Mononucleosis differential diagnosis: Difference between revisions
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{{Mononucleosis}} | |||
{{CMG}} | |||
==Overview== | ==Overview== | ||
*Acute mononucleosis, [[Cytomegalovirus|acute cytomegalovirus infection]] and [[Toxoplasmosis|toxoplasma gondii infection]] have similar clinical presentations. | *Acute mononucleosis, [[Cytomegalovirus|acute cytomegalovirus infection]] and [[Toxoplasmosis|toxoplasma gondii infection]] have similar clinical presentations. | ||
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:*[[Influenza]] | :*[[Influenza]] | ||
==Differentiating | ==Differentiating Monoucleosis from Other Diseases== | ||
====Pharyngitis==== | ====Pharyngitis==== | ||
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*[[Edema|Edema of the uvula]] is rare but if present differentiates mononucleosis from all other types of pharyngitis | *[[Edema|Edema of the uvula]] is rare but if present differentiates mononucleosis from all other types of pharyngitis | ||
====Cytomegalovirus vs | ====Cytomegalovirus vs EBV==== | ||
*Almost all cases of mononucleosis are caused by the [[EBV]]; however, [[cytomegalovirus]] can produce a similar symptoms but milder and with less [[throat pain]] and no [[rash]]. | *Almost all cases of mononucleosis are caused by the [[EBV]]; however, [[cytomegalovirus]] can produce a similar symptoms but milder and with less [[throat pain]] and no [[rash]]. | ||
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*An elevated antibody ([[IgM]]) titer specific for [[CMV]] helps to differentiate it from [[EBV|EBV infection]] | *An elevated antibody ([[IgM]]) titer specific for [[CMV]] helps to differentiate it from [[EBV|EBV infection]] | ||
====Toxoplasmosis vs | ====Toxoplasmosis vs EBV==== | ||
*In pregnant women, it is imperative to differentiate mononucleosis from [[toxoplasmosis]] as ''toxo'' is associated with significant consequences in the fetus. | *In pregnant women, it is imperative to differentiate mononucleosis from [[toxoplasmosis]] as ''toxo'' is associated with significant consequences in the fetus. | ||
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*In addition, normal to moderately elevated [[white blood cell|white blood cell count]], particularly the number of [[lymphocytes]] is observed with mononucleosis; while, in patients infected with [[Toxoplasmosis|toxo]], the [[white blood cell|white blood cell count]] is typically normal. | *In addition, normal to moderately elevated [[white blood cell|white blood cell count]], particularly the number of [[lymphocytes]] is observed with mononucleosis; while, in patients infected with [[Toxoplasmosis|toxo]], the [[white blood cell|white blood cell count]] is typically normal. | ||
====Viral | ====Viral Hepatitis vs EBV==== | ||
*[[Liver function tests]] may show a moderate elevation of liver enzyme levels in nearly 90% of patients infected with mononucleosis. On the contrary, there is a significant increase in enzyme levels observed in patients with [[viral hepatitis]]. | *[[Liver function tests]] may show a moderate elevation of liver enzyme levels in nearly 90% of patients infected with mononucleosis. On the contrary, there is a significant increase in enzyme levels observed in patients with [[viral hepatitis]]. | ||
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[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Medicine]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Mature chapter]] | |||
[[Category:Lymphocytes]] | |||
[[Category:Viral diseases]] | |||
Revision as of 21:45, 17 December 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
- Acute mononucleosis, acute cytomegalovirus infection and toxoplasma gondii infection have similar clinical presentations.
- In addition, since their management is much the same, it is not always helpful, or possible, to distinguish between infectious mononucleosis and cytomegalovirus infection.
- However, in pregnant women, it is imperative to differentiate mononucleosis from toxoplasmosis as toxo is associated with significant consequences in the fetus.
- Acute HIV infection can also mimic signs similar to those of infectious mononucleosis, and tests should be performed in pregnant women for the same reason as toxoplasmosis.[1]
- Other conditions to be differentiated from infectious mononucleosis include:
Differentiating Monoucleosis from Other Diseases
Pharyngitis
- EBV infection may cause either exudative or non-exudative pharyngitis and both of which is colonized by streptococcus pyogens present in the oropharynx
- Petechial hemorrhages present in the posterior oropharynx are characteristic of infectious mononucleosis
- Edema of the uvula is rare but if present differentiates mononucleosis from all other types of pharyngitis
Cytomegalovirus vs EBV
- Almost all cases of mononucleosis are caused by the EBV; however, cytomegalovirus can produce a similar symptoms but milder and with less throat pain and no rash.
- Extreme fatigue, bilateral supra-orbital edema, tender bilateral lymphadenopathy, splenomegaly, elevated liver function tests are characteristic of mononucleosis and may or may not be present in cytomegalovirus infections.
- Although, due to the presence of the atypical lymphocytes on the blood smear in both conditions, some physicians confusingly used to include both infections under the diagnosis of "mononucleosis," though EBV is by definition the infection that must be present for this illness.
- An elevated antibody (IgM) titer specific for CMV helps to differentiate it from EBV infection
Toxoplasmosis vs EBV
- In pregnant women, it is imperative to differentiate mononucleosis from toxoplasmosis as toxo is associated with significant consequences in the fetus.
- In contrast to tender bilateral lymphadenopathy observed in patients with mononucleosis, toxo causes unilateral lymphadenopathy.
- In addition, normal to moderately elevated white blood cell count, particularly the number of lymphocytes is observed with mononucleosis; while, in patients infected with toxo, the white blood cell count is typically normal.
Viral Hepatitis vs EBV
- Liver function tests may show a moderate elevation of liver enzyme levels in nearly 90% of patients infected with mononucleosis. On the contrary, there is a significant increase in enzyme levels observed in patients with viral hepatitis.
References
- ↑ Ebell MH (2004). "Epstein-Barr virus infectious mononucleosis". American Family Physician. 70 (7): 1279–87. PMID 15508538. Retrieved 2012-02-23. Unknown parameter
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