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Infectious mononucleosis in the athlete

Diagnosis, Complications, and Management

Infectious Disease Section and the Center for Trauma and Life Support, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin

Richard M. Reich, MD

Infectious Disease Section and the Center for Trauma and Life Support, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin

Although almost always a benign, self-limiting disease, infectious mononucleosis accounts for considerable symptomatic illness in the young athlete and can, on occasion, be truly life-threatening. Recognition of the syndrome "glandular fever," vis-a-vis infectious mononucleosis—fever, pharyngitis, lymphadenopa thy, and splenomegaly, with characteristic changes in the peripheral blood leukocytes—dates back over a half a century. However, seroepidemiologic studies have only recently established its viral causation and epidemiology. This acute infection by the Epstein-Barr virus is unique pathophysiologically—an acute, self- limiting, lymphoproliferative disorder with autoimmune features—and may well be the cause or one of the causes of several malignant neoplasms, Burkitt's lym phoma, and nasopharyngeal carcinoma.

This review (1) describes infectious mononucleosis, pathophysiologically, clinically, and epidemiologically; and outlines its most frequent and serious complica tions ; (2) discusses how to reliably diagnose infectious mononucleosis and evaluate the heterophile-negative case; and (3) addresses management, especially the thorny issues of the use of corticosteroids and restric tion from athletic training and participation.

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