Mononucleosis in Emergency Medicine Treatment & Management

  • Author: Michael S Omori, MD; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: May 23, 2012
 

Emergency Department Care

Treatment of patients with infectious mononucleosis (IM) generally is supportive, consisting primarily of rest, analgesics, and antipyretics.

  • Because of the risk of splenic rupture, health care providers should avoid vigorous abdominal examination and palpation in patients with infectious mononucleosis.
  • Certain clinical situations may warrant the administration of corticosteroids. Several studies have suggested that corticosteroids may be beneficial to patients with infectious mononucleosis, but the routine use of these agents in patients with uncomplicated disease should be avoided because these medications may adversely affect cell-medicated immune responses, thereby increasing the risk of bacterial superinfection.
    • Patients with complications due to infectious mononucleosis who may benefit from corticosteroids include those with massive edema of the Waldeyer ring with a potential for airway obstruction, patients with autoimmune hemolytic anemia, or those with severe thrombocytopenia.
    • Other complications that may warrant such therapy include severe involvement of the heart or central nervous system (CNS).
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Consultations

Appropriate consultations should be obtained in patients with infectious mononucleosis who have significant complications or in cases that present in an atypical fashion, suggesting another serious process.

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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, The University of Toledo College of Medicine

Michael S Omori, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

Eric L Weiss, MD, DTM&H  Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Progressor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

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.

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, University of California, Los Angeles, David Geffen School of Medicine; 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.

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. 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].

  4. 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].

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

  6. 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.

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

  8. 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].

  9. 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.

 
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