Infectious mononucleosis

ICD-9: 075

Description

Infectious mononucleosis is an acute infectious disease characterized by sore throat, fever, and swollen cervical lymph glands. The disease primarily affects adolescents and young adults. It is also called glandular fever.

Etiology

Infectious mononucleosis is caused by the Epstein-Barr virus (EBV). This virus is shed in the saliva of infected individuals and is usually spread through the oral-pharyngeal route (the reason for another name: the “kissing disease”). Once in the body, EBV infects B lymphocytes, a type of white cell found in the lymph, blood, and connective tissue, that are one important component of the body’s immune system. Infectious mononucleosis is most likely contagious for a period before symptoms develop until the fever subsides and the oral-pharyngeal lesions disappear.

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Signs and Symptoms

Initial symptoms are usually vague, mimic those of other diseases, and may include malaise, anorexia, and chills. After 3 to 5 days, sore throat, fever, and swollen lymph glands in the throat and neck occur. Early in the infection, a rash that resembles rubella sometimes develops.

Diagnostic Procedures

A thorough client history and physical examination are essential to rule out closely related disorders and will reveal the triad of symptoms: (1) sore throat, (2) fever, and (3) swollen lymph glands. A blood test is necessary to confirm the diagnosis. It will show increased numbers of leukocytes, lymphocytes, monocytes, and antibodies to EBV.

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Atypical lymphocytes seen in infectious mononucleosis

FIGURE. Atypical lymphocytes seen in infectious mononucleosis. (From Thomas, CL [ed]: Taber’s Cyclopedic Medical Dictionary, ed 21. FA Davis, Philadelphia, 2009, p 1488, with permission.)

Treatment

Treatment is supportive because mononucleosis resists prevention and antimicrobial treatment. Bed rest may be indicated during the acute phase, but clients may still need to lessen their activities until the disease completely subsides. Analgesics may be recommended for headache and sore throat. Warm saline gargles are also helpful.

Complementary Therapy

Bed rest is especially important in the acute phase of the infection. It is recommended that clients drink plenty of water, filtered to remove chlorine, heavy metals, benzene, lead, and mercury, and eat organic meats, eggs, milk, and poultry that contain no growth hormones or antibiotics. Vitamin supplements may be recommended.

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CLIENT COMMUNICATION

Stress adequate rest and reduction of activities. Clients may suffer from ongoing fatigue during much of the period of infection and tend to resume normal activity too quickly.

Prognosis

The prognosis is excellent, but recovery may take several weeks or months. Once infected with EBV, the virus remains—usually in a dormant state—for life. If the virus does reactivate, it does not cause illness. Mononucleosis sometimes leads to a serious condition called chronic active EBV infection, which causes illness more than 6 months after the initial diagnosis.

Prevention

The best prevention is to avoid oral-pharyngeal contact with a known EBV-infected person. Do not share dishes or eating utensils with someone who has mononucleosis. (EBV virus is spread when saliva from an infected person gets into another person’s mouth.)

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EPIGLOTTITIS ICD-9: 464.31 Description Epiglottitis occurs when the epiglottis covering the windpipe swells and blocks the flow of air into the lungs. It is life-threatening. Etiology Infection with Haemophilus influenzae type b (Hib) is the most common cause, followed by burns from hot liquids and direct injury to the throat. Other bacteria and viruses that cause epiglottitis are pneumococcus; streptococcus A, B, and C; Candida albicans; and varicella zoster. Swallowing a foreign object and smoking crack cocaine and heroin may also cause epiglottitis. Signs and Symptoms Onset of symptoms is sudden. Likely symptoms include sore throat, painful swallowing, fever, drooling, hoarseness, dyspnea, and cyanosis. Diagnostic Procedures Once the airway is open and the condition is stable, the throat is examined with a flexible fiberoptic tube. A blood test and throat culture are likely taken to establish the cause of any infection. Treatment The first priority is to establish a c...
Adenoid hyperplasia ICD-9: 474.12 Description Adenoid hyperplasia is the enlargement of the lymphoid tissue of the nasopharynx, causing partial breathing blockage. Etiology The cause is essentially unknown. Circumstances that may cause the adenoids to continue to grow when they normally would atrophy (approximately ages 5 to 8) may include repeated infection and nasal congestion, chronic allergies, and heredity. Signs and Symptoms The most common symptoms are chronic mouthbreathing, snoring, and frequent head colds. The child’s speech has a nasal quality. Diagnostic Procedures Diagnosis is usually made by visualizing the hyperplastic adenoidal tissue or by the use of lateral pharyngeal x-ray films. Treatment The treatment of choice is adenoidectomy, often performed in conjunction with a tonsillectomy. Complementary Therapy No significant complementary therapy is indicated. CLIENT COMMUNICATION Explain in simple terms the surgical procedure to a child. Be sympathetic...
Lung abscess ICD-9: 513.0 Description A lung abscess is an area of necrotized lung tissue containing purulent material. Abscesses are more frequent in the lower dependent portions of the lungs and in the right lung, which has a more vertical bronchus. Etiology Lung abscesses caused by infectious organisms may be a complication of pneumonia. Aspiration of infectious material is the most frequent etiology; however, aspiration due to dysphagia or compromised consciousness (e.g., seizure, cerebrovascular accident, head trauma, alcoholism) appears to be a predisposing factor. Poor oral hygiene, dental infections, and gingivitis are also common indicators. Antibiotic therapy has greatly decreased the number of deaths caused by lung abscess. However, the increased use of corticosteroids, immunosuppressive drugs, and chemotherapeutic agents in the past couple of decades has changed the natural environment of the oropharyngeal cavity and contributed to increased frequency of opportunistic lung abs...
Pleural effusion ICD-9: 511.9 Description Pleural effusion is an excess of fluid between the parietal and visceral pleural membranes enveloping each lung. The accumulating fluid may be characterized as transudate, which has little or no protein, or exudate, which is rich in protein. Etiology Pleural effusion may occur regardless of whether there is a pathological process affecting the pleurae themselves. Transudative pleural effusions frequently result from congestive heart failure, hepatic disease with ascites, and peritoneal dialysis. Exudative pleural effusions more often are seen with inflammation of the pleura, TB, rheumatoid arthritis, pancreatitis, respiratory neoplasms, and bacterial pneumonia. Signs and Symptoms The person may be asymptomatic. When signs and symptoms are manifested, they may include cough, dyspnea, and chest or pleuritic pain. The symptoms of pleural effusion will typically accompany those of any underlying condition. Diagnostic Procedures Auscultation of...
Thrush ICD-9: 111.20 Description Thrush is a yeast infection of the mucus membrane lining of the mouth and tongue. It is commonly seen in infants but occurs in individuals with diabetes, those taking antibiotics for a long period of time, individuals with poorly fitting dentures, and those receiving chemotherapy treatments. Persons with HIV or AIDS are susceptible, also. Etiology When the immune system is weakened, the small amount of Candida fungus normally living in the mouth grows unchecked and becomes a problem. The “sweet” saliva in the mouth of diabetics feeds the Candida, and long-term use of antibiotics destroys healthy bacteria that prevents its growth. Signs and Symptoms Thrush appears as whitish, velvety lesions in the mouth and on the tongue. The tissue underneath the lesions easily bleeds. The lesions gradually increase in number and size. It is painful to eat or swallow. Diagnostic Procedures Diagnosis is easily determined by a primary care provider or dent...