INFECTIOUS MONONUCLEOSIS
History
• Fever, pharyngitis, lymphadenopathy, HA, rash, nonspecific sxs
• 4–6 wk incubation period, 1–2 wk prodrome: Fatigue, malaise, myalgias, low-grade temp
Findings
• Low-grade temp, pharyngitis, tonsillitis
• Tender & firm LAD for 1–2 wk, most often postcervical nodes, but can be generalized
• Rash: Papular erythematous on UE, erythema nodosum, erythema multiforme
• Splenomegaly; severe abdominal pain uncommon, may indicate splenic rupture
• May have petechiae, jaundice, hepatomegaly, periorbital edema
Evaluation
• CBC: ↑ WBC, ↑ atypical lymphocytes, ↑ LFTs (bilirubin, AST, ALT); monospot test
Treatment
• Supportive, rest, analgesics, antipyretics
• Corticosteroids if airway edema
Disposition
• Admission rarely indicated; close PCP f/u
• Advise to avoid contact sports or vigorous exercise × 1 mo to prevent splenic rupture
Pearls
• Represents syndrome response to EBV (90% of people have EBV); most cases of mono caused by EBV but most EBV infections do not result in mono
• Secondary etiology: CMV
• Transmission through saliva; infects epithelial cells of oropharynx & salivary glands
• B lymphocytes become infected → allows viral entry into bloodstream
• Self-limited; usually spontaneous resolution in 3–4 wk, complete in several months
HIV/AIDS (Emerg Med Clin N Am 2008;26:367)
History
• Fever, fatigue, night sweats, pharyngitis, diarrhea, myalgia/arthralgias, HA, flu-like sxs
Findings
• Generalized maculopapular rash, oral ulcers (thrush), fever, lymphadenopathy
Evaluation
• CBC: Leukopenia, thrombocytopenia, ↑ LFTs
• ELISA to test for HIV Ab; if + confirm w/ Western blot (VL >100 K in acute infection)
• PCR to detect viral load, CD4 count
Treatment
• Counseling pre- & post-HIV testing
Disposition
• D/c unless systemically ill, ID f/u for antiretroviral tx
Pearls
• Transmitted through sexual contact (70%), IVDU; mother-to-child transmission possible during pregnancy or birth
• Untreated HIV → AIDS (CD4 <200) w/ life expectancy of 2–3 yr
