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