Mononucleosis and Athletic Participation: An Evidence-Based Subject Review

Abstract

Infectious mononucleosis (IM) is a common medical condition that afflicts thousands of young athletes each year. Despite the self-limited nature of this disorder, the variability of the clinical presentation and the rare risk of splenic rupture routinely present sports medicine clinicians with difficult return-to-play decisions. Currently there are no evidence-based guidelines regarding the management of the athlete with IM. This review discusses the available research data pertaining to the management of IM in young athletes and develops questions for future clinical research.

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

“…Bed rest is unnecessary, but contact sports are contraindicated (10,46,127,163). Patients generally adjust daily activities to the level of their exercise tolerance.…”

“…There is no consensus. A recent evidence-based review suggested that they may return as early as 3 weeks after the onset of illness provided that they are afebrile, have no remaining clinical symptoms, and have normal energy (163).…”

Gastrointestinal considerations related to youth sports and the young athlete

“…This calls into question the reliability of such examination, especially when the risk of splenic rupture, albeit rare, is on the table (31)(32)(33)(34). Because of this the benefits of imaging, such as ultrasound (US) or computed tomography (CT) are seen and allow for the best counseling of your young athlete.…”

“…The question then becomes, "who do I image?" Knowing the pitfalls of physical examination, any athlete you are caring for who has an illness or medical process that causes splenomegaly should be imaged if your index of suspicion is high as even light, noncontact, activities should be avoided initially (32). Imaging is not required for limiting participation, especially in IM as participation should be limited after the diagnosis is made.…”

“…Knowing the likely progression of splenomegaly or at least when the greatest risk for complication arises will allow for the best possible counseling of your patients. Splenic rupture is exceedingly rare, occurring between 0.1% and 0.2% of cases accounting for both traumatic and nontraumatic mechanisms (32). When it does occur, splenic rupture typically does so in the first 4 weeks of illness (33,34).…”