Dr. Sheela Mathew*, Dr. Aayilliath Kuttiyeri Adarsh and Dr. Aishwarya Ramesh


Back ground: Diphtheria is an ongoing epidemic in the state of Kerala in India since 2016. Disease is characterized by fever, odynophagia and membrane in throat with or without adenopathy. We had a group of young immunized patients admitted with membranous tonsillitis with unique investigational profile. Based on this presentation, PCR and antibody testing of Infectious mononucleosis (IMN) was done and found positive. Method: Data was collected from the records of patients admitted with a clinical diagnosis of diphtheria in infectious diseases ward of our institution. When the clinical, biochemical and hematological profiles were found different from diphtheria, EBV PCR and Ig M viral capsid antigen (VCA) were sent. Results: We had 18 patients with proved IMN. All had history of full dose childhood vaccination. All these patients were young, had regional adenopathy bilaterally, membrane in throat, tonsillar enlargement, elevated total count, Lymphocyte predominance, peripheral smear showing large numbers of atypical Lymphocytes, low CRP, normal or slightly elevated ESR and elevated liver enzymes. None had splenomegaly clinically and USG wise. All had EBV PCR and Ig M VCA positivity. All Diphtheria patients had very high ESR and CRP, polymorphonuclear leucocytosis and normal liver enzymes. Discussion: Youngsters with membranous tonsillitis with lymphocytosis, predominant atypical lymphocytes in peripheral smear, low CRP and altered LFT may be screened for EBV, thereby we can avoid administration of costly antitoxin, antibiotic and prolonged hospital stay. Also atypical lymphocytes in peripheral smear, low CRP and altered liver function abnormalities can be taken as surrogate markers for diagnosis of IMN without going for costly investigations.

Keywords: IMN, diphtheria, membranous tonsillitis.

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