Infectious Mononucleosis

Infectious mononucleosis should be suspected if a sore throat and malaise persist despite antibiotic treatment, and a white cell analysis and Paul-Bunnell test are indicated.

A white membrane covering one or both tonsils is characteristic and helpful in diagnosis. Hypersensitivity to ampicillin is increased in infectious mononucleosis, and the antibiotic should be avoided as a severe urticaria follows its use. The positive Paul-Bunnell blood test is diagnostic of infections mononucleosis, and atypical mononuclear white cells are increased on the blood film.

Fig. 4.54a, b Infectious mononucleosis.

Infectious Mononucleosis Film

Fig. 4.54a, b Infectious mononucleosis.

Fig. 4.55 Infectious mononucleosis in a patient without tonsils. In this case, the membrane characteristic of infectious mononucleosis is seen either on the lingual tonsil or, as in this case, on a prominent posterior pharyngeal band of lymphoid tissue. A similar white membrane also covers the lymphoid tissue in the postnasal space.

The appearance on examination of the postnasal space may lead to a suspicion of neoplasm. The increase in bulk of the adenoids also causes a "nasal voice," which is sometimes characteristic of infectious mononucleosis.

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