From the Guidelines
Infectious Mononucleosis (Mono) is typically characterized by symptoms such as fever, sore throat, and fatigue, and is usually treated with supportive care, including rest, hydration, and pain management.
Symptoms of Mono
- Fever
- Sore throat
- Fatigue
- Elevated white blood cell count with an increased percentage of atypical lymphocytes 1
Diagnosis of Mono
Diagnosis is often made based on clinical presentation and laboratory tests, including:
- Heterophile antibody tests, such as the Monospot test 1
- EBV antibody testing for IgG and IgM to viral capsid antigen (VCA) and Epstein-Barr nuclear antigen (EBNA) 1
Treatment Options for Mono
- Supportive care, including rest, hydration, and pain management
- Antiviral medications are not typically effective in treating Mono, but may be considered in certain cases, such as in immunocompromised patients 1
- Corticosteroids may be used to reduce inflammation and swelling in severe cases 1 Note that the evidence does not provide specific treatment guidelines, but rather focuses on diagnosis and laboratory testing. Therefore, treatment options are based on general medical knowledge and may vary depending on the individual patient and clinical context.
From the Research
Symptoms of Infectious Mononucleosis
- Fever, tonsillar pharyngitis, and lymphadenopathy are the characteristic triad of symptoms 2
- Fatigue may be profound but tends to resolve within three months 2
- Periorbital and/or palpebral edema, typically bilateral, occurs in one-third of patients 2
- Splenomegaly and hepatomegaly occur in approximately 50% and 10% of cases, respectively 2
- A skin rash, which is usually widely scattered, erythematous, and maculopapular, occurs in approximately 10 to 45% of cases 2
- Peripheral blood leukocytosis is observed in most patients; lymphocytes make up at least 50% of the white blood cell differential count 2
- Atypical lymphocytes constitute more than 10% of the total lymphocyte count 2
Diagnosis of Infectious Mononucleosis
- The classic test for infectious mononucleosis is the demonstration of heterophile antibodies 2
- The monospot test is the most widely used method to detect the serum heterophile antibodies of infectious mononucleosis 2
- When confirmation of the diagnosis of infectious mononucleosis is required in patients with mononucleosis-like illness and a negative mono-spot test, serologic testing for antibodies to viral capsid antigens is recommended 2
- EBV-specific antibody profiles are the best choice for staging EBV infection 3, 4
- Real-time PCR (RT-PCR) and measurement of Epstein-Barr virus viral load (EBV-VL) in peripheral blood may provide useful tools for the early diagnosis of infectious mononucleosis in cases with inconclusive serological results 5
Treatment Options for Infectious Mononucleosis
- Treatment is mainly supportive 2
- Reduction of activity and bed rest as tolerated are recommended 2
- Patients should be advised to avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present 2
- Antivirals (mainly acyclovir and valacyclovir) may have a role in the treatment of infectious mononucleosis with complications 5
- Novel potential therapeutic patents including 5-substituted uracyle, azacytosine derivatives, and peptides inhibiting EBV-mediated membrane fusion have been presented 5
- A vaccine is currently not available, but development of an effective, safe, and affordable EBV vaccine that can confer life-long immunity is considered the most effective way to prevent EBV infection and infectious mononucleosis 2, 4