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Related Experiment Video

Updated: Apr 30, 2026

Separation of Immune Cell Subpopulations in Peripheral Blood Samples from Children with Infectious Mononucleosis
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Return to play after infectious mononucleosis.

Jonathan A Becker1, Julie Anne Smith2

  • 1Department of Family and Geriatric Medicine, University of Louisville and Kentucky One Health Sports Medicine Fellowship, Louisville, Kentucky.

Sports Health
|May 3, 2014
PubMed
Summary

Return-to-play decisions for athletes with infectious mononucleosis (IM) require individual assessment due to the disease's variable nature. Current guidelines lack evidence, making clinical judgment crucial for managing splenic injury risks and chronic fatigue.

Keywords:
chronic fatiguemononucleosisspleen imagingsplenomegaly

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Area of Science:

  • Sports Medicine
  • Infectious Diseases
  • Clinical Management

Background:

  • Infectious mononucleosis (IM) primarily affects adolescents and young adults.
  • Splenic injury and chronic fatigue pose significant challenges for athlete return-to-play decisions.
  • The variability of IM necessitates careful clinical management.

Purpose of the Study:

  • To review the epidemiology, diagnosis, clinical manifestations, and management of infectious mononucleosis in athletes.
  • To evaluate the role of the spleen and imaging in guiding return-to-play decisions.
  • To address the challenges in managing athletes with IM, particularly regarding persistent symptoms and fatigue.

Main Methods:

  • Systematic literature search of PubMed and MEDLINE databases up to December 2012.
  • Inclusion of studies on epidemiology, diagnosis, clinical features, management, and splenic involvement in IM.
  • Clinical review with Level 4 evidence.

Main Results:

  • Infectious mononucleosis is common in young athletes, with diverse presentations affecting multiple organ systems.
  • Supportive care is primary; corticosteroids have limited roles. Physical examination and ultrasound are unreliable for spleen assessment.
  • Exercise does not seem to increase chronic fatigue risk, but identifying at-risk athletes for persistent symptoms remains difficult.

Conclusions:

  • Individualized return-to-play decisions are essential for athletes with infectious mononucleosis.
  • The variable disease course and lack of evidence-based guidelines underscore the need for personalized management.
  • Clinicians must carefully assess athletes to mitigate risks associated with splenic injury and prolonged fatigue.