Infectious mononucleosis in the athlete. Diagnosis, complications, and management

Although almost always a benign, self-limiting disease, infectious mononucleosis accounts for considerable symptomatic illness in the young athlete and can, on occasion, be truly life-threatening. Recognition of the syndrome "glandular fever," vis-a-vis infectious mononucleosis--fever, pharyngitis, lymphadenopathy, and splenomegaly, with characteristic changes in the peripheral blood leukocytes--dates back over a half a century. However, seroepidemiologic studies have only recently established its viral causation and epidemiology. This acute infection by the Epstein-Barr virus is unique pathophysiologically--an acute, self-limiting, lymphoproliferative disorder with autoimmune features--and may well be the cause or one of the causes of several malignant neoplasms, Burkitt's lymphoma, and nasopharyngeal carcinoma. This review (1) describes infectious mononucleosis, pathophysiologically, clinically, and epidemiologically; and outlines its most frequent and serious complications; (2) discusses how to reliably diagnose infectious mononucleosis and evaluate the heterophile-negative case; and (3) addresses management, especially the thorny issues of the use of corticosteroids and restriction from athletic training and participation.