Infectious mononucleosis: Difference between revisions

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***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
*Definitive testing for suspected Mono during pregnancy (to r/o other pathology)
*Suspected mononucleosis during pregnancy (also need to r/o other pathology):
**Send for: Epstein Barr virus, cytomegalovirus, and HIV
**Epstein Barr Virus, Cytomegalovirus, and HIV


==Differential Diagnosis==
==Management==
*[[Hepatitis]]
*Supportive
*Avoid contact sports


{{Throat pain DDX}}
==Disposition==
*Discharge


{{Peds Rash DDX}}
==References==
<references/>


==Treatment==
*Supportive
==Source==
<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

Differential Diagnosis

Acute Sore Throat

Bacterial infections

Viral infections

Noninfectious

Other

Pediatric Rash

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

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