para>Splenic rupture may be fatal if not recognized. Occurrence is estimated at 0.1%.
Patient Monitoring
- Avoid contact sports, heavy lifting, and excess exertion until spleen and liver have returned to normal size (ultrasound can verify in athletic populations).
- Eliminate alcohol and exposure to other hepatotoxic drugs or herbal supplements until LFTs normalize.
- Closely monitor patients during the first 2 to 3 weeks after the onset of symptoms since complication rates are highest during this period.
- Alert patients that symptoms (malaise, fatigue, intermittent sore throat, lymphadenopathy) may persist for months.
DIET
No restrictions. Hydration during acute phase is important.
PROGNOSIS
- Most recover in ~4 weeks.
- Fatigue may persist for months.
COMPLICATIONS
- Neurologic (rare)
- Aseptic meningitis, meningoencephalitis
- Bell palsy; Guillain-Barr © syndrome
- Transverse myelitis
- Cerebellar ataxia
- Acute psychosis
- Hematologic (rare)
- Thrombocytopenia, slight to moderate, early in illness
- Hemolytic anemia with marked neutropenia during early weeks
- Aplastic anemia
- Agammaglobulinemia
- Pneumonitis
- Splenic rupture
- Rare, but most often occurs in the first 21 days of illness
REFERENCES
11 Grywalska E, Rolinski J. Epstein-Barr virus-associated lymphomas. Semin Oncol. 2015;42(2):291-303.22 Dowd JB, Palermo T, Brite J, et al. Seroprevalence of Epstein-Barr virus infections in the U.S. children ages 6-19, 2003-2010. PLoS One. 2013;8(5):e64921.33 Thorley-Lawson DA, Hawkins JB, Tracy SI, et al. The pathogenesis of Epstein-Barr virus persistent infection. Curr Opin Virol. 2013;3(3):227-232.44 Chovel-Sella A, Ben Tov A, Lahav E, et al. Incidence of rash after amoxicillin treatment in children with infectious mononucleosis. Pediatrics. 2013;131(5):e1424-e1427.55 Odumade OA, Hogquist KA, Balfour HHJr. Progress and problems in understanding and managing primary Epstein-Barr virus infections. Clin Microbiol Rev. 2011;24(1):193-209.
ADDITIONAL READING
- Almohmeed YH, Avenell A, Aucott L, et al. Systematic review and meta-analysis of the sero-epidemiological association between Epstein Barr virus and multiple sclerosis. PLoS One. 2013;8(4):e61110.
- Klein G, Klein E, Kashuba E. Interaction of Epstein-Barr virus (EBV) with human B-lymphocytes. Biochem Biophys Res Commun. 2010;396(1):67-73.
ICD10
- B27.00 Gammaherpesviral mononucleosis without complication
- B27.09 Gammaherpesviral mononucleosis with other complications
- B27.01 Gammaherpesviral mononucleosis with polyneuropathy
- B27.02 Gammaherpesviral mononucleosis with meningitis
ICD9
075 Infectious mononucleosis
SNOMED
- 271558008 Infectious mononucleosis (disorder)
- 186668002 Gammaherpesviral mononucleosis (disorder)
- 402121009 Epstein-Barr virus infection (disorder)
CLINICAL PEARLS
- In cases of acute symptomatic infectious mononucleosis, 98% present with fever, sore throat, cervical node enlargement, and tonsillar hypertrophy.
- False-negative monospot (heterophile antibody) common in the first 10 to 14 days of illness. 90% will have heterophile antibodies by week 3 of illness.
- Lymphocytosis (not monocytosis) is common in infectious mononucleosis.