They ought to be afebrile and well hydrated. Keeping in mind that the highest risk for splenic injury is during the first 21 days of illness, it has not been shown that early return to light activity causes deleterious effects. The return to activities that place the spleen at risk for injury is a confounding matter. At this time, recommendations vary, and there is a lack of evidence-based protocols. Most recommendations support that the athlete with IM should rest for 3 weeks and then begin resumption of light activity.
Ultrasonography may play a role in return-to-play decisions, but the variability in baseline spleen size can limit its utility. Any return to competition must include a detailed explanation of the risk of splenic injury, since full recovery may take months Figure 2.
Return-to-play recommendations for infectious mononucleosis IM. Level of evidence, 4. There have been some novel attempts made to protect the spleen from contact for collision sports with a flak jacket 22 or a customized protective brace for a college basketball season. Counseling the athlete with IM remains a challenge.
The disease has a long latency period, the onset of illness may be difficult to identify, and the disease course is variable. There is no specific physical examination finding, laboratory test, or imaging modality that provides a definitive answer. To minimize complications of IM, return-to-play decisions must be individualized. The authors report no potential conflicts of interest in the development and publication of this manuscript.
National Center for Biotechnology Information , U. Journal List Sports Health v. Sports Health. Jonathan A. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC.
Abstract Context: Infectious mononucleosis is a disease primarily of adolescence and early adulthood. Evidence Acquisition: Data were obtained from the PubMed and MEDLINE databases through December by searching for epidemiology, diagnosis, clinical manifestations, management, and the role of the spleen in infectious mononucleosis. Study Design: Clinical review.
Level of Evidence: Level 4. Results: Infectious mononucleosis is commonly encountered in young athletes. Conclusion: Return-to-play decisions for the athlete with infectious mononucleosis need to be individualized because of the variable disease course and lack of evidence-based guidelines.
Keywords: mononucleosis, spleen imaging, splenomegaly, chronic fatigue. Epidemiology Infectious mononucleosis is a self-limiting clinical syndrome typically caused by the Epstein-Barr virus EBV. Pathogenesis Epstein-Barr virus, like other members of the herpes virus group, persists within the host in its latent form.
Clinical Manifestations The history and physical examination are pertinent for making the correct diagnosis. Open in a separate window. Figure 1. Diagnosis The diagnosis of IM can be made through history and physical examination as well as atypical laboratory findings Table 1. Management and Prevention There is no specific treatment for IM. Return-to-Play Considerations There is general consensus that the athlete must be asymptomatic with resolution of symptoms such as fever, fatigue, and pharyngitis before they initiate any return to activity.
Figure 2. Conclusion Counseling the athlete with IM remains a challenge. Footnotes The authors report no potential conflicts of interest in the development and publication of this manuscript. References 1. Auwaerter PG. Infectious mononucleosis: return to play. Clin Sports Med. Evaluation of 12 commercial tests for detection of Epstein-Barr virus-specific and heterophile antibodies. Clin Diagn Lab Immunol. Predictors of fatigue following the onset of infectious mononucleosis. Psychol Med.
Candy B, Hotopf M. The so-called kissing disease, infectious mononucleosis, or mono, can cause an enlarged spleen. It spreads by saliva exchange, which may happen through kissing, sneezing or coughing, and sharing a glass, eating utensils, or even toothbrushes.
The incubation period for mono is weeks. Epstein-Barr virus EBV is the name for human herpesvirus 4. Found globally, EBV is one of the most common human viruses. Nine out of 10 people have been or will become infected with Epstein-Barr during their lifetime.
EBV is one of the most common viruses because it spreads by exchanging bodily fluids. A monospot is a rapid test for EBV infectious mononucleosis. The test checks if you have an Epstein-Barr viral infection, which is the cause of your mononucleosis.
This blood test detects heterophile antibodies, which form in response to antigens toxins or foreign substances. External antigens, such as a virus or bacterial infection, initiate the development of heterophile antibodies.
Some other diseases and infections can also cause mono. These include cytomegalovirus, another type of herpes virus; toxoplasmosis, a parasitic infection; HIV; rubella, and hepatitis A, B, or C. Teens and young adults are likely to show all the symptoms of mono. Within a few weeks, the fever and sore throat will improve. While hepatic involvement to some degree is seen in the majority of patients, clinical manifestations of cholestatic hepatitis is considered rare. Only a few cases in the literature have been reported of cholestatic hepatitis secondary to EBV infection.
The mechanism is not well understood but thought to be associated with a mildly swollen bile duct. It can present with dark urine, scleral icterus, transaminitis, jaundice, and abdominal pain, to name a few.
This potential complication and the potential complications listed above should be considered in any patient presenting to the ED with a history of a pharyngitis, fever, and lymphadenopathy. Gregory M. He also serves as a physician in the United States Air Force.
Adam M. Vieder, D. Teaching Hospital of Michigan State University. Mononucleosis is spread through saliva. If you're infected, you can help prevent spreading the virus to others by not kissing them and by not sharing food, dishes, glasses and utensils until several days after your fever has improved — and even longer, if possible. And remember to wash your hands regularly to prevent spread of the virus.
The Epstein-Barr virus may persist in your saliva for months after the infection. No vaccine exists to prevent mononucleosis. Mayo Clinic does not endorse companies or products.
Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Infectious mononucleosis mono is often called the kissing disease. Request an Appointment at Mayo Clinic. Enlarged spleen Open pop-up dialog box Close. Enlarged spleen The spleen is a small organ usually about the size of your fist.
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