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Full text of "Diseases Of The Nose Throat And Ear"

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Infectious mononucleosis (glandular fever) is a systemic virus infection of
unknown aetiology. It is thought to be due to a virus, and is spread by direct
contact with the mouth, such as kissing. It is a disease of young adults and is
characterized by an increase in the large mononuclear cells of the blood.

SYMPTOMS. In the prodromal period which lasts from 4 to 14 days there is
anorexia, malaise, a low-grade fever and a sore throat of varying severity.

CLINICAL FEATURES. The pharynx is very congested and there may be
superficial ulcers, especially on the tonsils. Crops of red spots may appear on
the palate and last for several days. A transient maculopapular rash is often
found. There is enlargement of the cervical lymph nodes, and the post-
auricular, suboccipital, axillary and inguinal glands may also be affected.
This adenopathy may persist for several months. In about half of the cases
there is a moderate enlargement of the spleen. The acute febrile symptoms
may persist for several weeks, and relapses are common.

DIAGNOSIS. The diagnosis is confirmed by finding atypical large mononuclear
cells in a blood film. A blood count will usually show a leucocytosis of
10-0-20-0 x 109/1. Serum agglutinin tests (Paul-Bunnell) should be done, but the
results are not invariably positive. In over half of the cases liver function tests
will show some rise in the serum glutamic pyruvate transaminase level.

TREATMENT. There is no specific treatment apart from the usual remedies
such as soluble aspirin to lower the pyrexia. Antibiotics play no part in
treatment, and ampicillin should never be used as it will cause a toxic skin
reaction if given during any phase of infectious mononucleosis. Cortico-
steroids should be reserved for the severe case in which they give good results.

COMPLICATIONS. These are few but occasionally a peripheral neuropathy
may occur. Many patients remain depressed and devitalized for several
months, and during this time the adenopathy, the abnormal blood picture and
a positive serological reaction may be found.

Agranulocytic angina is characterized by a reduction of the neutrophil
polymorphs in the blood, and may be associated with pharyngeal ulceration.
The cause is a depression of white cell formation in the bone marrow, and is
often drug induced. The treatment is that of the blood dyscrasia.

Acute leukaemia may also be associated with necrotic ulceration in the
pharynx (Plate K, 3). Purpuric haemorrhages and a typical leucocytosis of
20*0-100-0 x 109/1 will confirm the diagnosis.

Hodgkirfs disease may occur in the lymphoid tissue of the pharynx and
nasopharynx. There may be a unilateral enlargement and ulceration of a
tonsil which is a dark purplish colour. The cervical lymph nodes show a
characteristic enlargement.


The most frequently found fungus in the throat is that which produces
moniliasis or thrush. It is found in marasmic infants or poorly nourished
children, but it may occur in older patients suffering from a debilitating
illness. Creamy-white plaques are found on the tongue and on the buccal and
pharyngeal mucosa. These are easily removed with slight bleeding. The
treatment is by painting the lesions with 1 per cent aqueous solution of