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Sore throat - acute - Making a diagnosis
Infectious mononucleosis
- Infectious mononucleosis (glandular fever) presents in most people as a clinical triad of sore throat, fever, and lymphadenopathy. Sore throat is the most frequent complaint. It is usually severe for 3–5 days and then gradually resolves over 7–10 days. The degree of malaise is often out of proportion to the clinical picture [Epstein and Crawford, 2003; Bisno, 2005; Johannsen et al, 2005]:
- A fever of 38–39°C is usually present.
- Cervical lymphadenopathy is symmetrical. Posterior lymphadenopathy is most common, but submandibular and anterior cervical lymphadenopathy are also common. Individual nodes are only mildly tender on palpation.
- The tonsils are usually enlarged, occasionally meeting in the midline.
- The pharynx may be erythematous with exudate. Palatal petechiae may be present but are not diagnostic of infectious mononucleosis.
- There is usually a moderate bradycardia.
- Splenomegaly occurs in over 50% of people and is maximal at the beginning of the second week. In athletic teenagers in whom well developed abdominal musculature impairs palpation the spleen may be percussible [Fisher and Boyce, 2005].
- A few people may develop jaundice, hepatomegaly, or a rash which may be macular, petechial, scarletiniform, urticarial, or like erythema multiforme.
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