fiebre escarlatina, kawasaki y mononucleosis infecciosa
TRANSCRIPT
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FIEBRE ESCARLATINA, KAWASAKI Y MONONUCLEOSIS
INFECCIOSA
Dr. Alcibíades Batista González
Pediatría II (MED-530)
UNACHI
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ESTREPTOCOCOS GRUPO A (GAS)
• La infección aguda más frecuente por GAS es la faringoamigadalitis aguda.
• Complicaciones purulentas ocurren en algunos pacientes, con mayor frecuencia los no tratados, e incluyen: – Otitis media – Sinusitis – Abscesos peritonsilares y retrofaríngeos– Adenitis cervicales supurativas
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 124_63. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Group A Streptococcal Infections. Streptococcus pyogenes, 24h sheep Blood Agar Plate, beta hemolysis (close-up view)
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 124_65. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Group A streptococcal pharyngitis with inflammation of the tonsils and uvula.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 124_01. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Erythematous tonsils in a child with group A streptococcal pharyngitis.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 124_03. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Group A streptococcal pharyngitis with petechiae on the soft palate.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 124_43. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Group A streptococcal nasopharyngitis in toddlers often is associated with tender anterior cervical lymphadenopathy. A throat culture is not always positive when the infection has localized to the cervical
lymph nodes.
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ESTREPTOCOCOS GRUPO A (GAS)
• En menores de 3 años (1 a 3 años) puede presentarse una infección de vías respiratorias altas por GAS.
• Se le conoce como:– Estreptococosis– Fiebre estreptocócica
• Su importancia clínica se relaciona con la morbilidad aguda y no con las secuelas no supurativas.
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ESTREPTOCOCOS GRUPO A (GAS)
• Características clínicas de la fiebre estreptocócica:– 1-3 años con cuadro febril agudo.– Rinitis con descarga serosa,
serosanguinolenta o mucopurulenta.– Irritabilidad e hiporexia.– Lesiones impetiginizadas alrededor de las
narinas.
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ESTREPTOCOCOS GRUPO A (GAS)
• Características clínicas de la fiebre estreptocócica:– Puede presentarse artritis reactiva.– El cuadro clínico puede presentarse asociado
a H. influenzae y S. pneumoniae.– La clásica presentación de la infección por
GAS con faringitis es poco frecuente en < 3 años.
– La fiebre reumática es muy rara en < 3 años.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 124_42. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Protracted nasopharyngitis is the most common presentation of group A streptococcal infection in toddlers. Inflammation of the skin beneath the nares often is present as in this child.
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FIEBRE ESCARLATINA
• Resulta de una infección por GAS que produzca cualquiera de las 3 exotoxinas pirogénicas (eritrogénicas).
• Foco primario de infección es con mayor frecuencia una faringitis.
• También puede ocurrir secundaria a una herida infectada o a una infección de la piel.
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FIEBRE ESCARLATINA
• El inicio es agudo y se caracteriza por:– Fiebre– Escalofríos– Vómitos– Cefalea– Toxicidad– Exantema generalizado que parece
quemadura solar (escarlatiniforme).
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FIEBRE ESCARLATINA
Figure 35-2 Schematic diagram of a typical case of untreated uncomplicated scarlet fever. The rash usually appears within 24 hours of onset of fever and sore throat.
Gershon: Krugman's Infectious Diseases of Children, 11th ed. 2004
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FIEBRE ESCARLATINAFigure 35-3 Schematic drawing illustrating development and distribution of scarlet fever rash.
Gershon: Krugman's Infectious Diseases of Children, 11th ed. 2004
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FIEBRE ESCARLATINA
• El exantema es más acentuado en las axilas, áreas inguinales y el cuello.
• Punteado de máculas rojas o finas pápulas que blanquean con la presión.
• Puede haber petequias en partes distales de las extremidades.
• En algunos individuos el exantema da la sensación de papel de lija.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 124_78. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
A 4-1/2 year-old white male with the rash and strawberry tongue of scarlet fever.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 124_79. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Confluent rash of scarlet fever over the posterior surfaces of the 4-1/2 year old white male in the previous image.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 124_80. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Erythema and desquamation of the palms and confluent rash of scarlet fever over the anterior surfaces of the 4-1/2 year old white male in the 2 previous images.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 124_06. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Group A streptococcal rash in a white male with a positive throat culture for group A streptococci and an elevated antistreptolysin O titer.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 124_73. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Pastias lines in the antecubital space of a 12-year-old white male with scarlet fever
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SÍNDROME DE KAWASAKI
• Síndrome mucocutáneo-nódulo linfático.• Enfermedad febril, exantemática.• Vasculitis aguda de niños pequeños.
