infectious diseases
Infectious Mononucleosis
Key Points
EBV infection is very common; the virus remains within the host for life and is intermittently and asymptomatically shed from the oropharynx. Only about 5% of patients acquire EBV from someone who has acute infection. Typical manifestations include fatigue (sometimes persisting weeks or months), fever, pharyngitis, splenomegaly, and lymphadenopathy. Uncommon severe complications include encephalitis and other neurologic manifestations, splenic rupture, airway obstruction due to tonsillar enlargement, hemolytic anemia, thrombocytopenia, and jaundice. A positive heterophile antibody test or specific EBV antibody test is helpful in the appropriate clinical situation. Primary HIV infection can have a clinical presentation similar to acute EBV; therefore, HIV testing should be done in patients at risk of HIV infection. Provide supportive care and recommend avoidance of heavy lifting and contact sports; antivirals are not indicated. Consider corticosteroids for complications such as impending airway obstruction, severe thrombocytopenia, and hemolytic anemia. 