Treatment for Infectious Mononucleosis
The treatment for infectious mononucleosis is primarily supportive care, as antiviral therapy has not been shown to be effective in otherwise healthy individuals. 1, 2
Diagnosis Confirmation
- Infectious mononucleosis should be suspected in patients 10-30 years of age presenting with fever, sore throat, swollen lymph nodes, and fatigue 3
- Heterophile antibody test (Monospot) is the recommended initial test, typically becoming positive between the sixth and tenth day after symptom onset 4
- EBV serologic testing (VCA IgM, VCA IgG, and EBNA antibodies) is recommended when clinical suspicion remains high despite a negative heterophile test 4, 5
- Atypical lymphocytosis ≥20% or atypical lymphocytosis ≥10% plus lymphocytosis ≥50% strongly supports the diagnosis 3
Supportive Treatment Approach
- Adequate hydration, analgesics, antipyretics, and rest form the mainstay of treatment 2, 3
- Activity should be guided by the patient's energy level rather than enforced bed rest 3
- Warm saline mouthwashes are recommended to cleanse the oral cavity for painful pharyngitis 2
- Topical analgesics such as benzydamine hydrochloride rinses may be considered for painful oral lesions 2
Medication Considerations
- Acyclovir therapy does not ameliorate the course of infectious mononucleosis in otherwise healthy individuals and is not recommended 1, 2
- Corticosteroids are not recommended for routine treatment but may be indicated for specific complications 2, 3:
- Severe airway obstruction
- Significant pharyngeal edema
- Neurological complications
- Hemolytic anemia or severe thrombocytopenia
Activity Restrictions
- Patients should be withdrawn from contact or collision sports for at least 4-8 weeks after symptom onset or while splenomegaly is present to prevent splenic rupture 3, 6
- Spontaneous splenic rupture occurs in 0.1-0.5% of patients and is potentially life-threatening 6
Special Considerations for Immunocompromised Patients
- Immunomodulator therapy should be reduced or discontinued if possible in patients with primary EBV infection 1, 2
- In severely immunocompromised patients with severe primary EBV infection, antiviral therapy with ganciclovir or foscarnet may be considered despite limited supporting evidence 1, 2
- Immunocompromised patients require careful monitoring due to increased risk of lymphoproliferative disorders 1, 2
Duration and Prognosis
- Most symptoms resolve within 2-3 weeks, though fatigue may persist for several months 3, 7
- Most cases are self-limiting with full recovery, though rare severe complications can occur 8, 6
Common Pitfalls to Avoid
- Unnecessary antibiotic use, which may lead to a maculopapular rash, especially with ampicillin or amoxicillin 5
- Failure to consider differential diagnoses in heterophile-negative cases (CMV, HIV, toxoplasmosis, adenovirus) 4
- Inadequate activity restrictions, which may increase risk of splenic rupture 6
- Routine use of corticosteroids without specific indications 2, 8