Management of Infectious Mononucleosis

Diagnostic Approach

The Infectious Diseases Society of America recommends that heterophile antibody test (Monospot) is the most widely used initial test, becoming positive between the sixth and tenth day after symptom onset 3, 2
Presence of VCA IgM (with or without VCA IgG) antibodies without EBNA antibodies indicates recent primary infection, according to the Centers for Disease Control and Prevention 4, 2
False-negative heterophile results are common early in infection and in children under 10 years, as stated by the American Academy of Pediatrics 3, 2

The American College of Physicians recommends that supportive care is the mainstay of treatment, including antipyretics for fever 1, 5
The American Academy of Family Physicians suggests that aciclovir does not improve outcomes in otherwise healthy individuals 1

The Infectious Diseases Society of America states that corticosteroids are not recommended for routine treatment but may be indicated for severe neurologic, hematologic, or cardiac complications 1
The American Society of Clinical Oncology notes that antiviral agents, such as ganciclovir or foscarnet, may be considered in severe primary EBV infection in immunocompromised patients, despite limited supporting evidence 4, 2

The American Gastroenterological Association recommends that immunomodulator therapy should be reduced or discontinued if possible in patients with primary EBV infection 4, 2
The National Institute of Allergy and Infectious Diseases states that patients on immunosuppressive therapy have increased risk of lymphoproliferative disorders 1, 4
The Centers for Disease Control and Prevention suggests that discontinuation of immunosuppressive therapy may result in spontaneous regression of EBV-associated lymphoproliferative disease 4

The American Academy of Pediatrics advises that false-negative heterophile antibody tests are common early in the course of infection 3, 2
The American College of Emergency Physicians notes that symptoms of EBV infection in immunocompromised patients may be minimal, particularly in those receiving corticosteroids 5