Patient Education and Management for Infectious Mononucleosis
Understanding the Illness
Infectious mononucleosis is a self-limited viral illness caused by Epstein-Barr virus that typically resolves within 2-3 weeks, though fatigue may persist for months. 1, 2 The infection spreads through saliva and close personal contact, affecting primarily adolescents and young adults aged 15-24 years. 3
What to Expect: Symptoms and Timeline
- Classic symptoms include the triad of fever, severe sore throat (tonsillar pharyngitis), and swollen lymph nodes in the neck (posterior cervical lymphadenopathy). 1, 3
- Fatigue is often profound but typically resolves within three months, though it may occasionally persist longer. 2, 4
- Eye swelling (periorbital/palpebral edema), usually affecting both eyes, occurs in one-third of patients. 2
- Enlarged spleen (splenomegaly) occurs in approximately 50% of cases, while liver enlargement (hepatomegaly) occurs in about 10%. 2
- Skin rash appears in 10-45% of patients, typically as widespread red spots (erythematous and maculopapular). 2
Treatment Approach
Supportive care is the mainstay of treatment—there is no specific antiviral therapy recommended for otherwise healthy individuals. 1, 4
Symptom Management
- Use acetaminophen or ibuprofen for fever and pain control. 1
- Ensure adequate hydration throughout the illness. 4
- Get adequate rest, but strict bed rest is not necessary—let your energy level guide your activity. 4
Medications NOT Routinely Recommended
- Acyclovir (antiviral) does not improve outcomes in otherwise healthy individuals. 1, 4
- Corticosteroids are not recommended for routine treatment and should only be used for severe complications like respiratory compromise or severe throat swelling. 1, 4
- Antihistamines are not recommended for routine treatment. 4
Critical Activity Restrictions
You must avoid contact sports and strenuous exercise for at least 3-4 weeks from symptom onset to prevent splenic rupture. 1, 3 This is the most important safety measure, as splenic rupture occurs in 0.1-0.5% of patients and is potentially life-threatening. 2, 5
- Wait at least 3 weeks before returning to athletic activity (current guidelines). 3
- Some experts recommend waiting 4-8 weeks or until splenomegaly resolves. 2, 4
- Discuss timing of return to activity with your physician using shared decision-making. 3
When to Seek Immediate Medical Attention
Return to the emergency department immediately if you experience:
- Sudden, severe abdominal pain (especially left upper abdomen)—this could indicate splenic rupture. 2, 5
- Difficulty breathing or swallowing due to severe throat swelling. 4
- Severe weakness or dizziness that could indicate internal bleeding. 5
Recovery Timeline and Follow-Up
- Acute symptoms typically last 2-3 weeks. 6
- Fatigue, muscle aches, and increased need for sleep may persist for several months after the acute infection resolves. 4
- Most patients have an uneventful recovery without complications. 2
Important Precautions
- Avoid sharing utensils, drinks, or kissing during the acute illness to prevent transmission, though precautions are generally not strictly necessary given the high rate of prior infection in adults. 6
- Do not take ampicillin or amoxicillin unless specifically prescribed for a confirmed bacterial infection, as these antibiotics commonly cause a rash in patients with mononucleosis. 2
- Monitor for complications including persistent fever, severe fatigue lasting beyond 3 months, or new symptoms. 2, 3
Long-Term Considerations
- Infectious mononucleosis is a risk factor for chronic fatigue syndrome in some patients. 2
- EBV infection has been linked to certain cancers (including Hodgkin lymphoma, non-Hodgkin lymphoma, and nasopharyngeal carcinoma) and some autoimmune diseases, though these are rare complications. 3
- Over 95% of adults worldwide have been infected with EBV, and most develop lifelong immunity. 6