– 1-8 años (80% son < 4 años).
• Aneurismas coronarios en 20% de los pacientes no tratados.
• Muerte súbita puede resultar de IAM, miocarditis o ruptura de aneurisma coronario.
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SÍNDROME DE KAWASAKI
• Descrito en 1967, en Japón, cuando Tomisaku Kawasaki describió su experiencia con 50 casos.
• Desarrolló los criterios diagnósticos que aún se utilizan.
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SÍNDROME DE KAWASAKI
• Causa desconocida.
• Gatillo infeccioso – Marcada respuesta inmune inflamatoria.
• Hallazgos patológicos ampliamente descritos y virtualmente idénticos en todos los pacientes afectados, con variaciones en la severidad.
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SÍNDROME DE KAWASAKI
• Lesiones inflamatorias sistémicas:– Vasculares (arterias de mediano calibre)– Sistema cardiovascular:
• Miocarditis • Pericarditis • Endocarditis (menos frecuente)
– Sistema respiratorio:• Bronquitis • Neumonía intersticial
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SÍNDROME DE KAWASAKI
• Lesiones inflamatorias sistémicas:– Sistema digestivo:
• Estomatitis• Adenitis sialoductal• Enteritis• Hepatitis, colangitis• Pancreatitis• Ductitis pancreática
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SÍNDROME DE KAWASAKI
• Lesiones inflamatorias sistémicas:– Sistema urinario:
• Nefritis intersticial focal• Cistitis• Prostatitis
– Sistema nervioso:• Meningitis aséptica• Neuritis
– Sistema hematopoyético:• Linfadenitis y esplenitis.
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SÍNDROME DE KAWASAKI
• El cuadro clínico es la base del diagnóstico.
• No existe una prueba de laboratorio que apoye o confirme el diagnóstico.
• El diagnóstico se basa en los criterios diagnósticos del síndrome de Kawasaki.
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DIAGNOSTIC CRITERIA FOR KAWASAKI SYNDROME
Fever, daily for more than 5 days, high spiking and intermittent, with
four of the five following clinical features: •Bulbar conjunctival injection, generally nonpurulent•Changes in the oral mucosa, consisting of:
- Red, fissured lips
- Redness of the mouth
- Strawberry tongue
•Changes in the hands and feet, consisting of:
- Redness of the palms and soles - Swelling of the hands and feet - Peripheral desquamation in the subacute stage of illness
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DIAGNOSTIC CRITERIA FOR KAWASAKI SYNDROME
Fever, daily for more than 5 days, high spiking and intermittent, with
four of the five following clinical features:
•Rash, erythematous and polymorphous but nonvesicular: - Maculopapular - Erythema multiforme–like - Scarlatiniform
•Cervical lymphadenopathy, greater than 1.5 cm in diameter
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ASSOCIATED FEATURES OF KAWASAKI SYNDROME
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SÍNDROME DE KAWASAKI
• Tratamiento:– Inmunoglobulina Intravenosa 2 g/kg en 10-12
horas.– ASA 80-100 mg/kg/día divididos c/6h– Medidas de sostén.– Seguimiento con ecocardiograma.
