What are the guidelines for sport participation in a patient with infectious mononucleosis (mono)?

Guidelines for Sport Participation in Patients with Infectious Mononucleosis

Athletes with infectious mononucleosis should avoid contact sports and strenuous exercise for at least 4 weeks from symptom onset or until splenomegaly is no longer present to prevent the risk of splenic rupture. 1, 2

Risk Assessment and Return-to-Play Timeline

• Splenic rupture is a rare but potentially life-threatening complication of infectious mononucleosis, occurring in 0.1% to 0.5% of cases 3, 2
• Most splenic ruptures (73.8%) occur within 21 days of symptom onset, but a substantial number (16.7%) occur between 21 and 31 days 3
• Current evidence suggests extending activity restriction to at least 4 weeks (31 days) after symptom onset to minimize risk of splenic injury 3, 4
• Avoid all "burst" exertion activities with rapid acceleration/deceleration during the recovery period 5

Evaluation Before Return to Sports

• Serial ultrasonography is recommended to assess splenic size before clearing athletes to return to contact sports 6
  • In one study, 84% of athletes had normal splenic dimensions on ultrasonography 1 month after diagnosis 6
  • The remaining 16% had normal dimensions by 2 months post-diagnosis 6

Sport Participation Guidelines

• First 4 weeks after symptom onset:

  • Complete restriction from contact sports and strenuous exercise 1, 2
  • Avoid activities with risk of abdominal trauma 2
  • Light, non-contact activities may be permitted based on patient symptoms and energy levels 2

• After 4 weeks:

  • Athletes with normal splenic dimensions on ultrasonography may return to contact sports 6
  • Athletes with persistent splenomegaly should continue to avoid contact sports until splenomegaly resolves 2, 7
  • Some athletes may require up to 8 weeks of restricted activity if splenomegaly persists 2

Special Considerations

• Shared decision-making should be used when determining exact timing of return to activity, taking into account:

  • Presence or absence of splenomegaly on physical exam or ultrasound 6, 7
  • Duration of illness (splenic rupture has not been reported after 3 weeks of illness) 7
  • Type of sport (contact vs. non-contact) 1
  • Severity of symptoms, particularly fatigue 2

• Athletes should be educated about the importance of:

  • Proper personal hygiene to prevent transmission (handwashing, avoiding sharing water bottles, towels) 1
  • Gradually increasing activity levels when returning to sports 2
  • Reporting any abdominal pain immediately 3, 7

Common Pitfalls to Avoid

• Returning athletes to contact sports too early (before 4 weeks) significantly increases risk of splenic rupture 3
• Failing to obtain objective measurement of splenic size before clearing for contact sports 6
• Not recognizing that fatigue may persist for up to 3 months and may affect athletic performance even after clearance 2
• Overlooking the need for proper infection control measures to prevent transmission to teammates 1

Following these guidelines will help ensure safe return to sports participation while minimizing the risk of potentially life-threatening complications in athletes recovering from infectious mononucleosis.