Mononucleosis in Emergency Medicine Follow-up

Updated: Mar 16, 2017
  • Author: Michael S Omori, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Follow-up

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.

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Further Inpatient Care

Admission rarely is necessary in patients with uncomplicated infectious mononucleosis.

Circumstances that warrant inpatient treatment include serious complications, as detailed below.

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Deterrence/Prevention

The ubiquitous nature of Epstein-Barr virus (EBV) coupled with its typically benign and self-limited course renders deterrence a moot issue.

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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]

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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.

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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.

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