EB- VIRUS

Q). with a 5-day history of fever, sore throat, and fatigue. Physical examination reveals an

exudative tonsillitis and bilateral enlarged and slightly tender posterior cervical lymph nodes. The spleen is palpable 3 cm below the rib cage. Which agent is most likely responsible for this patient’s illness?

(A) Group A β-hemolytic streptococcus

(B) Adenovirus

(C) Toxoplasma gondii

(D) Epstein-Barr virus

(E) Corynebacterium diphtheriae

Ans: (D).

The agent most likely responsible for this child’s illness is the Epstein-Barr virus (EBV). The clinical picture is strongly suggestive of mononucleosis.

Although this patient could be infected with group A streptococcus or adenovirus, several

features are much more characteristic of EBV infection than either of these. They include the

fact that the child is a college student, the presence of splenomegaly, and the fact that

the adenopathy is posterior rather than anterior and is only slightly tender. While these

findings also could be explained by toxoplasmosis, this diagnosis is rarely confirmed as a

cause of acute exudative tonsillitis and cervical adenitis. Although it is appropriate to think of diphtheria in patients with acute exudative tonsillitis, there is nothing specific in this case to suggest that diagnosis. Infectious mononucleosis is clearly the most likely diagnosis.