– Sx = Teen w/ fever, sore throat, muscle soreness, malaise, and fatigue.
→ Central sx = Fatigue, Malaise, Appetite loss, Headache
→ Visual sx = Photophobia
→ Tonsils sx = Erythema, Swelling, White patches
→ Throat sx = Erythema and Soreness
→ Lymph nodes sx = Swelling
→ Respiratory sx = Cough
→ Spleen sx = Enlargement, LUQ Abdominal pain
→ Gastric sx = Nausea
→ Systemic sx = Chills, Fever, and Aches
– ~90% of people will acquire EBV no symptoms
– Mononucleosis is usually caused by the Epstein-Barr virus (EBV), which infects B cells (B-lymphocytes), producing a reactive lymphocytosis and atypical T cells (T-lymphocytes) known as Downey bodies.
DDX:
– Infectious Mononucleosis* – Hepatitis – Viral or Bacterial Pharyngitis – Acute HIV Infection – Secondary Syphilis
Work-up:
– CBC, peripheral smear
more white blood cells (lymphocytes) than normal
atypical lymphocytes
fewer than normal neutrophils or platelets
– Monospot test
– AST/ALT/bilirubin/alkaline phosphatase
abnormal liver function
– Throat culture
– HIV antibody and viral load
– Anti-EBV antibodies VDRL/RPR
Treatment:
Self Care
Throat lozenge, Activity restriction, and Bed rest
Supportive Care
Fluid replacement
Medication
NSAID – Ibuprofen
Analegesic – Acetominophen
Laryngitis
Presentation:
– inflammation in the larynx, or voice box.
– larynx sits in the front of the throat, above the windpipe, and it contains the vocal cords.
– Inflammation of the vocal cords cause hoarseness of the voice, and some lose their voice temporarily.
– Painful inflammation of pharynx, and is colloquially referred to as a sore throat.
– Infection of the tonsils (tonsillitis) and/or larynx (laryngitis) may occur simultaneously.
– ~90% of cases are caused by viral infection, with the rest d/t bacterial infection and, in rare cases, oral thrush (fungal candidiasis e.g. in babies).
– Some cases of pharyngitis are caused by irritation from elements such as pollutants or chemical substances.
gargling with warm salt water several times a day (use one half teaspoon or 3 grams of salt in a glass of warm water)
Medications
Analgesic – Acetaminophen
Strep Tonsillitis/ Scarlet Fever
Presentation:
– Caused by an exotoxin released by Streptococcus pyogenes Group A
– Presentation = sore throat, fever, a ‘strawberry’ tongue, and a fine sandpaper rash over upper (or entire) body
– Day 1 = Abrupt onset → Sore throat, reddened fauces, Punctate, bright red rash on hard palate = Coated “strawberry tongue”
– Day 2 = Polymorphonuclear leukocytosis. Eosionphiles increased
– Day 3 = Flushed cheeks, Punctate blush over neck and chest spreading to entire body. Rash is fine, red, w/ rough-textures, blanches; Pastia lines in armpits and goin, appear (can last after rash gone)
– Day 4 = Desquamation (peeling) begins
• Scarlet Fever ≠ Rheumatic Fever, but may progress into RF.
Treatment:
• Penicillin G or Clindamycin to prevent RF (will not prevent post-streptococcal glomerulonephritis)
Tonsillitis
Presentation:
an inflammation of the tonsils.
a viral or a bacterial infection.
Bacterial tonsillitis – group A Streptococcus bacteria.
Symptoms similar to pharyngitis
a sore throat
red and swollen tonsils
white or yellow dots on the tonsils
difficulty swallowing
abdominal pain
a headache
stiffness of the neck
Work-up:
Throat Culture
Rapid strep test
Treatment:
Self Care – Tea with honey, Salt water gargle, and Throat lozenge
Medication:
NSAID – Ibuprofen
Analgesic – Acetaminophen
Penicillin antibiotic – Amox, Amoxi/Clav, Pen V, Pen G
