Management of Infectious Mononucleosis in a 17-Year-Old Male
Treatment for infectious mononucleosis in this 17-year-old male is entirely supportive, as antiviral therapy with acyclovir does not ameliorate the course of disease in otherwise healthy individuals. 1
Supportive Care Measures
Primary management consists of:
- Adequate hydration, analgesics, and antipyretics to manage fever and pharyngitis symptoms 2
- Activity modification guided by the patient's energy level rather than enforced bed rest 2
- Rest as tolerated with gradual return to normal activities 1, 3
Critical Activity Restrictions
The patient must avoid contact sports and strenuous exercise for at least 4 weeks after symptom onset (some sources recommend 8 weeks or until splenomegaly resolves) to prevent splenic rupture, which occurs in 0.1-0.5% of cases and is potentially life-threatening 3, 2
When Corticosteroids Are Indicated
Corticosteroids should be reserved exclusively for:
- Airway obstruction or severe pharyngeal edema causing respiratory compromise 1, 2
- They are not recommended for routine treatment of uncomplicated infectious mononucleosis 4, 1
What NOT to Use
Avoid the following medications:
- Acyclovir has no proven benefit in immunocompetent patients with established disease 4, 1
- Antihistamines are not recommended for routine treatment 2
Expected Clinical Course
Typical recovery timeline:
- Most symptoms resolve within a few weeks, though fatigue may persist for up to 3 months 3, 2
- The majority of patients have an uneventful recovery 3
Prevention of Transmission
Counsel the patient to:
- Avoid sharing personal items contaminated with saliva (drinking glasses, utensils, lip balm) 5, 1
- Practice hand hygiene, especially in close community settings 5, 1
Monitoring Considerations
While routine laboratory monitoring is not necessary in uncomplicated cases, be aware that:
- Splenomegaly occurs in approximately 50% of cases and hepatomegaly in 10% 3
- Spontaneous splenic rupture is the most feared complication, though rare 3, 6
Important Caveats
This patient is immunocompetent based on the clinical scenario. If he were immunocompromised (on immunosuppressive therapy), management would differ significantly, requiring reduction or discontinuation of immunomodulators and consideration of antiviral therapy with ganciclovir or foscarnet in severe cases 4, 1
The diagnosis should already be confirmed with either a positive heterophile antibody (Monospot) test or EBV-specific serology showing VCA IgM antibodies in the absence of EBNA antibodies 4, 1