Management Options for Infectious Mononucleosis
Management Options for Infectious Mononucleosis
For the majority of patients, IM runs a self-limiting course and recovery occurs without sequelae, although complications can occur. Hematologic complications are the most common, occurring in 25% to 50% of all cases of IM. These complications may include hemolytic anemia, thrombocytopenia, thrombotic thrombocytopenic purpura, and disseminated intravascular coagulation. These complications are generally characterized as mild due to the slight dip in laboratory values, which typically return to normal within a month, whereas severe complications, such as aplastic anemia requiring bone marrow transplantation, are rare. Neurologic complications occur in 1% to 5% of cases and can include Guillain-Barré syndrome, facial-nerve palsy, meningoencephalitis, aseptic meningitis, transverse myelitis, peripheral neuritis, cerebellitis, and optic neuritis. Other rare, but potentially life-threatening complications include upper airway obstruction and X-linked lymphoproliferative disease (XLP). Males with XLP syndrome have an inability to mount an immune response to EBV because of an X-chromosome mutation, which results in very severe or fatal IM. This disorder can be diagnosed prenatally, and early bone marrow transplantation is an option to correct the disease.
Persistent fatigue lasting for 6 months or longer with functional impairment can also occur. Female gender and greater fatigue severity at symptom onset demonstrate a higher risk of developing chronic fatigue syndrome (CFS).
Complications
For the majority of patients, IM runs a self-limiting course and recovery occurs without sequelae, although complications can occur. Hematologic complications are the most common, occurring in 25% to 50% of all cases of IM. These complications may include hemolytic anemia, thrombocytopenia, thrombotic thrombocytopenic purpura, and disseminated intravascular coagulation. These complications are generally characterized as mild due to the slight dip in laboratory values, which typically return to normal within a month, whereas severe complications, such as aplastic anemia requiring bone marrow transplantation, are rare. Neurologic complications occur in 1% to 5% of cases and can include Guillain-Barré syndrome, facial-nerve palsy, meningoencephalitis, aseptic meningitis, transverse myelitis, peripheral neuritis, cerebellitis, and optic neuritis. Other rare, but potentially life-threatening complications include upper airway obstruction and X-linked lymphoproliferative disease (XLP). Males with XLP syndrome have an inability to mount an immune response to EBV because of an X-chromosome mutation, which results in very severe or fatal IM. This disorder can be diagnosed prenatally, and early bone marrow transplantation is an option to correct the disease.
Persistent fatigue lasting for 6 months or longer with functional impairment can also occur. Female gender and greater fatigue severity at symptom onset demonstrate a higher risk of developing chronic fatigue syndrome (CFS).
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