Patient selection: acute infectious mononucleosis
Severe symptoms:
(1) unable to swallow liquids because of severe pharyngitis
(2) severe headache (prompts lumbar puncture or brain CT/MRI)
(3) fever > 104°F for > 2 weeks
(4) fever > 101°F for > 5 weeks
(5) homebound during worst symptoms (unable to leave home)
(6) reduced walking distance during symptoms
(7) trouble breathing
(8) GI symptoms but not diarrhea alone (anorexia, nausea, vomiting)
Severe findings on physical exam:
(1) jaundice
(2) "bull neck"
(3) painful splenomegaly
(4) painful hepatomegaly
(5) palatal petechiae
Complications:
(1) cardiac (myocarditis)
(2) hematologic (platelet count < 150,000 per µL; absolute neutrophil count < 1,000 per microliter; absolute lymphocyte count < 2,000 per µL; hemolytic anemia; hemophagocytic lymphohistiocytosis)
(3) neurologic (meningoencephalitis)
(4) pulmonary (pleural effusion; pneumonitis)
|
Finding
|
Points
|
|
absent
|
0
|
|
present
|
1
|
score for severe symptoms =
= SUM(points for severe symptoms)
score for severe physical findings =
= SUM(points for severe findings)
score for complications =
= SUM(points for complications
total score =
= SUM(points for symptoms, physical findings, complications) - (number of findings counted more than once)
Interpretation:
• minimum score: 0
• maximum score for symptoms: 8
• maximum score for physical findings: 5
• maximum score for complications: 4
• maximum total score: 16
• A finding cannot be counted more than once. The example given is trouble breathing and pleural effusion. Another might be palatal petechiae and thrombocytopenia.
• Only 3 of the 8 symptoms were endorsed by the subjects.
• Trouble breathing and pneumonitis were combined in a revised model.
