What is the treatment for infectious mononucleosis (mono)?

Treatment for Infectious Mononucleosis (Mono)

The treatment for infectious mononucleosis (mono) is primarily supportive care, as there is no specific antiviral therapy recommended for routine management of this self-limiting illness. 1, 2

Clinical Presentation and Diagnosis

Before discussing treatment, it's important to recognize mono by its classic presentation:

• Triad of fever, pharyngitis, and cervical lymphadenopathy
• Fatigue (often profound)
• Periorbital/palpebral edema (in about one-third of patients)
• Splenomegaly (in approximately 50% of cases)
• Hepatomegaly (in about 10% of cases)
• Skin rash (in 10-45% of cases)
• Laboratory findings: atypical lymphocytosis (>10% of total lymphocytes)
• Positive heterophile antibody test ("Monospot")

Treatment Approach

Supportive Care

1. Adequate hydration

   • Ensure sufficient fluid intake to prevent dehydration
   • Particularly important when fever is present

2. Pain and fever management

   • Acetaminophen or NSAIDs for symptom relief
   • Manage sore throat and fever

3. Rest guided by energy levels

   • Activity as tolerated - bed rest is not enforced
   • Allow the patient's symptoms to guide activity level
   • Gradual return to normal activities as symptoms improve

Activity Restrictions

• Avoid contact sports for at least 4-8 weeks after symptom onset or while splenomegaly is present
• This is critical to prevent the rare but potentially life-threatening complication of splenic rupture
• Splenic rupture occurs in 0.1-0.5% of cases and is most common within the first month of illness 2

What NOT to Use Routinely

• Antivirals (acyclovir): Not recommended for routine treatment 1, 3
• Corticosteroids: Not recommended for routine treatment unless there are severe complications such as:
  • Airway obstruction
  • Severe pharyngeal edema
  • Hemolytic anemia
  • Thrombocytopenia 3
• Antihistamines: Not recommended for routine treatment 3

Special Considerations

Duration of Illness and Recovery

• Acute symptoms typically last 2-4 weeks
• Fatigue may persist for several months after the acute infection resolves
• Athletes may take 3-6 months to regain top form 4

Monitoring for Complications

Monitor for rare but serious complications:

• Splenic rupture (0.1-0.5% of cases)
• Neurological complications
• Airway obstruction
• Hemolytic anemia
• Thrombocytopenia

Common Pitfalls to Avoid

1. Prescribing antibiotics: Mono is viral, and antibiotics are ineffective unless there is a confirmed bacterial superinfection

2. Allowing return to contact sports too early: This increases the risk of splenic rupture

3. Enforcing strict bed rest: This can prolong recovery; activity should be guided by the patient's energy levels

4. Missing the diagnosis: False-negative heterophile antibody tests can occur early in the course of infection; consider EBV-specific antibody testing if clinical suspicion is high

In conclusion, while mono can cause significant symptoms and temporary lifestyle limitations, the vast majority of cases resolve with supportive care alone. The focus should be on symptom management, preventing complications through appropriate activity restrictions, and allowing adequate time for full recovery.