Epstein-Barr Virus (EBV) Infectious Mononucleosis (Mono) Follow-up

Updated: Apr 21, 2021
  • Author: Kartika Shetty, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
  • Print

Further Outpatient Care

Monitor patients to be sure that the infection is improving over time. Serial CBC counts should document the increase in lymphocytes as well as atypical lymphocytes, and this may be monitored on a weekly basis until these values normalize.

Patients with positive heterophile tests should not be monitored with serial testing because the heterophile test may remain positive for as much as 1 year after infection.

Serial specific Epstein-Barr virus (EBV) antibody testing is usually not necessary in patients with acute infection. Caution patients that increased IgG, VCA, and EBNA levels persist for life. Also, inform patients that titers vary and that IgG titers have no relationship to disease activity or to how the patient feels.

Patients should be advised that fatigue may take some time to resolve, and some patients may develop a state of chronic fatigue that is induced, but not caused by, EBV infectious mononucleosis.


Further Inpatient Care

Patients with extreme tonsillar enlargement may require extended care if intubation is required.



Avoid close contact with body fluid secretions, particularly saliva.



Extreme enlargement of the tonsils may result in airway obstruction.

Encephalitis and myocarditis are rare complications.

Splenic rupture is a rare, but potentially lethal, complication of EBV infectious mononucleosis.

Rare patients with EBV infectious mononucleosis develop lymphoma.



If splenic rupture is recognized and expeditiously treated surgically, the prognosis is good.

Patients with EBV infectious mononucleosis who become asplenic as the result of splenic rupture and/or surgical removal should be treated as other patients with asplenia.


Patient Education

Counsel patients to refrain from strenuous physical activity for the first 3 weeks of illness.

Patients should avoid exposing other people to their body secretions because EBV remains viable in patients with EBV infectious mononucleosis for months after the initial infection.

For excellent patient education resources, visit eMedicineHealth's Bacterial and Viral Infections Center and Back, Ribs, Neck, and Head Center. Also, see eMedicineHealth's patient education articles Mononucleosis and Chronic Fatigue Syndrome.