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Last Updated: 5/30/2014  

Infectious Mononucleosis

Diagnosis
  • Ask about fatigue, sore throat, fever, abdominal discomfort, lymphadenopathy in neck, and headache or stiff neck.

  • Look for fever, pharyngitis, tonsillar swelling and exudate, bilateral cervical lymphadenopathy, splenomegaly, and hepatic tenderness.

  • Look for acute primary EBV infection presenting in atypical ways in patients older than 40 years, such as hepatitis and prolonged fever.

  • Obtain a CBC with differential and look for atypical lymphocytes.

  • Obtain a monospot test.

  • Obtain EBV serologic tests if the monospot test result is negative or if the diagnosis is uncertain.

Therapy
  • Maintain hydration orally or parenterally in those who are unable to drink.

  • Use corticosteroids if there is airway obstruction, especially in pediatric patients.

  • Do not routinely prescribe antiviral drugs for treatment of infectious mononucleosis.

DOI: 10.7326/d924
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Authors and Disclosures:
Joseph S. Pagano, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Alyssa Harrison, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. A. Martin Lerner, MD, FACP patent owner CFS LLC, regarding diagnosis and treatment of chronic fatigue syndrome.

The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, FACP, Editor.

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