Infectious Mononucleosis and Corticosteroids

Abstract

Although many studies have examined the effects of systemic corticosteroid therapy (SCT) on the clinical course of infectious mononucleosis (IM), few have evaluated the influence of these studies on treatment patterns and outcomes. The purpose of this study was to review current therapeutic strategies and outcomes in uncomplicated and complicated IM. Design: Retrospective case series. Setting: Tertiary care center. Patients: We identified 206 immunocompetent patients with IM diagnosed during the previous 5 years. Patient information, including age, sex, history and physical findings at presentation, pertinent laboratory data, management practices, and treatment outcomes, were analyzed. Interventions: Systemic corticosteroid therapy was used in 44.7% of patients. Evaluation of treatment indications for SCT revealed that 8.0% of the study population qualified by traditional criteria for the use of corticosteroids; 92.0% of patients received SCT for other indications. Factors associated with the observed increase in corticosteroid use included a history of repeat visits, inpatient admission, and otolaryngology consultation. Main Outcome Measures: Diagnosis was made on the basis of a positive heterophil antibody test (monospot test) with appropriate clinical findings (97.5% of patients) or by the presence of lymphocytosis with appropriate clinical findings (2.4% of patients). Results: Systemic corticosteroid therapy was not positively associated with fever, decreased oral intake, tonsillar hypertrophy, or duration of symptoms. No significant differences in incidence of disease complications, rates of hospital admission, or length of hospital stay were noted between the steroid and nonsteroid treatment groups. Conclusions: Despite consistent and uniform acceptance in the medical literature that SCT in the setting of IM should be reserved for patients with impending airway obstruction, corticosteroids continue to be used on a much broader scale at this tertiary care institution. This observation suggests that clinicians see value in SCT for treatment of IM beyond the classically accepted reasons. Moreover, despite previous reports of possible adverse consequences of SCT in IM, our review failed to demonstrate any such trend.

Epstein–Barr virus infection as a cause of cervical lymphadenopathy in children

“…All cases included in this study had cervical lymphadenopathy; the posterior group was typically enlarged bilaterally in all cases associated with enlarged other neck nodes in 58.3% of cases and generalized lymphadenopathy in 41.6%. Thompson et al [15] described that the most common physical finding of IM patients was cervical lymphadenopathy as they detected it in 78.8% of their patients, Macsween et al [13] observed cervical lymphadenopathy in 88% while Grotto et al [12] observed it in 88.9% of their IM patients. Chan et al [11] described lymphadenopathy in 91% of their pediatric patients, while Krabbe et al [21] found lymphadenopathy in all children that proved to have IM.…”

“…Rapid (monospot) tests for these heterophile antibodies are used to screen patients for infectious mononucleosis [14,15]. Heterophile antibody tests are negative in 25% of patients during the first week of infection and in 5-10% during or after the second week; once antibodies are present, they may persist for a year or more.…”

“…Antivirals and corticosteroids were not used as their effectiveness in disease eradication is not yet proved [6,15]. Patients may excrete high levels of EBV in their saliva, so advice was given to avoid transmission of infection to patient's friends and family members.…”

Progress and Problems in Understanding and Managing Primary Epstein-Barr Virus Infections

“…A review of the medical records of Rochester Medical Center, Rochester, NY, found that nearly 45% of patients with infectious mononucleosis received systemic corticosteroids (200). Hence, the use of corticosteroids in infectious mononucleosis is a relatively common practice.…”

Adenitis abscesificada bilateral como complicación de una mononucleosis infecciosa

“…Otras indicaciones bien establecidas serían la anemia hemolítica o la trombopenia severas (5). Estudios recientes, sin embargo, demuestran que el uso de los corticosteroides en la práctica clí-nica es mucho más frecuente de lo esperado, no limitándose a las indicaciones antes comentadas y sin que por ello se objetive un aumento de las complicaciones (6). Probablemente, en este uso más liberal subyace la apreciación de un dramático alivio de los síntomas en los pacientes con MI que han recibido corticosteroides (7).…”