Pediatric Mononucleosis and Epstein-Barr Virus Infection Treatment & Management

Updated: Dec 05, 2018
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
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Medical Care

Infectious mononucleosis is a self-limited illness that does not usually require specific therapy in patients with mild or moderate illness. However, if the tonsils are markedly enlarged (kissing tonsils) or if the patient has prolonged illness, most experts recommend a short course of steroids (1-2 mg/kg of prednisone daily for 3-7 d).

Because of low transmissibility of Epstein-Barr virus (EBV), isolation is not indicated.

Most affected individuals can be evaluated and treated as outpatients. Inpatient therapy of medical and surgical complications may be required.

Patients with chronic post–Epstein-Barr virus fatigue may benefit from psychological and behavioral approaches. [18]


Surgical Care

Splenic rupture is an acute abdominal emergency that usually requires surgical intervention.

Rupture may occur with trauma as minor as palpation, and is occasionally the presenting symptom.

Diagnosis can be confirmed using imaging procedures or peritoneal lavage in an unstable patient.

Splenectomy is usually required.

Occasionally, observation and supportive measures are adequate treatment for a hemodynamically stable patient.

Although partial splenectomy or suturing the capsular tear has been advocated to preserve splenic function, the acute changes that led to rupture militate against the success of this approach.



Surgical consultation should be sought when the patient has abdominal pain or evidence of shock.

Consultation with the appropriate subspecialist is indicated for management of significant complications (eg infectious diseases, hematology/oncology, immunology).



No dietary modifications are required.



Acceptable activity level during the acute illness depends on severity of the patient's symptoms.

Extreme fatigue may require bed rest for 1-2 weeks.

Malaise may persist for 2-3 months, and activity can increase as tolerated.

Patients should not participate in contact sports or heavy lifting for at least 2-3 weeks, although some authors recommend avoiding activities that may cause splenic trauma for 2 months.