports
Disposition
- Discharge
References
- ↑ Luzuriaga K and Sullivan JL. Infectious mononucleosis. N Engl J Med. 2010; 362:1993-2000.
- ↑ Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
- ↑ Papesch M and Watkins R. Epstein-Barr virus infectious mononucleosis. Clin Otolaryngol Allied Sci. 2001; 26(1):3-8.