Mononucleosis in Emergency Medicine Follow-up
- Author: Michael S Omori, MD; Chief Editor: Pamela L Dyne, MD more...
Further Inpatient Care
- Admission rarely is necessary in patients with uncomplicated infectious mononucleosis.
- Circumstances that warrant inpatient treatment include serious complications, as detailed below.
Further Outpatient Care
- Patients with uncomplicated infectious mononucleosis should be advised to avoid participation in contact sports or vigorous exercise for at least one month due to the potential for splenic rupture.
- Routine follow-up care with primary care physicians is recommended to monitor symptomatic improvement and to watch for the development of complications.
Deterrence/Prevention
- The ubiquitous nature of Epstein-Barr virus (EBV) coupled with its typically benign and self-limited course renders deterrence a moot issue.
Complications
- Complications in patients with infectious mononucleosis are uncommon but may be serious.
- Airway obstruction may develop in patients with severe inflammation and swelling of the tonsils and adenoids. This complication may occur in 1 of every 100-1000 cases and most often occurs in younger patients with infectious mononucleosis. These patients should be identified and admitted. Corticosteroids are indicated in an effort to avoid intubation or the need for a surgical airway. Additionally, the development of peritonsillar abscess or massive retropharyngeal lymphadenopathy secondary to EBV mononucleosis has been reported.
- Splenic rupture is a serious complication of infectious mononucleosis, but it occurs in fewer than 0.5% of cases. More than 90% of splenic rupture cases occur in male patients. In rare cases, splenic rupture has been reported in patients without other clinical symptoms of infectious mononucleosis.[4]
- CNS complications may occur early in the course, often during the first few weeks of the illness, and may include meningitis, encephalitis, seizures, nerve palsies, cerebellar syndrome, coma, transverse myelitis, and Guillain-Barré syndrome.
- Autoimmune hemolytic anemia is present in approximately 2% of patients with IM.
- Other complications involving the hematologic system include the development of pancytopenia, severe thrombocytopenia, agranulocytopenia, red cell aplasia, and hemolytic-uremic syndrome.
- Ophthalmic complications include conjunctivitis, episcleritis, and uveitis.
- Dermatologic complications include dermatitis, urticaria, and erythema multiforme.
- Other complications include psychosis, malabsorption, glomerulonephritis, nephrotic syndrome, bullous myringitis, orchitis, parotitis, monoarticular arthritis, and jaundice.
- Additional rare complications include cardiac involvement with myocarditis, pericarditis and ECG changes, fulminant hepatic disease, pneumonia, interstitial nephritis, and presentation as a cecal mass.[5]
Prognosis
- Infectious mononucleosis is a self-limited illness. Spontaneous resolution typically occurs in 3-4 weeks.
- While malaise and fatigue may persist for several months, the vast majority of patients fully recover with no significant permanent sequelae.
Patient Education
- Patients diagnosed with infectious mononucleosis should be educated as to the expected prognosis and time course of their illness.
- They should be instructed to avoid participation in contact sports and to refrain from vigorous physical activity for at least 1 month in order to minimize the possibility of splenic rupture.
- Routine follow-up care should be arranged to monitor patients for improvement or for the development of symptoms that are suggestive of complications.
- For patient education resources, see the Bacterial and Viral Infections Center and Ear, Nose, and Throat Center, as well as Mononucleosis and Tonsillitis.
Goldacre MJ, Wotton CJ, Seagroatt V, Yeates D. Multiple sclerosis after infectious mononucleosis: record linkage study. J Epidemiol Community Health. Dec 2004;58(12):1032-5. [Medline].
Haahr S, Plesner AM, Vestergaard BF, Hollsberg P. A role of late Epstein-Barr virus infection in multiple sclerosis. Acta Neurol Scand. Apr 2004;109(4):270-5. [Medline].
Cunha BA, Mickail N, Laguerre M. Babesiosis mimicking Epstein Barr Virus (EBV) infectious mononucleosis: Another cause of false positive monospot tests. J Infect. May 2012;64(5):531-2. [Medline].
Szoko M, Matolcsy A, Kovacs G, Simon G. Spontaneous splenic rupture as a complication of symptom-free infections mononucleosis. Orv Hetil. Jul 2007;148(29):1381-4. [Medline].
Keramidas DC, Antoniou D, Marinos L. Infectious mononucleosis manifested as a cecal mass. J Pediatr Surg. Jul 2007;42(7):1295-7. [Medline].
Cohen JI. Epstein-Barr virus infections, including infectious mononucleosis. In: Fauci AS, Braunwald E, Isselbacher KJ, Martin JB, eds. Harrison's Principles of Internal Medicine. 14th ed. McGraw Hill; 1998:1089-91.
Cozad J. Infectious mononucleosis. Nurse Pract. Mar 1996;21(3):14-6, 23, 27-8. [Medline].
Hickey SM, Strasburger VC. What every pediatrician should know about infectious mononucleosis in adolescents. Pediatr Clin North Am. Dec 1997;44(6):1541-56. [Medline].
Rosen P, Ling L, Markovchick V, et al. Epstein-Barr virus (infectious mononucleosis). In: Rosen's Emergency Medicine, Concepts and Clinical Practice. 4th ed. Mosby-Year Book; 1997:2540-2541.
Print
