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Infectious Mononucleosis Treatment & Management

  • Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Oct 06, 2015
 

Medical Care

Closely monitor patients with extreme tonsillar enlargement for airway obstruction. Steroids are indicated for impending or established airway obstruction in individuals with Epstein-Barr virus (EBV) infectious mononucleosis.

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Surgical Care

Surgery is necessary for spontaneous splenic rupture, which occurs in rare patients with EBV infectious mononucleosis and may be the initial manifestation of the condition.

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Consultations

See the list below:

  • Consult an infectious disease specialist in all but the most straightforward cases of EBV infectious mononucleosis.
  • Consulting a hematologist may be necessary if unusual hematologic manifestations of EBV infectious mononucleosis are present (eg, in anemia to determine the cause of the patient's anemia).
  • Consulting a neurologist is advised for patients with potential CNS involvement.
  • Consultation with a cardiologist is advised for the rare patients with EBV infectious mononucleosis who have presumed myocarditis.
  • Consult a gastroenterologist for patients with EBV-induced acalculous cholecystitis or if anicteric hepatitis is in the differential diagnoses.
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Diet

Normal diet is appropriate.

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Activity

Patients with acute EBV mononucleosis should be encouraged to rest as much as possible and to refrain from active physical activity for 3 weeks.

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Contributor Information and Disclosures
Author

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, Association of Subspecialty Professors, American Society for Microbiology, Infectious Diseases Society of America, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Charles S Levy, MD Associate Professor, Department of Medicine, Section of Infectious Disease, George Washington University School of Medicine

Charles S Levy, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, Medical Society of the District of Columbia

Disclosure: Nothing to disclose.

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Table 1. Differential Diagnoses of Infectious Mononucleosis
Clinical Parameters Epstein-Barr Virus Cyto-megalovirusToxoplasmosisViral Hepatitis
SymptomsFatigue+++++/-+
Malaise+++-+
Mild sore throat+++/-+/-
Early maculopapular rash±--+/-
SignsEarly bilateral upper eyelid edema±---
Unilateral localized adenopathy--+-
Bilateral posterior cervical adenopathy++-+/-
Tender hepatomegaly+/-+/--+
Splenomegaly++/-+/--
Laboratory abnormalitiesWBC countN*/-N/-N¯
Elevated SGOT/SGPT++++/-+++
Atypical lymphocytes (≥ 10%)++--
Thrombocytopenia+/-+/--+/-
Elevated IgM§ CMV titer-+--
Elevated IgM EBV VCAII titer+---
Elevated IgM toxoplasmosis titer--+-
Positive hepatitis (eg, A, B, D) test---+
*Normal



Serum glutamic-oxaloacetic transaminase



Serum glutamic-pyruvic transaminase



§ Immunoglobulin M



II Viral capsid antigen



Table 2. EBV Serologic Responses in EBV-Associated Diseases
EBV DiseasesEBV Antibody Responses
Anti-VCAAnti-EA
IgM



Monospot/



Heterophile



IgMIgGDiffuse EARestricted EAAnti-EBNA
Acute EBV mononucleosis++++--
Past EBV infection--+--+
Chronic active EBV infection--++++++
Burkitt lymphoma--++++/-++
Nasopharyngeal carcinoma--+++++/-+
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