From the Guidelines
Athletes who test positive for Epstein-Barr virus (EBV) should avoid contact sports for at least 4 weeks after symptom onset, or until the spleen is no longer palpable, as recommended by the Pediatrics journal in 2017 1. When considering return to play, it's crucial to prioritize the athlete's safety and prevent potential complications, such as splenic rupture, which can be life-threatening. The primary concern is the risk of splenic rupture due to a traumatic blow to an enlarged spleen during contact sports.
- Key factors to consider before returning to contact sports include:
- Complete resolution of symptoms
- Normalization of spleen size (if enlarged)
- Clearance from a healthcare provider
- Athletes should gradually return to activity, starting with light aerobic exercise and progressively increasing intensity as tolerated, to prevent prolonged recovery periods or persistent fatigue.
- Even after medical clearance, athletes should be monitored for any signs of complications or prolonged recovery, and return to full competitive play should be individualized based on the athlete's specific condition and recovery progress, as outlined in the study published in Pediatrics in 2017 1.
From the Research
Return to Contact Sports after EBV Infection
The decision to allow athletes to return to contact sports after testing positive for Epstein-Barr Virus (EBV) depends on several factors, including the risk of splenic rupture.
- According to a study published in 2011 2, athletes can safely return to contact sports after 1-2 months of diagnosis, provided their splenic dimensions have returned to normal as confirmed by abdominal ultrasonography.
- Another study from 2008 3 suggests that splenomegaly associated with acute EBV infection resolves within 4-6 weeks of symptom onset in the majority of cases, implying that athletes can return to contact sports after this period.
- However, it is essential to note that splenic rupture is a rare but potentially fatal complication of infectious mononucleosis, and athletes should be carefully evaluated before returning to contact sports 4, 5.
- The use of contrast-enhanced ultrasound (CEUS) has been recommended as a diagnostic tool for detecting splenic infarctions, which can be a complication of EBV infection 6.
- The exact timeframe for returning to contact sports may vary depending on individual factors, such as the severity of symptoms and the presence of complications.
- Serial abdominal ultrasonography and physical exams can help determine when an athlete can safely return to contact sports 2, 3.