907 Diagnosing Infectious Mononucleosis in Primary Care - Case Studies from a Pediatric Outpatient Clinic

Background Although a common viral disease Infectious Mononucleosis may represent a diagnostic challenge for the primary care physician. Objectives To describe the clinical and biological features of Infectious Mononucleosis by analizing cases diagnosed, treated and followed up in an outpatient pediatric clinic. Materials and Methods We conducted a retrospective study consulting the electronical medical records of all the children who were given the diagnosis “Infectious Mononucleosis” over a period of 3 years. Results 40 children (aged 2 to 18 years) were given this diagnose during the studied period. Out of these 3 cases were confirmed not to be “Infectious mononucleosis” being given an alternative diagnostic, 6 cases were not followed up for various reasons and were excluded from the study and 3 cases could not be confirmed because the parents refused blood withdrawal. 26 cases were confirmed serologically (positive Ig M for Epstein Barr virus). Most prevalent symptom was enlarged lymph nodes (84%), followed by altered general status (80.7%), fever (53%), exudative tonsilitis (34.6%). Lymphocytosis and elevated glutamic pyruvic transaminase were the most prevalent biological signs (50%) followed by elevated C reactive protein (42.3%). One case was found with trombocytopenia and 1 case exibit signs and symptoms of rhabdomyolisis (elevated CK, LDH, GOT; muscle pain). Conclusions Infectious mononucleosis may have polymorphic manifestations. One should consider this diagnostic especially when investigating fever that lasts longer than 4 days, enlarged lymph nods and exudative tonsilitis but be aware of particular forms of this disease.