From the Research
Managing infectious mononucleosis in a 61-year-old patient requires supportive care as the primary approach, as there is no specific antiviral treatment for Epstein-Barr virus (EBV), which causes the condition. Treatment focuses on symptom relief with adequate rest, hydration, and over-the-counter pain relievers such as acetaminophen (500-1000 mg every 6 hours, not exceeding 4000 mg daily) or ibuprofen (400-600 mg every 6-8 hours with food) to manage fever and sore throat, as suggested by 1. Warm salt water gargles (1/2 teaspoon salt in 8 oz warm water) several times daily can help relieve throat discomfort.
The patient should be monitored for complications, which are more common in older adults, including:
- Severe hepatitis
- Splenic rupture
- Airway obstruction
- Neurological issues Corticosteroids like prednisone (40-60 mg daily for 5-7 days with tapering) may be considered for severe pharyngeal swelling or significant complications, though they're not routinely recommended, as noted in 2. Patients should avoid contact sports and heavy lifting for at least 3-4 weeks to prevent splenic rupture, and alcohol should be avoided until liver function tests normalize.
Unlike in younger patients, infectious mononucleosis in older adults warrants consideration of other conditions that may mimic EBV infection, such as cytomegalovirus, HIV, toxoplasmosis, or lymphoma, so appropriate diagnostic testing is essential for accurate diagnosis and management, as highlighted in 3 and 1. The most recent and highest quality study, 1, emphasizes the importance of supportive care and monitoring for complications in the management of infectious mononucleosis.