At present, the symptoms presented by the student are consistent with infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV). This includes symptoms that appear to mimic those of the flu. In addition to a sore throat, the patient complains of aching joints and fatigue. It should be noted that an elevated temperature and swollen lymph nodes were revealed following an initial examination by the FNP. The lab results were, however, unremarkable and a Monospot test turned out to be negative. It is important to note that “because peak heterophile antibody levels are seen between 2 to 6 weeks from infection, testing too early in the disease process may lead to increased rates of false negative testing†(Stuempfig and Seroy, 2019). In the case study, we are told that the patient in question has been having “flu-like†symptoms for the last one week. Therefore, the Monospot test in this case could have been undertaken too early – hence the negative result.
Infectious mononucleosis is, according to Dunmire, Hugguist, Balfour (2015), characterized by sore throat, cervical lymph node enlargement, fatigue and fever†(219). As the authors further point out, in as far as lymph node enlargement is concerned, there is often the equal enlargement of anterior and posterior cervical nodes. Age is also an important consideration on this front. To a large extent, although one could get IM at any age, it has a higher rate of occurrence amongst teenagers. IM has been variously referred to as the ‘kissing disease’ owing to the fact that one key mode of transmission of the virus is saliva. According to Balfour, Dunmire, and Hogguist (2015), the Epstein-Barr Virus is often responsible for the vast majority of all infectious mononucleosis cases. It therefore follows that in the present case, on the basis of the discussion and findings above, the expected diagnosis would be infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV). This would be the basis for the patient’s clinical course as well as treatment options.
To begin with, given that the Monospot test was initially negative, I would schedule another similar test a week later. If the results returned are persistently negative for three consecutive weeks, I would order a specific EBV serological test. It is important to note that EBV, as the Centers for Disease Control and Prevention – CDC (2018) observes, happens to belong to the herpes virus family. As CDC further points out, this particular virus is rather common – effectively meaning that most persons will encounter the virus at some point. Apart from saliva, as has been pointed out elsewhere in this text, EBV could also be transmitted via other body fluids including, but not limited to, blood and semen. At present, no vaccine has been developed to protect against IM. However, IM is rarely fatal.
It is important to note that IM does not have a specific treatment – just as is the case with the common cold. This is more so the case given that being a viral infection, antibiotics would largely be ineffective. An individual with IM could, however, be an easy target for secondary bacterial infections. In the present scenario, I would largely focus on resolving the symptoms presented by the patient. For instance to reduce tonsil swelling and clear the sore throat, I could prescribe corticosteroid medication. Antibacterial medications are effective in the resolution of tonsil, strep, as well as sinus infections. I would expect the symptoms associated with IM to have cleared in a month or two. To ensure the resolution of all symptoms and monitor the occurrence of any complications, close follow-up is recommended. I would expect to see the patient again in 1 month. Further, I would advise the patient to return if symptoms worsen.
Patient education would also come in handy in seeking to further ease the 22-year-old’s symptoms. In that regard, if the sore throat persists, I would advise the patient to seek OTC medications to soothe the same. Any discomfort and pain could be managed using acetaminophen or other OTC medications. Yet another effective remedy on this front in as far as a sore throat is concerned is gargling salty water. Further, I would also advise the patient to ensure that they take plenty of water so as to stay hydrated and also get a lot of rest. In as far as the management of the present infection and protection against future infections are concerned, the relevance of immune system boosting cannot be overstated. For this reason, I would recommend that the patient ingests plenty of fruits (such as apples) and vegetables (specifically leafy green vegetables). In addition to being rich in antioxidants, the said foods also have anti-inflammatory properties.
I would also see to it that the patient is aware of effective strategies and approaches to protect himself from future EBV infection. On this front, I would advise that he avoids the sharing of personal items such as a toothbrush. Having a single intimate partner would also minimize the risk of contracting IM via kissing or sexual intercourse.
It should be noted that as I have pointed out elsewhere in this text, in most cases, IM is not serious and resolves in a month or two. However, in some rare instances, complications do occur. In the words of Balfour, Dunmire, and Hogguist (2015), “splenic rupture occurs in <1% in patients but is the most feared complication, which sometimes keeps athletes out of competition for weeks†(37). With this in mind, I would advise the patient to avoid vigorous activities for at least 1 month so as to minimize the risk of a raptured spleen. Such activities could be inclusive of, but they are not limited to, contact sports and heavy object lifting.
References
Balfour, H.H., Dunmire, S.K. & Hogguist, K.A. (2015). Infectious Mononucleosis. Clin Transl Immunology, 4(2), 33-39.
Centers for Disease Control and Prevention – CDC (2018). About Epstein-Barr Virus (EBV). Retrieved from https://www.cdc.gov/epstein-barr/about-ebv.html
Dunmire, S.K., Hugguist, K.A. & Balfour, H.H. (2015). Infectious Mononucleosis. Curr Top Microbiol Immunol, 390, 211-240.
Stuempfig, N.D. & Seroy, J. (2019). Monospot Test. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539739
