Pediatric Mononucleosis and Epstein-Barr Virus Infection Guidelines

Updated: Mar 22, 2021
  • Author: Jaya Sureshbabu, MBBS, MRCPCH(UK), MRCPI(Paeds), MRCPS(Glasg), DCH(Glasg); Chief Editor: Russell W Steele, MD  more...
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Guidelines Summary

Guidelines on the diagnosis, prevention, prophylaxis, and treatment of Epstein-Barr virus (EBV)–related post transplant lymphoproliferative disorders in allogeneic hematopoietic stem cell transplant patients were published in 2016 by the Sixth European Conference on Infections in Leukemia. The guidelines recommend rituximab, immunosuppression reduction, and EBV-specific cytotoxic T-cell therapy as first-line treatment in these patients. Unselected donor lymphocyte infusions and chemotherapy are recommended as second-line options, while antiviral drugs are not recommended for prophylaxis, with evidence indicating that they are ineffective against latent EBV. [57]

A Cochrane review, which included 7 randomized controlled trials and 333 patients, found that the efficacy of antivirals (eg, acyclovir, valaciclovir) in infectious mononucleosis is uncertain, and the quality of evidence is very low. [53]  An improvement in time taken to recover (by 5 days) occurred in patients who received antiviral treatment, but the result was not precise and measurement for improvement was not clearly defined.