Treatment of Infectious Mononucleosis
Supportive care is the mainstay of treatment for infectious mononucleosis, with no role for antiviral therapy in otherwise healthy individuals. 1, 2
Primary Treatment Approach
- Symptomatic management includes adequate hydration, analgesics, antipyretics, and rest guided by the patient's energy level rather than enforced bed rest 1, 3
- Patients allowed out of bed as soon as they feel able report quicker recovery compared to those with imposed bed rest 4
- Fatigue may persist for several months after acute infection resolves, but typically improves within three months 3, 5
Medications to Avoid in Routine Care
- Aciclovir does not improve outcomes or ameliorate the course of infectious mononucleosis in otherwise healthy individuals and is not recommended 1, 2
- Corticosteroids are not recommended for routine treatment 1, 3
- Antihistamines have no role in routine management 3
Specific Indications for Corticosteroids
Corticosteroids should be reserved only for severe complications:
- Airway obstruction or severe pharyngeal edema causing respiratory compromise 2, 3
- Severe neurologic, hematologic, or cardiac complications 1
This represents a narrow therapeutic window where corticosteroids may provide benefit, but they should not be used for typical presentations.
Activity Restrictions
- Patients must be withdrawn from contact or collision sports for at least 4 weeks after symptom onset 3
- Some sources recommend avoiding contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present 5
- This precaution addresses the risk of splenic rupture, which occurs in 0.1-0.5% of cases and is potentially life-threatening 5
Management in Immunocompromised Patients
In immunocompromised patients with primary EBV infection, a different approach is warranted:
- Immunomodulator therapy should be reduced or discontinued if possible 1, 2
- Antiviral agents such as ganciclovir or foscarnet may be considered in severe primary EBV infection in immunocompromised patients, despite limited supporting evidence 1
- Discontinuation of immunosuppressive therapy may result in spontaneous regression of EBV-associated lymphoproliferative disease 1
- These patients require specialist consultation due to increased risk of lymphoproliferative disorders 2
Important Clinical Caveats
- Symptoms in immunocompromised patients may be minimal, particularly in those receiving corticosteroids, making diagnosis more challenging 1
- Full blood count, blood film, and liver function tests should be obtained in patients on immunosuppressive therapy with possible primary EBV infection 2
- The most feared complication is spontaneous splenic rupture, which typically occurs within the first month of symptom onset 5