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The nine year old girl with lump at the neck has: Infectious Mononucleosis Infectious mono is a common infection in teenagers which is easy for most primary care clinicians to diagnose. Usually there is sore throat, fever, tiredness, enlarged tonsils, and white spot at throat (exudate). There is enlarged lymph nodes also at the neck. Occasionally, there is swelling or edema of the eyelids. Some children have an enlarged spleen and liver. Infectious mono is a viral infection caused by Epstein-Barr virus (EBV). This is a worldwide infection. Most adults had been in contact with this virus. It is transmitted through the saliva from person to person and can be detected in the saliva as long as 6 months after the acute infection. The incubation periods is from 30 to 50 days. Other conditions that can mimic Infectious mono are: cytomegalovirus infections, toxoplasmosis, infectious hepatitis A, strep throat, adenoviral infection, and rubella. The classic signs of Infectious mono do not occur in all patients. Sometime, tiredness is the only symptom even without sore throat. Infectious mono test is called the Paul-Brunnell heterophile antibody. Treatment is symptomatic. Recovery might take several weeks in some. Short course of prednisone might help those patients with an upper airway obstruction. In most instances there is no complications arising from Infectious mono. However, in few patients, there could be splenic rupture, encephalitis, Guillain-Barre syndrome, myocarditis, hemolytic anemia, aplastic anemia, and upper airway obstruction. Some expert claim that chronic fatique syndrome could be a result of Infectious mono. Leo Leonidas, MD, FAAP |
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