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Dr Basu
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Hello Doctor: We have a question, please. My son 24 years

Resolved Question:

Hello Doctor:

We have a question, please. My son 24 years old has developed significant sore throat, plus fewer and fatigue on last Monday evening. On Tuesday we went to a Walk-in-Clinic and he was seen there by some doctor’s assistant. She got concerned with Mono, but he does not have any much swollen glands. At the clinic there she didn’t even run any strep-throat culture test to exclude any bacterial infection in a first place. Instead, she told him to wait a few days and go for Mono test. Also, she did not give him any antibiotics as she thought they could falsify the Mono test, otherwise. His fever went to 102 F and the following day we went to some other walk-in clinic to see another doctor in there. The doctor at that clinic also examined him and said he did not think most likely it would be any Mono infection at all as his glands are not even swollen so. He also ran a strep-throat test on him on the premises, but it came back negative. He thought more it could be some viral infection, but on the top of that he gave him a prescription for antibiotics to purchase and start taking only if my son would have noticed any white spots in his throat, so he would not be running back and forth.
I know that Mono tests gives 20% negative results if done during the first week anyways, as per medical literature. On the other hand, if it is bacterial infection now we would not like to wait with the antibiotic. My son actually has developed white spots in his through now which are clearly visible today (following day from the last doctor’s visit) and we think it may be a strong indication of bacterial infection, and therefore requiring antibiotics as soon as possible, and perhaps not to wait any longer (especially that his fever stays on all the time).

Now my questions are regarding all the same:
1. Would this be wise to start taking antibiotics now as the other doctor prescribed in
case of noticing any white spots in his throat?
2. And if he starts taking antibiotics now, and on Monday will go for Mono test just in
case, wouldn’t that falsify his Mono antibody test, what are the chances of that?
3. Also if it turned out he had Mono infection after all, wouldn’t antibiotics taken now put
him in some extra serious risk of some kind like spleen rupture or so – other than
possibility of rush which we are aware of?
4. Couldn’t white spots in his throat be also caused by some viral infection, or it is just
typical to bacterial infection only?
5. Is it acceptable (normal) that his fever of around 102 stays on after 3 days if it was not Mono, but some other viral throat infection with his described symptoms (as it is not a flu – no typical symptoms for that I believe)?

I trust this will receive your consideration, and I look forward to your opinion, please.

P.S. With all respect, we would like to ask some U.S. internal M.D. or so, due to specificity of tests done here in the USA, if possible.

Respectfully yours,
Andrew.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr Basu replied 1 year ago.

Mysticdoc :

The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.

Mysticdoc :

Hi there,


I am Mysticdoc, experienced Internal Medicine Specialist.


I am here to help you with your concerns.

Mysticdoc :

1. Mono can also cause white spots by the way.

Mysticdoc :

But absence of significant lymphadenopathy is uncommon.

Mysticdoc :

But given continuous fever with negative mono, bacterial infectino is more likely.

Mysticdoc :

hence, antibiotic can be started now.

Mysticdoc :

2. Mono test is not that sensitive.

Mysticdoc :

I will suggest testing for Epstein Barr virus serology tests (IgM and IGG antibodies against viral capsid antigen VCA).

Mysticdoc :

This is very sensitive in the early period of illness 97% sensitivity.

Mysticdoc :

3. only amoxicillin can cause the rare side effect of enlargedspleen.

Mysticdoc :

other antibiotic do not cause that.

Mysticdoc :

4. as I said earlier, white spots are non specific for bacterial infection.

Customer:

I don't see your answer on my screen at all - please repeat!

Mysticdoc :

Please scroll up or down

Mysticdoc :

I type a lot of information!

Mysticdoc :

5. fever for more than 3 days should be given some importance.

Mysticdoc :

Blood tests like blood count, blood culture, chest xrays, urine culture should be considered.

Mysticdoc :

let me know if you do not see my replies still from question 1

Mysticdoc :


1. Mono can also cause white spots by the way.






12:17 PM



But absence of significant lymphadenopathy is uncommon.






