So-called heterophil negative mononucleosis may be caused by other organisms including CMV or Toxoplasma or by acute HIV infection or leptospirosis. Mononucleosis is most common in young adults, and most of the adult population has had clinically inapparent EBV disease. If patients with mononucleosis are treated with amoxicillin, they will almost uniformly develop a morbilliform rash. Diagnosis is by CBC revealing the typical lymphocytosis with atypical lymphocytes. If there is any doubt, an EBV antibody titer can be performed.
Liver enzymes are almost uniformly elevated.
CNS problems including encephalitis and aseptic meningitis, hematologic complications including hemolytic anemia and splenic rupture, as well as airway obstruction secondary to paratracheal lymphadenopathy. Symptomatic, and the illness generally resolves within 2 weeks. However, prednisone has been shown to reduce the length of the illness. Contact sports or activities producing other forms of trauma should be avoided because of the risk of splenic rupture. An abnormality of vocal cord vibratory function that results from injury, mucosal tear, or edema.