What is the treatment for infectious mononucleosis (mono)?

Treatment of Infectious Mononucleosis (Mono)

The treatment for infectious mononucleosis is primarily supportive care, as aciclovir therapy does not ameliorate the course of infectious mononucleosis in otherwise healthy individuals. 1

Diagnosis Confirmation

• Heterophile antibody test (Monospot) is the most widely used initial test, typically becoming positive between the sixth and tenth day after symptom onset 1
• EBV serologic testing is recommended when clinical suspicion remains high despite a negative heterophile test, including IgM and IgG antibodies to viral capsid antigen (VCA) and antibodies to Epstein-Barr nuclear antigen (EBNA) 1, 2
• Presence of atypical lymphocytes (>10% of total lymphocyte count) and lymphocytosis (≥50% of white blood cells) strongly supports the diagnosis 2, 3

Supportive Care Management

• Adequate hydration, analgesics, and antipyretics for symptom relief 3
• Rest as tolerated, with activity guided by the patient's energy level rather than enforced bed rest 3
• Patients should avoid contact sports or strenuous exercise for at least 8 weeks or while splenomegaly is present to prevent splenic rupture 2, 3
• Reduction of activity is recommended, but complete bed rest is not necessary 2

Special Considerations

• Corticosteroids are not recommended for routine treatment of infectious mononucleosis 3
• Corticosteroids should be reserved for specific complications such as:
  • Impending airway obstruction due to severe pharyngeal edema 1, 3
  • Significant hematological complications 4
• Prolonged steroid use in uncomplicated infectious mononucleosis may lead to serious complications including sepsis 4
• Acyclovir and antihistamines are not recommended for routine treatment 3

Monitoring for Complications

• Monitor for splenic rupture (occurs in 0.1-0.5% of cases), which is potentially life-threatening 2
• Watch for neurological complications, which may require specialized management 2, 5
• Be aware that fatigue may persist for several months after the acute infection has resolved 3
• In immunocompromised patients, consider reducing or discontinuing immunomodulator therapy if possible 1
• In severe cases with immunocompromised patients, antiviral therapy with ganciclovir or foscarnet may be considered, though supporting evidence is limited 6

Duration and Prognosis

• Most symptoms resolve within a few weeks, though fatigue may persist for up to three months 2
• Most patients have an uneventful recovery with supportive care alone 2
• Infectious mononucleosis is a risk factor for chronic fatigue syndrome 2

Patient Education

• Explain that infectious mononucleosis is transmitted primarily through saliva 2, 7
• Advise patients that no vaccine is currently available 7
• Inform patients that symptoms, particularly fatigue, may persist for several months 3