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CMV infection, toxoplasmosis, acute HIV infection, secondary syphilis, HHV-6, rubella, and drug hypersensitivity reactions may be indistinguishable from infectious mononucleosis due to EBV, but exudative pharyngitis is usually absent and the heterophil antibody tests are negative; false-positive heterophil antibody tests can occur with CMV and toxoplasmosis With acute HIV infection, a rash is sometimes seen but lymphocytic atypia is much less common Mycoplasmal infection may also present as pharyngitis, though lower respiratory symptoms usually predominate A hypersensitivity syndrome induced by carbamazepine may mimic infectious mononucleosis The differential diagnosis of acute exudative pharyngitis includes diphtheria, gonococcal and streptococcal infections, and infections with adenovirus and herpes simplex Head and neck soft tissue infections (pharyngeal and tonsillar abscesses) may occasionally be mistaken for the lymphadenopathy of mononucleosis

Be sure to use uppercase when entering X or A. To keep the code simple, there is no code to check for lowercase letters or other inappropriate input.

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The protean manifestations reflect the pathogenesis of infection with viruses disseminating in the oral cavity, peripheral blood lymphocytes, and cell-free plasma Symptoms typically include fever, sore throat, fatigue and toxic symptoms (malaise, anorexia, and myalgia) in the early phase of the illness Physical findings include lymphadenopathy (discrete, nonsuppurative, slightly painful, especially along the posterior cervical chain) and splenomegaly (in up to 50% of patients) A maculopapular or occasionally petechial rash occurs in less than 15% of patients unless ampicillin has been given (when rash is seen in > 90%) Exudative pharyngitis, tonsillitis, or gingivitis may occur and soft palatal petechiae may be noted Other manifestations include hepatitis, nervous system involvement (mononeuropathies and occasionally aseptic meningitis, encephalitis, or Guillain Barr syndrome), renal failure (interstitial nephritis), pulmonary involvement (dyspnea and cough, and in severe forms, pseudocroup ), and myocarditis Airway obstruction from lymph node enlargement, pericarditis, life-threatening thrombocytopenia, severe CNS complications, and massive splenomegaly are all considered indications for hospitalization or close observation

Secondary bacterial pharyngitis can occur and is often streptococcal Splenic rupture is a rare but dramatic complication, and a history of preceding trauma can be elicited in 50% of the cases Fulminant hepatitis with massive necrosis is a reported complication Pericarditis and myocarditis are also infrequent complications, although nonspecific electrocardiographic changes are seen in about 5% of all EBV-infected patients Neurologic involvement including transverse myelitis, encephalitis, and Guillain Barr syndrome is infrequent

Initially, EBV infection is associated with granulocytopenia followed within 1 week by a lymphocytic leukocytosis Many lymphocytes are atypical; specifically, they are larger than normal mature lymphocytes, stain more darkly, and show vacuolated, foamy cytoplasm and dark chromatin in the nucleus Hemolytic anemia, usually secondary to anti-i antibodies, occurs occasionally as does thrombocytopenia (at times marked)

Building the interface The first step in creating the application is to construct the user interface in Interface Builder. The general cycle is to create your application s interface component, such as a window, populate it with interface controls by dragging each control from the Cocoa Views palette to the window, and connect the appropriate controls to program elements such as outlets and actions.

You will remember that the for loop header has three parts initialization, expression, and iteration and the syntax is as follows:

Given that over 95% of patients recover without specific antiviral therapy, treatment is largely symptomatic Acyclovir decreases viral shedding but does not have verified clinical benefit Symptomatic relief can be achieved with acetamino-

phen or other nonsteroidal anti-inflammatory drugs and warm saline throat irrigations or gargles three or four times daily Corticosteroid therapy, although widespread, is not recommended in uncomplicated cases; its use is reserved for impending airway obstruction from enlarged lymph nodes, hemolytic anemia, and severe thrombocytopenia The value of corticosteroid therapy in impending splenic rupture, pericarditis, myocarditis, and nervous system involvement is less well defined If a throat culture grows -hemolytic streptococci, a 10-day course of penicillin or erythromycin is indicated Ampicillin and amoxicillin are avoided because of the frequent association with rash

plasms, including oral tumors; systemic lupus erythematosus; pediatric multiple sclerosis (a meta-analysis showed that the relative risk for multiple sclerosis was 23 after infectious mononucleosis); encephalitis; rheumatoid arthritis; drug-induced hypersensitivity reactions; and S zary s and Sj gren s syndromes

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Bell AT et al Clinical inquiries What test is the best for diagnosing infectious mononucleosis J Fam Pract 2006 Sep; 55(9):799 802 [PMID: 16948964] Candy B et al Steroids for symptom control in infectious mononucleosis Cochrane Database Syst Rev 2006 Jul 19;3: CD004402 [PMID: 16856045] Sitki-Green DL et al Biology of Epstein Barr virus during infectious mononucleosis J Infect Dis 2004 Feb 1;189(3): 483 92 [PMID: 14745706] Thacker EL et al Infectious mononucleosis and risk for multiple sclerosis: a meta-analysis Ann Neurol 2006 Mar;59(3):499 503 [PMID: 16502434] Wei WI et al Nasopharyngeal carcinoma Lancet 2005 Jun 11 17;365(9476):2041 54 [PMID: 15950718] Williams H et al Epstein-Barr virus: the impact of scientific advances on clinical practice Blood 2006 Feb 1;107(3):862 9 [PMID: 16234359]

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