Infectious mononucleosis: Difference between revisions
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===Evaluation=== | ===Evaluation=== | ||
*Clinical features in | *Clinical features | ||
*Amoxicillin reaction is helpful in diagnosis | *Lab features | ||
**Amoxicillin in pt w/ EBV will cause maculopapular rash in most | **CBC | ||
*Suspected mononucleosis during pregnancy (also need to r/o other pathology): | ***Lymphocytosis (≥50% lymphocytes) | ||
**Epstein Barr Virus, Cytomegalovirus, and HIV | ***10% or more atypical lymphocytes | ||
**LFTs | |||
***Elevations in AST and ALT is expected up to 5x | |||
**Heterophile antibody (monospot) test | |||
***Up to 25% of pts in 1st week of symptoms may have false negative test<ref>Pitetti RD, Laus, S, and Wadowsky, RM. Clinical evaluation of a quantitative real time polymerase chain reaction assay for diagnosis of primary Epstein-Barr virus infection in children. Pediatr Infect Dis J. 2003; 22:736–739.</ref> | |||
***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> | |||
**EBV IgM Assay | |||
***Carries 97% sensitivity and 94% specificity at symptom onset<ref>Bruu, AL, et al. Evaluation of 12 commercial tests for detection of Epstein-Barr virus-specific and heterophile antibodies. Clin Diagn Lab Immunol. 2000; 7:451–456.</ref> | |||
**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== | ==Management== | ||
Revision as of 14:46, 26 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
- CBC
- BMP
- LFTs
- Heterophile antibody (monospot) test
- EBV IgM Assay
Evaluation
- Clinical features
- Lab features
- CBC
- Lymphocytosis (≥50% lymphocytes)
- 10% or more atypical lymphocytes
- LFTs
- Elevations in AST and ALT is expected up to 5x
- Heterophile antibody (monospot) test
- EBV IgM Assay
- Carries 97% sensitivity and 94% specificity at symptom onset[5]
- 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
- CBC
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.
- ↑ Pitetti RD, Laus, S, and Wadowsky, RM. Clinical evaluation of a quantitative real time polymerase chain reaction assay for diagnosis of primary Epstein-Barr virus infection in children. Pediatr Infect Dis J. 2003; 22:736–739.
- ↑ Papesch M and Watkins R. Epstein-Barr virus infectious mononucleosis. Clin Otolaryngol Allied Sci. 2001; 26(1):3-8.
- ↑ Bruu, AL, et al. Evaluation of 12 commercial tests for detection of Epstein-Barr virus-specific and heterophile antibodies. Clin Diagn Lab Immunol. 2000; 7:451–456.