eMedicine Specialties > Emergency Medicine > Infectious Diseases

Mononucleosis: Treatment & Medication

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

Treatment

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).

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.

Medication

The treatment of infectious mononucleosis is largely supportive except when coexisting complications may indicate the use of corticosteroids.

Corticosteroids

These agents are recommended in patients with severe edema of the Waldeyer ring with potential for airway obstruction, autoimmune hemolytic anemia, severe thrombocytopenia, or significant involvement of the heart or CNS.


Prednisone (Deltasone, Orasone, Sterapred)

Useful in the treatment of inflammatory and autoimmune reactions. By reversing increased capillary permeability and suppressing PMN activity, it may decrease inflammation. The routine use of prednisone in patients with uncomplicated IM is not recommended. Generally is reserved for patients with significant symptoms or complications.

Adult

40-60 mg/d PO divided bid/qid for 1-2 wk; taper over 2 wk as symptoms resolve

Pediatric

4-5 mg/m2/d PO qd or divided tid/qid
Alternatively, 1-2 mg/kg PO qd; taper over 2 wk as symptoms resolve

Coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin, may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics

Documented hypersensitivity; viral, fungal, or tubercular skin lesions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use

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.