0071643192.pdf

INFECTIOUS DISEASE

SYMPTOMS/EXAM

■ Characterized by:

■ Fever and malaise

■ Exudative pharyngitis

■ Cervical lymphadenopathy (particularly posterior LAN)

■ Splenomegaly in half of cases

■ Rash common following antibiotics (classically amoxicillin; also levaquin

and azithromycin)

DIFFERENTIAL

Strep pharyngitis, hepatitis

DIAGNOSIS

■ Transaminitis is common.

■ Atypical lymphocytes in peripheral blood smear

■ Heterophil antibody tests, eg, Monospot (viral capsid IgM) =definitive

■ May have false-negatives early in disease

TREATMENT

■ Supportive

■ Steroids if significant tonsillar hypertrophy

■ Avoid contact sportsif splenomegaly.

COMPLICATIONS

Rare: Burkitt lymphoma, nasopharyngeal carcinoma

Hantavirus

■ Single-stranded RNA virus of the Bunyaviridae family

■ Vector: Rodents (eg, deer mouse)

■ Spread via inhalation of feces/urine or direct bite

■ In North America, majority of cases occur in southwestern United States.

TABLE 8.1. Influenza Antiviral Treatment

DRUG INDICATION SIDEEFFECT CAUTIONS

Amantadine Influenza A Insomnia, anxiety, nausea, Caution in renal failure

and confusion (elderly)

Rimantadine Influenza A Insomnia, anxiety, nausea, Not approved for treatment

and confusion (elderly) in children

Zanamivir Influenza A Wheezing Contraindicated with

Influenza B asthma/COPD

Oseltamivir Influenza A Nausea Adjust dose for kidney disease

Influenza B Caution in children, possible

increased suicide risk

If patients with mono are

falsely diagnosed with strep

pharyngitis and given

antibiotics, they can develop a

diffuse maculopapular rash

and be incorrectly told they

have a drug allergy.