What are the key points to cover in patient education about infectious mononucleosis (mono)?

Patient Education for Infectious Mononucleosis (Mono)

The most important aspects of patient education for infectious mononucleosis include explaining the viral cause, expected symptoms, supportive care measures, activity restrictions to prevent splenic rupture, and the typically self-limited course with potential for prolonged fatigue.

Disease Overview and Transmission

• Causative agent: Epstein-Barr virus (EBV) 1, 2
• Transmission: Primarily through saliva (often called "kissing disease"), but can also spread through sharing drinks, food, or utensils 2
• Population affected: Most commonly affects adolescents and young adults aged 15-24 years 2
• Incubation period: Typically 4-6 weeks from exposure to symptom onset 2

Key Symptoms to Recognize

• Classic triad: Fever, tonsillar pharyngitis (sore throat), and lymphadenopathy (swollen lymph nodes, especially posterior cervical) 2, 3
• Other common symptoms:
  • Profound fatigue (may last weeks to months)
  • Periorbital/palpebral edema (swollen eyelids) in about one-third of patients
  • Splenomegaly (50% of cases) and hepatomegaly (10% of cases)
  • Maculopapular rash (10-45% of cases), more common if amoxicillin is taken 2

Diagnostic Testing

• Blood count changes: Lymphocytosis (lymphocytes >50% of white blood cells) with atypical lymphocytes (>10% of total) 2, 3
• Heterophile antibody test (Monospot): Standard initial test, but may be negative early in illness or in young children 1, 3
• EBV-specific antibody testing: Used when Monospot is negative but clinical suspicion remains high 1, 4

Treatment and Self-Care Measures

• Supportive care is the mainstay of treatment 2, 4:

  • Adequate hydration
  • Analgesics/antipyretics for fever and pain (acetaminophen or NSAIDs)
  • Rest as needed, guided by energy levels (not enforced bed rest)
  • Throat lozenges or warm salt water gargles for sore throat

• Medications to avoid:

  • Amoxicillin/ampicillin (can cause rash in EBV infection)
  • Routine use of corticosteroids, acyclovir, or antihistamines is not recommended 4

Activity Restrictions

• Sports and strenuous activity: Avoid contact/collision sports and strenuous exercise for at least 3-4 weeks from symptom onset or while splenomegaly is present 2, 3
• Return to normal activities: Gradual return based on energy levels and resolution of symptoms
• School/work: May need modified schedule during recovery period due to fatigue

Potential Complications

• Splenic rupture: Most serious acute complication (0.1-0.5% of cases) 2

  • Teach patients to recognize warning signs: sudden, severe abdominal pain (especially left upper quadrant), shoulder pain, lightheadedness
  • Emphasize importance of avoiding contact sports and trauma to abdomen

• Other possible complications:

  • Airway obstruction from severe tonsillar swelling (rare)
  • Hepatitis with jaundice
  • Neurological complications (rare): meningitis, encephalitis, Guillain-Barré syndrome
  • Hematologic issues: hemolytic anemia, thrombocytopenia

Expected Course and Follow-up

• Typical duration: Acute symptoms usually resolve within 2-4 weeks 2, 4
• Fatigue: May persist for several months after other symptoms resolve 4
• When to seek medical attention:
  • Severe throat pain/difficulty swallowing or breathing
  • Severe abdominal pain, especially in left upper quadrant
  • Persistent high fever not responding to antipyretics
  • Extreme weakness, dizziness, or fainting
  • Yellowing of skin or eyes (jaundice)

Long-term Considerations

• Chronic fatigue: EBV infection is a risk factor for chronic fatigue syndrome 2
• Recurrence: True recurrence is rare; persistent fatigue is not the same as reinfection
• Long-term immunity: Most people develop lifelong immunity after infection 2

Prevention for Others

• Avoiding transmission:
  • Avoid kissing or sharing drinks/utensils during illness and for several weeks after recovery
  • Practice good hand hygiene
  • Cover coughs and sneezes

By providing comprehensive education about infectious mononucleosis, healthcare providers can help patients understand their condition, manage symptoms effectively, prevent complications, and set appropriate expectations for recovery.