RISK FACTORS
β’ Age
β’ Sociohygienic level
β’ Geographic location
β’ Close, intimate contact
GENERAL MEASURES :
β’ The treatment is chiefl y supportive
β’ During acute stage, rest in bed
SURGICAL MEASURES :
β’ With profound thrombocytopenia, refractory to corticosteroid therapy, splenectomy may be necessary.
ACTIVITY :
β’ Decided on an individual basis during convalescence
β’ Excess exertion, heavy lifting and participation in contact sports are prohibited during acute illness and also
in the presence of splenomegaly. Rupture of the spleen may be fatal if not recognized and requires blood transfusions, treatment for shock, and splenectomy.
DRUG(S) OF CHOICE :
. Antimicrobial agents (usually a penicillin) if throat culture is positive for Group A, beta-hemolytic streptococci.
Avoid ampicillin because of rash that occurs with ampicillin in mononucleosis.
. Aspirin and warm saline gargles for the pain of pharyngeal involvement and enlarged lymph nodes
. Codeine or meperidine, for unrelieved pain
. Corticosteroids
. With severe pharyngotonsillitis with oropharyngeal edema and airway encroachment, a short course of corticosteroids may be utilized. Prednisone or its equivalent is used. Start with an initial dosage of 10-15 mg qid for 2 days. Decrease by 5 mg daily so that steroid treatment is discontinued in approximately 10 days.
. Considered for patients with marked toxicity or major complications (e.g., hemolytic anemia, thrombocytopenic purpura, neurologic sequelae, myocarditis, pericarditis and severe generalized dermatologic
lesions).
PATIENT MONITORING :
. Avoid contact sports, heavy lifting, and excess exertion until the spleen and liver have returned to normal size.
. Eliminate alcohol or exposure to other hepatotoxic drugs until liver function studies return to normal
. Monitor patients closely during the f rst 2-3 weeks after onset of symptoms. Thereafter follow until symptoms
subside.
. Rarely, laboratory results resolve more slowly and symptoms (malaise, fatigue, intermittent sore throat,
lymphadenopathy) may persist for several months
POSSIBLE COMPLICATIONS :
. Airway obstruction
. Hematologic or neurologic complications
. Toxemia
. Splenic rupture (rare); greatest risk is during the 2nd-3rd week of illness
. Hypersensitivity rash
. Develops 7-10 days after initiation of ampicillin (or its analogues and other penicillins like methicillin) treatment; this generalized erythematous maculopapular eruption occurs mainly over the trunk and extremities,
including palms and soles. Rash persists for a week; desquamation may continue for several days
EXPECTED COURSE/PROGNOSIS :
. IM usually mild or moderate severity . Acute symptoms 2-3 weeks with full recovery in 4-8 weeks
AGE-RELATED FACTORS :
Pediatric:
β’ Infection during infancy and childhood usually subclinical and inapparent
β’ Clinical IM more common in older children and young adults
Geriatric: Heterophile positive IM has been reported in an elderly patient 5 weeks following blood transfusion