Major Research Findings

Infectious mononucleosis (IM), also known as glandular fever or the kissing disease, is a viral infection caused by the Epstein-Barr virus (EBV). 3 Most cases of IM occur in older teenagers or young adults. 3 Typically, IM is a mild and self-limiting illness, resolving within a few weeks. 9 However, in some cases, IM can become severe and prolonged, leading to complications and decreased productivity. 3

The use of immunosuppressive agents in inflammatory bowel disease has been the subject of controversy. 17 However, extensive clinical data have conclusively proved their efficacy with respect to potential toxicity. 17 Azathioprine is one of the most widely used immunosuppressive agents in the treatment of Crohn's disease. 17 Patients with Crohn's disease under azathioprine treatment are at risk of developing severe IM. 8 A 24-year-old male treated with azathioprine for corticosteroid-dependent Crohn's disease died due to massive upper gastrointestinal bleeding secondary to infectious mononucleosis. 17

Tinidazole, an antibiotic, was found to shorten the duration of sore throat and pharyngotonsillitis in patients with IM. 1 The effect was believed to be mediated through its activity against anaerobic bacteria. 1

Acyclovir (ACV), an antiviral drug, showed a significant reduction in the rate of oropharyngeal EBV shedding at the end of therapy in patients with IM. 18 However, this effect was not observed three weeks later. 18 Overall, clinical data do not support the use of ACV for the treatment of IM. 18

Dexamethasone, a steroid, was found to be effective in relieving pain in patients with acute exudative pharyngitis associated with IM. 12 However, there is no consensus on whether steroids should be used routinely for symptom control in IM.

Famciclovir, an antiviral drug, has shown potential therapeutic benefit for severe cases of IM. 14

Antibiotics, particularly ampicillin, have been associated with a high incidence of rash in patients with IM. 5

Conservative management, including observation and restricted physical activity, is an option for patients with spontaneous splenic rupture due to IM. 13

Treatment Summary

Treatment for IM typically involves supportive care and symptom management. 3 Steroids may be used to alleviate symptoms, but there is no clear evidence to support their routine use. In severe cases, famciclovir may be beneficial. 14

Benefits and Risks

Benefit Summary

Supportive care and symptom management are effective in treating IM. 3 Steroids can help alleviate symptoms. 2

Risk Summary

Antibiotics, especially ampicillin, can lead to rash in IM patients. 5

Comparison Across Studies

Commonalities

Most studies agree that IM is usually a mild and self-limiting illness that resolves within a few weeks. 3 9

Differences

There is no consensus on the effectiveness of antiviral drugs like acyclovir for treating IM. 18 The use of steroids for symptom management is also debated.

Consistency and Contradictions of Results

The results of studies on the treatment of IM are not entirely consistent. 14

Implications for Real-Life Application

Most cases of IM are mild and resolve on their own. 3 9 However, it's important to consult a doctor if symptoms persist or worsen. 17 8

Limitations of Current Research

More research is needed to determine the most effective treatments for IM. 14

Future Research Directions

Further research is required to develop more effective treatments for IM. 14

Conclusion

IM is generally a mild illness that resolves on its own. 3 9 If you experience symptoms, consult a doctor. 17 8

Treatment List

Supportive care, symptom management, steroids, famciclovir, tinidazole.