Infectious mononucleosis (glandular fever) is caused by Epstein-Barr virus (EBV). Symptoms are varied and include fever, malaise, pharyngitis, tonsillitis, and lymphadenopathy. Other features are petechiae on the soft palate, jaundice, hepatomegaly and splenomegaly. Symptoms may persist for as long as 3 months.
Infectious mononucleosis is diagnosed by finding atypical lymphocytes on the blood film or by demonstrating the presence of heterophile antibodies (i.e. antibodies that agglutinate sheep or horse erythrocytes, but that are not absorbed by guinea-pig kidney extracts!).
This is known as the monospot test or the Paul Bunnell test. Treatment is symptomatic.
In this case, the GP incorrectly prescribed antibiotics. Administration of ampicillin or amoxicillin in infectious mononucleosis causes widespread maculopapular rash. This makes treatment of any form of tonsillitis or pharyngitis with these antibiotics difficult, as EBV cannot be ruled out clinically. Penicillin is difficult to administer due to its bitter taste, although it is better to use this than potentially to cause a drug reaction with amoxicillin or ampicillin.
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