What are the management and treatment options for a young adult or adolescent patient who has tested positive for infectious mononucleosis (mono)?

Management of Infectious Mononucleosis

Treatment for infectious mononucleosis is entirely supportive, focusing on symptomatic relief with rest, hydration, antipyretics for fever, and analgesics for throat pain. 1

Immediate Management

Symptomatic care is the cornerstone of treatment:

• Provide antipyretics (acetaminophen or ibuprofen) for fever control 2
• Ensure adequate hydration throughout the illness 2, 3
• Allow rest as tolerated by the patient's energy level—enforced bed rest is not necessary 3
• Use analgesics for pharyngeal pain relief 3

What NOT to Do

Avoid routine use of antivirals and corticosteroids:

• Acyclovir, ganciclovir, and foscarnet have no proven benefit in immunocompetent patients 2, 1
• Corticosteroids are NOT routinely recommended 2
• Reserve corticosteroids ONLY for airway obstruction or severe pharyngeal edema causing respiratory compromise 1, 3

Activity Restrictions (Critical for Safety)

Patients must avoid contact sports and strenuous exercise for 8 weeks after symptom onset or while splenomegaly persists 4, 3:

• Splenic rupture occurs in 0.1-0.5% of cases and is potentially life-threatening 4, 5
• This is the most feared and potentially fatal complication 5, 6
• Physical activity should be guided by the patient's energy level, not arbitrarily restricted beyond sports avoidance 3

Expected Clinical Course

Most patients recover without complications, though fatigue may persist:

• Fatigue typically resolves within 3 months but may persist longer 4, 3
• The illness is generally self-limited and benign 4
• Infectious mononucleosis is a risk factor for chronic fatigue syndrome 4

When to Escalate Care

Seek immediate evaluation for:

• Signs of splenic rupture (abdominal pain, left shoulder pain, hemodynamic instability) 4, 5
• Respiratory compromise or severe pharyngeal edema (may require corticosteroids) 1, 3
• Neurologic, hematologic, or cardiac complications (may require corticosteroids) 2

Prevention of Transmission

Counsel patients on transmission prevention:

• Avoid sharing personal items contaminated with saliva (cups, utensils, toothbrushes) 1
• Practice hand hygiene, especially in close community settings 1
• EBV is transmitted primarily through saliva 4

Special Considerations

For immunocompromised patients, management differs significantly:

• Reduce or discontinue immunomodulator therapy if possible 1
• Obtain complete blood count, blood film, and liver function tests 1
• These patients have increased risk of EBV-associated lymphoproliferative disease and require specialist consultation 1