Infectious mononucleosis (quick hits)

2 Apr

possible symptoms

  • fever
  • tonsillar pharyngitis
  • lymphadenopathy
  • fatigue
  • generalized maculopapular, urticarial, or petechial rash


peak incidence in the 15 to 24-year age range.

incubation period prior to the development of symptoms averages four to eight weeks. 

Fatigue may be persistent and severe.


Splenomegaly is seen in 50 to 60 percent of patients with IM and usually begins to recede by the third week of the illness.

Splenic rupture is a rare but potentially life-threatening complication of IM, estimated to occur in one to two cases per thousand.

Neurologic syndromes include Guillain-Barré syndrome, facial and other cranial nerve palsies, meningoencephalitis, aseptic meningitis, transverse myelitis, peripheral neuritis, optic neuritis, and encephalomyelitis.  These manifestations tend to occur two to four weeks or more after initial symptom onset.


The most common laboratory finding:

  • lymphocytosis, absolute count >4500/microL or, on peripheral smear, a differential count >50 percent.
  • Elevated aminotransferases are seen in the vast majority of patients.



  • supportive care.
  • Tylenol or nonsteroidal antiinflammatory drugs 
  • The use of corticosteroids has been controversial.
    • In a multicenter, placebo-controlled study of 94 patients with acute IM…
    • the combination of acyclovir and prednisone reduced oropharyngeal shedding of the virus
    • did not affect the duration of symptoms or lead to an earlier return to school or work.
    • A trial of corticosteroids is warranted in individuals with impending airway obstruction.


Submitted by H. Reed-Day.


References: Infectious mononucleosis in adults and adolescents; picture


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