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Infectious mononucleosis
From WikEM
(Redirected from EBV)
Contents
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
- Headache, fever, and malaise common, sore throat and lymphadenopathy follow
- Rash in 10-15% usually between 4th-6th day of illness
- red macular or maculopapular morbilliform rash of trunk & upper arms
- occassionally involves face, thigh and legs, periorbital & eyelid edema in 50% of cases
- Previously treated as 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
- Coxsackievirus
- HIV (Acute Retroviral Syndrome)
Noninfectious
- Stevens-Johnson Syndrome
- Pemphigus
- Angioedema
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
Pediatric Rash
- Drug rash
- Erythema Infectiosum (Fifth disease)
- Hand-foot-and-mouth disease
- Henoch-Schonlein Purpura (HSP)
- Herpangina
- Herpes simplex virus
- Infectious Mononucleosis
- Meningitis
- Measles
- Molluscum contagiosum
- Roseola infantum
- Rubella German measles)
- Scarlet fever
- Smallpox
- Varicella (Chickenpox)
Evaluation
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]
- CBC
- Amoxicillin reaction is helpful in diagnosis
- Amoxicillin in patient with EBV will cause maculopapular rash in most
- Suspected mononucleosis during pregnancy (also need to rule out other pathology):
- Epstein Barr Virus, Cytomegalovirus, and HIV
Management
- Supportive
- Avoid contact sports for 1-2 months[6] (decrease risk of splenic rupture)
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.
- ↑ O'Connor TE, Skinner LJ, Kiely P, Fenton JE. Return to contact sports following infectious mononucleosis: the role of serial ultrasonography. Ear Nose Throat J. 2011 Aug;90(8):E21-4.
