A 32 year old man has recently been to Thailand and returned with cervical lymphadenopathy

A 32 year old man has recently been to Thailand and returned with cervical lymphadenopathy, malaise and a mild fever. What is the SINGLE most likely infectious agent causing his symptoms?

A. Human immunodeficiency virus (HIV)
B. Treponema pallidum
C. Salmonella typhi
D. Measles
E. Epstein-Barr virus

Cervical lymphadenopathy is one of the main features of infectious mononucleosis.

If this was a HIV infection, there would be more of a generalized lymphadenopathy.

Infectious Mononucleosis

Infectious mononucleosis (glandular fever) is caused by the Epstein-Barr virus (also known as human herpesvirus 4, HHV-4). It is most common in adolescents and young adults.

Features • Sore throat; tonsillar enlargement is common, classically exudative and may be massive • Palatal petechiae • Lymphadenopathy, especially neck glands • Pyrexia • Malaise • Splenomegaly - may rarely predispose to splenic rupture • A maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis. Thus, they should not be given in any patient who might have infectious mononucleosis.

Diagnosis • heterophil antibody test (Monospot test) (Paul Bunnell)

Other investigations: • FBC
• raised white cell count with lymphocytosis and a relative atypical lymphocyte count greater than 20% • ESR is elevated

Management is supportive Simple analgesia for any aches or pains