infectious mononucleosis and kawasaki disease

Question 1

what is infectious mononucleosis also known as? caused by?

Answer 1

• glandular fever

- EBV

Question 2

if there is tonsillitis, what are your other differentials?

Answer 2

• strep infection
• diphtheria
• leukaemia
• lymphoma
• toxoplasmosis and CMV
• hepatitis

Question 3

what are the main clinical features of infectious mononucleosis?

Answer 3

• marked cervical lymphadenopathy
• fever
• sore throat
• enlarged purulent tonsils
• splenomegaly
• macular rash

Question 4

what investigations should you carry out for infectious mononucleosis?

Answer 4

• FBC: look for atypical lymphocytes (10-25% of WCC)
• heterophiles antibodies +ve in 60% of cases
• EBV IgM presents in early stages
• LFTs

Question 5

what is the management of IM?

why advice should they be given?

Answer 5

• self limiting
• symptomatic treatment
• give steroids if severe
• don’t do contact sports due to splenomegaly

Question 6

what age group is kawasaki most common in?

what is the pathophysiology?

Answer 6

• 6 months to 5 years

- autoimmune mediated systemic vasculitis, affecting small and medium sized arteries

Question 7

what is the diagnostic criteria?

Answer 7

• fever lasting >5 days
• marked irritability
• erythema, swelling and desquamation affecting skin and extremities
• bilateral conjunctivitis
• widespread non-vesicular rash
• strawberry tongue (inflammation of lips and mouth)
• cervical lymphadenopathy >15mm (anterior cervical chain)

Question 8

what investigations could you do?

Answer 8

• ESR and CRP
• LFTs (raised)
• urinalysis (pyuria and proteinuria)
• high platelets
• ECG and ECHO

Question 9

what cardiovascular things can Kawasakis cause?

What renal effects does kawasakis have?

Answer 9

• pancarditis,
• aortic or mitral valve incompetence tachycardia
• sterile pyuria, mild proteinuria

Question 10

what GI effects does Kawasakis have?

Answer 10

• hydrops of gallbladder
• jaundice
• hepatomegaly
• diarrhoea

Question 11

what musculoskeletal effects does Kawasakis have?

CNS?

Answer 11

• arthritis and arthralgia

- aseptic meningitis

Question 12

how should they be managed (Kawasakis)?

Answer 12

• Aspirin if NO fever
• IV Ig reduces incidence of coronary artery aneurysms by 20%
• corticosteroids
• Anti-TNF and immunosuppressive treatments

Question 13

what is the most common complication of kawasakis and how is it treated?

Answer 13

• coronary artery aneurysms
• PCI or CABG
• Aspirin and warfarin or LMWH
• most regress after 2 years

Note these can cause MI, valvular disease, cardiac arrhythmia, or HF as a consequence