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Infectious mononucleosis should be suspected in patients 10 to 30 years of age who present with sore throat and significant fatigue, palatal petechiae, posterior cervical or auricular adenopathy, marked adenopathy, or inguinal adenopathy. An atypical lymphocytosis of at least 20 percent or atypical lymphocytosis of at least 10 percent plus lymphocytosis of at least 50 percent strongly supports the diagnosis, as does a positive heterophile antibody test. False-negative results of heterophile antibody tests are relatively common early in the course of infection. Patients with negative results may have another infection, such as toxoplasmosis, streptococcal infection, cytomegalovirus infection, or another viral infection. Symptomatic treatment, the mainstay of care, includes adequate hydration, analgesics, antipyretics, and adequate rest. Bed rest should not be enforced, and the patient's energy level should guide activity. Corticosteroids, acyclovir, and antihistamines are not recommended for routine treatment of infectious mononucleosis, although corticosteroids may benefit patients with respiratory compromise or severe pharyngeal edema. Patients with infectious mononucleosis should be withdrawn from contact or collision sports for at least four weeks after the onset of symptoms. Fatigue, myalgias, and need for sleep may persist for several months after the acute infection has resolved. (Am Fam Physician 2004;70:1279-87,1289-90. Copyright© 2004 American Academy of Family Physicians.)
Infectious mononucleosis is a clinical syndrome caused by Epstein-Barr virus (EBV) that is particularly common in adolescents and children. Typical features of infectious mononucleosis include fever, pharyngitis, adenopathy, malaise, and an atypical lymphocytosis. Splenomegaly, hepatomegaly, jaundice, and splenic rupture can occur in patients with infectious mononucleosis, but these complications are rare.1
Data collected more than 30 years ago on the incidence of infectious mononucleosis show the highest rates in persons 10 to 19 years of age (six to eight cases per 1,000 persons per year).2,3 The incidence in persons younger than 10 years and older than 30 years is less than one case per 1,000 persons per year,2,3 but mild infections in younger children often may be undiagnosed. The infection is most common in populations with many young adults, such as active-duty military personnel and college students, in whom the annual incidence for infectious mononucleosis ranges from 11 to 48 cases per 1,000 persons.4,5
Infectious mononucleosis is relatively uncommon in adults, accounting for less than 2 percent of all...