12:17 PM



But given continuous fever with negative mono, bacterial infectino is more likely.






12:17 PM



hence, antibiotic can be started now.






12:18 PM



2. Mono test is not that sensitive.






12:20 PM


JACUSTOMER-761l3vkp- has entered this chat!




Mysticdoc says:

12:20 PM



I will suggest testing for Epstein Barr virus serology tests (IgM and IGG antibodies against viral capsid antigen VCA).






12:20 PM



This is very sensitive in the early period of illness 97% sensitivity.






12:21 PM



3. only amoxicillin can cause the rare side effect of enlargedspleen.






12:21 PM



other antibiotic do not cause that.






12:21 PM



4. as I said earlier, white spots are non specific for bacterial infection.






<div class="JA_chatMsgAuthor"Customersays:

12:22 PM



I don't see your answer on my screen at all - please repeat!






Mysticdoc says:

12:22 PM



Please scroll up or down






12:22 PM



I type a lot of information!






12:23 PM



5. fever for more than 3 days should be given some importance.






12:23 PM



Blood tests like blood count, blood culture, chest xrays, urine culture should be considered.



Mysticdoc :

I reposted above

Mysticdoc :

are you able to see now?

Customer:

Doctor, I have used this site before without any problems. However, I can not see your answers wide on the screen. Scrowling up and down gives me only single lines at the top and not the full screen with answers plus is missing some points-answers beginning from # XXXXX

Customer:

We are honest people, Doctor.

Mysticdoc :

looks like the chat window is not working for you.

Mysticdoc :

I will switch to the Q & A

Customer:

Whatever the reason, but how can I benefit from the answer, please?

Mysticdoc :

Please check your email soon --you will get the answer in your email.

Expert:  Dr Basu replied 1 year ago.
Mysticdoc : The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.
Mysticdoc : Hi there,
I am Mysticdoc, experienced Internal Medicine Specialist.
I am here to help you with your concerns.
Mysticdoc : 1. Mono can also cause white spots by the way.
Mysticdoc : But absence of significant lymphadenopathy is uncommon.
Mysticdoc : But given continuous fever with negative mono, bacterial infectino is more likely.
Mysticdoc : hence, antibiotic can be started now.
Mysticdoc : 2. Mono test is not that sensitive.
Mysticdoc : I will suggest testing for Epstein Barr virus serology tests (IgM and IGG antibodies against viral capsid antigen VCA).
Mysticdoc : This is very sensitive in the early period of illness 97% sensitivity.
Mysticdoc : 3. only amoxicillin can cause the rare side effect of enlargedspleen.
Mysticdoc : other antibiotic do not cause that.
Mysticdoc : 4. as I said earlier, white spots are non specific for bacterial infection. Customer: I don't see your answer on my screen at all - please repeat!
Mysticdoc : Please scroll up or down
Mysticdoc : I type a lot of information!
Mysticdoc : 5. fever for more than 3 days should be given some importance.
Mysticdoc : Blood tests like blood count, blood culture, chest xrays, urine culture should be considered.
Customer: replied 1 year ago.


Doctor, as I said he does not have any results for Mono yet. It is not negative as you mentioned. The question is if he can take antibiotics now (considering white spots in his throat as this was mentioned by the other doctor) or not, and he should first go for Mono test?


If he goes for Mono test on Monday is it o.k. to take antibiotic now, anyways ?

Expert:  Dr Basu replied 1 year ago.
Which antibiotic was prescribed for him?
Customer: replied 1 year ago.


It looks like Z-Pack (Azythromycin) I think, is that ok?

Expert:  Dr Basu replied 1 year ago.
Ok.
Zpack or azithromycin is ok to take.
This will not interfere with mono test or will not cause spleen enlargement.

Best wishes,


Dr Basu, Experienced Specialist
Category: Medical
Satisfied Customers: 23079
Experience: MD
Dr Basu and 5 other Medical Specialists are ready to help you
Customer: replied 1 year ago.


Thank You Doc!

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