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Approximately 95% of adults worldwide are infected with Epstein-Barr virus (EBV). The infection is often asymptomatic, but some develop the clinical syndrome of infectious mononucleosis (IM). This article reviews common questions about patients with this syndrome.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | References |
|---|---|---|
| IM should be suspected in patients presenting with sore throat, fever, fatigue, tonsillar enlargement, lymphadenopathy (posterior cervical, axillary, or inguinal), pharyngeal inflammation, and palatal petechiae, especially in those between 15 and 24 years of age. | C | 6, 8, 10, 12 |
| Heterophile antibody testing is the best initial test for diagnosis of Epstein-Barr virus infection because it is fast, inexpensive, and has high specificity. | C | 12, 17, 19, 23 |
| Glucocorticoids and antiviral medications do not meaningfully affect the duration or clinical course of IM. | A | 24-27 |
| Athletic participation should be restricted for the first three weeks of illness in patients with IM to decrease the risk of splenic rupture. | C | 28 |
IM = infectious mononucleosis.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
Who Is Most Likely to Present with IM, and How Often Does It Occur?
The incidence is highest between 15 and 24 years of age. The annual incidence in the general population is approximately five cases per 1,000 persons; however, in a practice with a large young adult population, the incidence can approach nine to 48 cases per 1,000 persons annually.
EVIDENCE SUMMARY
More than 90% of adults worldwide are seropositive for EBV antibodies by 35 years of age. IM most commonly affects those who acquire primary EBV in their teenage years. There is no gender predisposition, yearly cycle, or seasonal variation in the incidence of the syndrome.1
Annually, 10% to 20% of EBV-naive persons become infected, and 30% to 50% develop IM. Those 15 to 24 years of age have the highest annual incidence at 0.5%.1 In young adults, the rate of developing IM from primary EBV infection is estimated at 50%, with a range between 26% and 74%.2-4
Studies have demonstrated an annual incidence of 0.9% to 4.8% in...