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Mononucleosis: Patients
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Mononucleosis will generally run its course within two to four weeks, although the feeling of tiredness can linger much longer (three to four months). Patients are advised to return to normal activities slowly as they begin to regain their full strength. There is... one major caveat. Any mono patient who has shown evidence of enlargement of the spleen should avoid strenuous activity—including contact sports—until cleared by a physician to return to such activity.
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Mononucleosis can cause the spleen to swell. Rupture may occur without trauma, but impact to the spleen is ... a factor. Other complications include hepatitis (inflammation of the liver) causing elevation of serum bilirubin (in approximately 40% of patients), jaundice (approximately 5% of cases), and anemia (a deficiency of red blood cells). In rare cases, death may result from severe hepatitis or splenic rupture.
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There is usually very little treatment for mononucleosis except bed rest, watchful intake of fluids, and antibiotics when strep throat in present. Anti-viral medications have shown little benefit in patients with mononucleosis. Severe swelling of the spleen or liver may require the use of oral steroids like prednisone, and those with swelling of the organs may need to be more closely monitored so that permanent damage to the spleen or liver does not occur.
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Leukocytosis with a WBC count of 10,000-20,000 cells/mL (10-20 X 109/L) is found in 40-70% of patients with acute infectious mononucleosis. By the second week of illness, approximately 10% of patients have a WBC count greater than 25,000 cells/mL.
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Reports of splenomegaly (enlarged spleen) in infectious mononucleosis suggest variable prevalence rates of 25% to 75%. Among pediatric patients, a splenomegaly rate of 50% is expected,[1] with a rate of 60% reported in one case series.[2] Although splenic rupture is a rare complication of infectious mononucleosis, it is the basis of advice to avoid contact sports for 4-6 weeks after diagnosis.
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Few well-designed studies have been conducted to determine the value of clinical examination in patients with infectious mononucleosis in the primary care setting. The best study is a series including more than 700 patients 16 years of age and older with sore throat, 15 of whom were found to have infectious mononucleosis on the basis of a positive heterophile antibody test.
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