A 2-year-old presents with 5 days of high fever, generalised lymphadenopathy, tonsillopharyngitis with membrane, and the Monospot (heterophile antibody) test is positive. Which virus is responsible, and which complication requires immediate intervention?
- A CMV; hepatitis
- B EBV (Epstein-Barr virus); splenic rupture ✓
- C Adenovirus; myocarditis
- D HIV; opportunistic infections
Explanation
Infectious mononucleosis (glandular fever) is caused by Epstein-Barr virus (EBV, human herpesvirus 4) and presents with fever, pharyngitis/tonsillitis with exudate or membrane, generalised lymphadenopathy (posterior cervical), and hepatosplenomegaly. The Monospot (heterophile antibody/Paul-Bunnell) test is positive in 90% of adolescents and adults but less sensitive in young children. The most serious acute complication is splenic rupture (rare, ~0.1–0.5%) occurring in the first 3 weeks, mandating avoidance of contact sports for 4 weeks. Airway obstruction from tonsillar swelling and autoimmune haemolytic anaemia are other complications. Ampicillin/amoxicillin causes a characteristic morbilliform rash in EBV mononucleosis.
Reference: Ghai Essential Pediatrics, 10th ed.
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