Cytomegalo Virus

Choice "A" is the best answer. Cytomegalovirus (CMV) mononucleosis is the most common cause of heterophile-negative infectious mononucleosis-like infections. Primary CMV infection is defined as infection in an individual who has never had a CMV infection before. In primary CMV infection patients, the first antibody to appear is the CMV IgM. It can be found as early as four weeks after infection and can remain positive for up to 20 weeks. Other antibodies present in primary CMV infection patients include antibodies to the envelope glycoprotein gB surrounding the cytomegalovirus. CMV presents very similarly to EBV but there are a few differences, CMV often has no accompanying posterior cervical adenopathy, nonexudative pharyngitis is minimal, splenomegaly is much less common, and CMV tends to persist for a longer period of time then EBV.

CMV can be diagnosed with findings of viral inclusion bodies “owl’s eye” found on histocytological examination, though this is considered diagnostic
Hepatitis A virus infection is transmitted in the fecal oral form or through vertical transmission in preganancy. HAV presents with flu like symptoms, low grade fevers, nausea, anorexia, and vomiting. Pharyngeal erythema is not a common finding seen in HAV infection. . Nucleic acid testing (NAT) is the gold standard for diagnosis HAV infection.

Choice "D" is not the best answer. Streptococcal pharyngitis (GABHS) is another cause of heterophile-negative infectious mononucleosis. Findings characteristically absent in GABHS include: conjunctivitis, cough, hoarseness, coryza, diarrhea, anterior stomatitis, discrete ulcerative lesions, and a viral exanthema. The presence of these symptoms indicate a diagnosis other than GABHS. Throat culture remains the gold standard for diagnosis of GABHS pharyngitis. By comparison, rapid antigen detection tests (RADTs) quickly demonstrate the presence of GABHS pharyngitis and have an adequate specificity and