Infectious Mononucleosis: Rapid Evidence Review

Area of Science:

• Infectious Diseases
• Virology
• Immunology

Background:

• Infectious mononucleosis is a common viral illness, typically caused by the Epstein-Barr virus (EBV).
• It primarily affects adolescents and young adults, characterized by fever, pharyngitis, and lymphadenopathy.
• Transmission occurs through close personal contact, often via saliva.

Purpose of the Study:

• To outline the diagnostic approaches for infectious mononucleosis.
• To discuss current treatment recommendations and return-to-activity guidelines.
• To highlight the long-term health implications associated with Epstein-Barr virus.

Main Methods:

• Initial laboratory diagnosis involves a complete blood count with differential and a rapid heterophile antibody test.
• Assessing for atypical lymphocytes and heterophile antibodies aids in diagnosis.
• Elevated liver enzymes can support a diagnosis when heterophile tests are negative.

Main Results:

• The heterophile antibody test shows 87% sensitivity and 91% specificity but can yield false negatives early in illness or in young children.
• Epstein-Barr viral capsid antigen-antibody testing offers higher sensitivity and specificity but is more costly and time-consuming.
• Supportive care is the recommended treatment; antivirals and corticosteroids are generally not advised.

Conclusions:

• Infectious mononucleosis management focuses on supportive care and adherence to activity restrictions.
• A three-week hiatus from athletic activity is advised, with shared decision-making for return to play.
• EBV infection is associated with an increased risk of certain cancers and autoimmune diseases.