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Some clinical signs of Kawasaki syndrome. A, Discrete vascular injection of the bulbar conjunctiva. B, Generalized lip erythema with mild edema, cracking, and bleeding fissures. C, Diffuse red-purple discoloration of the palm(s). D, Desquamation beginning at the fingertips just below the nailbeds. E, Diffuse erythematous, nonvesicular and nonbullous, polymorphic rash. F, Unilaterally enlarged cervical lymph node.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_01. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_01. Kawasaki Disease. Child with Kawasaki syndrome with striking facial rash and erythema of the oral mucous membrane.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_02. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_02. Kawasaki Disease. Child with Kawasaki syndrome with conjunctivitis. Note the absence of conjunctival discharge.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_03. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_06. Kawasaki Disease. Periungual desquamation of a patient with Kawasaki syndrome. This is the same patient as in images 068_03, 068_04, and 068_05.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_04. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_06. Kawasaki Disease. Periungual desquamation of a patient with Kawasaki syndrome. This is the same patient as in images 068_03, 068_04, and 068_05.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_05. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_06. Kawasaki Disease. Periungual desquamation of a patient with Kawasaki syndrome. This is the same patient as in images 068_03, 068_04, and 068_05.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_06. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_06. Kawasaki Disease. Periungual desquamation of a patient with Kawasaki syndrome. This is the same patient as in images 068_03, 068_04, and 068_05.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_07. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_08. Kawasaki Disease. Distal desquamation of Kawasaki syndrome. This is the same patient as in image 068_07.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_08. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_08. Kawasaki Disease. Distal desquamation of Kawasaki syndrome. This is the same patient as in image 068_07.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_09. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_09. Kawasaki Disease. A child with the characteristic desquamation of the hands in a later stage of Kawasaki syndrome.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_10. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_10. Kawasaki Disease. Bulbar conjunctivitis in a patient with Kawasaki syndrome. Exudation generally is absent.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_11. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_11. Kawasaki Disease. Erythematous lips and injection of the oropharyngeal membranes in a patient with Kawasaki syndrome. Scarlet fever, toxic shock syndrome, staphylococcal scalded skin
syndrome, and measles may be confused with this disease.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_12. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_12. Kawasaki Disease. Hyperemia and fissuring of lips in a patient with Kawasaki syndrome.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_19. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_19. Kawasaki Disease. Desquamation of the skin of the toes following Kawasaki syndrome. This is the same patient as shown in image 068_18.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_20. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_20. Kawasaki Disease. A 20-month old white male with acute erythroderma and fever associated with Kawasaki Disease
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_21. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_21. Kawasaki Disease. This one-year old white child presented with fever, generalized erythroderma, and conjunctivitis compatible with Kawasaki Disease
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_22. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_22. Kawasaki Disease. Erythroderma of the palm of the hand of the child in the previous image with Kawasaki disease
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_23. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_23. Kawasaki Disease. Erythroderma of the plantar foot surface of the child in the previous 2 images with Kawasaki disease
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 068_24. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 068_24. Kawasaki Disease. The one-year old white child in the above 3 images presented with this erythema multiforme-like rash most pronounced over the back. The clinical course was characteristic of
Kawasaki disease
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MONONUCLEOSIS INFECCIOSA
• Etiología viral– Epstein Barr virus.– Incubación: 4-6 semanas.– Características clínicas:
• Fiebre• Linfadenopatía• Tonsilofaringitis• Esplenomegalia• Hepatitis• Rash• Neumonitis• Compromiso del Sistema Nervioso
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 043_01. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 043_01. Epstein-Barr Virus Infections (Infectious Mononucleosis). Atypical lymphocyte in a peripheral blood smear of a patient with infectious mononucleosis. This lymphocyte is larger than normal lymphocytes with a higher ratio of cytoplasm to nucleus. The cytoplasm is vacuolated and basophilic. This
may also be present in cytomegalovirus infections.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 043_02. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 043_02. Epstein-Barr Virus Infections (Infectious Mononucleosis). Epstein-Barr virus disease. Bilateral cervical lymphadenopathy.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 043_04. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 043_04. Epstein-Barr Virus Infections (Infectious Mononucleosis). Epstein-Barr virus disease with pharyngeal and tonsillar exudate.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 043_06. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 043_06. Epstein-Barr Virus Infections (Infectious Mononucleosis). Cervical lymphadenopathy in a 7-year-old girl with infectious mononucleosis.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 043_07. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 043_08. Epstein-Barr Virus Infections (Infectious Mononucleosis). Rash in the same patient as in image 043_07 with infectious mononucleosis who was receiving ampicillin. These morbilliform rashes are
considered nonallergic.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 043_08. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 043_08. Epstein-Barr Virus Infections (Infectious Mononucleosis). Rash in the same patient as in image 043_07 with infectious mononucleosis who was receiving ampicillin. These morbilliform rashes are
considered nonallergic.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 043_09. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 043_09. Epstein-Barr Virus Infections (Infectious Mononucleosis). A preadolescent child with infectious mononucleosis with petechiae on the soft palate and uvula without exudation.
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Copyright ©2006 American Academy of Pediatrics
Red Book Online Visual Library, 2006. Image 043_10. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007
Image 043_10. Epstein-Barr Virus Infections (Infectious Mononucleosis). A conjunctival hemorrhage of the right eye of a patient with infectious mononucleosis. At times, noninfectious conjunctivitis, as well as other corneal abnormalities, may manifest itself due to the body's systemic response to viral infections
such as infectious mononucleosis.