eMedicine Specialties > Emergency Medicine > Infectious Diseases

Mononucleosis: Follow-up

Author: Michael S Omori, MD, Attending Staff, Emergency Medicine Residency, St Vincent Mercy Medical Center; Acting Director, Pediatric Emergency Center, Mercy Children's Hospital; Clinical Assistant Professor, Department of Surgery, University of Toledo Medical Center
Contributor Information and Disclosures

Updated: Apr 2, 2009

Follow-up

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.3
  • 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.4

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 excellent patient education resources, visit eMedicine's Bacterial and Viral Infections Center and Ear, Nose, and Throat Center. Also, see eMedicine's patient education articles Mononucleosis and Tonsillitis.

Miscellaneous

Medicolegal Pitfalls

  • Correct diagnosis is essential to avoid circumstances that predispose the patient to splenic rupture and to allow appropriate monitoring of patients for the development of other significant complications.
 


More on Mononucleosis

Overview: Mononucleosis
Differential Diagnoses & Workup: Mononucleosis
Treatment & Medication: Mononucleosis
Follow-up: Mononucleosis
References
[ CLOSE WINDOW ]

References

  1. 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].

  2. 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].

  3. 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].

  4. Keramidas DC, Antoniou D, Marinos L. Infectious mononucleosis manifested as a cecal mass. J Pediatr Surg. Jul 2007;42(7):1295-7. [Medline].

  5. 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.

  6. Cozad J. Infectious mononucleosis. Nurse Pract. Mar 1996;21(3):14-6, 23, 27-8. [Medline].

  7. 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].

  8. 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.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

infectious mononucleosis, IM, Epstein-Barr virus, EBV, Herpesviridae, tonsillitis, lymphadenopathy, hepatomegaly, splenomegaly, hepatosplenomegaly, African Burkitt lymphoma, nasopharyngeal cancers, hepatic failure, myocarditis, edema of the Waldeyer ring, meningitis, encephalitis, hemiplegia, psychosis, cranial nerve palsies, Guillain-Barré syndrome, transverse myelitis, peripheral neuritis, autoimmune hemolytic anemia, pancytopenia, red cell aplasia, severe thrombocytopenia, agranulocytopenia, papular erythematous eruption, macular erythematous rash, erythema nodosum, erythema multiforme, petechiae, adenovirus, cytomegalovirus, CMV, group A beta-hemolytic streptococci, hepatitis A, human herpes virus, human immunodeficiency virus, HIV, rubella, Toxoplasma gondii, lymphomas, leukemias

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Michael S Omori, MD, Attending Staff, Emergency Medicine Residency, St Vincent Mercy Medical Center; Acting Director, Pediatric Emergency Center, Mercy Children's Hospital; Clinical Assistant Professor, Department of Surgery, University of Toledo Medical Center
Michael S Omori, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Robert M McNamara, MD, FAAEM, Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine
Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.