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Acyclovir
75%
57/76
Amoxicillin
7%
5/76
Ganciclovir
9%
7/76
Prednisone
4%
3/76
Supportive care
3%
2/76
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This patient with exudative pharyngitis, splenomegaly, atypical lymphocytes on peripheral smear, and a positive heterophile antibody test likely has infectious mononucleosis. Infectious mononucleosis is best treated with supportive care, including rest and avoidance of contact sports due to the particularly increased risk of splenic rupture. Infectious mononucleosis is an infectious syndrome most commonly caused by the Epstein-Barr virus (EBV). Other potential causes include cytomegalovirus (CMV) and acute HIV infection. It is more common in younger patients and is transmitted by body fluids, particularly saliva (e.g. "kissing disease"). Common signs and symptoms include tonsillitis, splenomegaly, and marked fatigue. Lymphadenopathy in the posterior cervical chain is especially specific. Peripheral blood smear often demonstrates atypical lymphocytes. Diagnosis is typically made clinically. The monospot antibody test may aid in the diagnosis. However, it is often falsely negative, especially in cases due to infection with CMV. Complications associated with the disease include splenic rupture secondary to trauma, Guillain-Barre syndrome, encephalitis, hemolytic anemia, and maculopapular rash with ampicillin treatment (when infectious mononucleosis is mistakenly treated with antibiotics). Sylvester et. al review the diagnosis and management of infectious mononucleosis. They note the varied manifestations including tonsillitis, fatigue and other lymphadenopathy. They discuss the limited utility of heterophile antibody testing in diagnosis.Illustration A shows the exudative pharyngitis seen in EBV infectious mononucleosis. Illustration B shows a peripheral blood smear from a patient with infectious mononucleosis; note the atypical lymphocytes with large, irregular nuclei. Incorrect Answers:Answer 1: Acyclovir would not address this patients likely infection with EBV. Antiviral medications do not have a role in the management of patients with infectious mononucleosis. Answer 2: Amoxicillin may be appropriate for bacterial pharyngitis. However, this patient has features suggestive of infectious mononucleosis. Amoxicillin is not indicated for infectious mononucleosisAnswer 3: Ganciclovir would not address this patients likely infection with EBV. Antiviral medications do not have a role in the management of patients with infectious mononucleosis.Answer 4: Prednisone is not typically indicated for management of infectious mononucleosis. Bullet Summary: Infectious mononucleosis typically presents with fatigue, tonsillitis, and splenomegaly, and is managed with supportive care.
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