12 year old boy came with fever, sorethroat and cervical lymph node enlargement. Throat swab positive for group A beta hemolytic streptococci and started on penicillin. But he came back with worsening of symptoms even while on treatment. Next step is:
Arts) b (Blood monospot test and CBC) Ref Nelson 18th ed p1375The features given in the question are classically seen in IMN. So the next step is to confirm the diagnosis by monospot test and CBC and then only start treatment with acyclovir and steroids.There are rapid IgM and IgG antibody which is used in the diagnosis, but IgE antibody assay is not usedInfectious mononucleosisInfectious mononucleosis is the best-known clinical syndrome caused by Epstein-Barr virus (EBV). It is characterized by systemic somatic complaints consisting primarily of fatigue, malaise, fever, sore throat, and generalized lymphadenopathy. Originally described as glandular fever, it derives its name from the mononuclear lymphocytosis with atypical-appearing lymphocytes that accompany the illness.Primary EBV infection in adolescents and adults manifests in >50% of cases as the classic triad of fatigue, pharyngitis, and generalized lymphadenopathy, which constitute the major clinical manifestations of infectious mononucleosis.The physical examination is characterized by generalized lymphadenopathy (90% of cases), splenomegaly (50% of cases), and hepatomegaly (10% of cases). Lymphadenopathy occurs most commonly in the anterior and posterior cervical nodes and the submandibular lymph nodes and less commonly in the axillary and inguinal lymph nodes.Epitrochlear lymphadenopathy is particularly suggestive of infectious mononucleosis.The diagnosis of infectious mononucleosis implies primary EBV infection. A presumptive diagnosis may be made by the presence of typical clinical symptoms with atypical lymphocytosis the peripheral blood.The diagnosis is usually confirmed by serologic testing, either for heterophile antibody or specific EBV antibodies.Approximately 5% of cases of EBV-associated infectious mononucleosis have positive throat cultures for group A streptococcus', this represents pharyngeal streptococcal carriage. Failure of a patient with streptococcal pharyngitis to improve within 48-72 hr should evoke suspicion of infectious mononucleosis.EBV-specific antibody testing is useful to confirm acute EBV infection, especially in heterophile-negative cases, or to confirm past infection and determine susceptibility to future infection.The EBNA, EA, and VCA antigen systems are most useful for diagnostic purposes.The acute phase of infectious mononucleosis is characterized by rapid IgM and IgG antibody responses to VCA in all cases and an IgG response to EA in most cases.
Start azithromycin
Blood monospot test and CBC
IgE for IMN
Presume it as EBV and start acyclovir and prednisolone
Infection