Evidence-Based Medicine for Student Health Services Robert J. Flaherty, MD Swingle Student Health Service Montana State University Bozeman, MT 59717  

Infectious Mononucleosis 
  

Etiology	Monitoring
Epidemiology	Prognosis
Diagnosis	Prevention
Treatment	Patient Education

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Etiology   No evidence is cited.       Epidemiology   No evidence is cited.       Diagnosis   Clinical Diagnosis  No evidence is cited.       Laboratory/X-ray Diagnosis  Monolatex, Mono-Latex, Mono-Lex, Mono-Plus and Clearview IM can be recommended for the confirmation of EB-virus-associated infectious mononucleosis. Clearview IM combined a high sensitivity and specificity with very simple one-step solid-phase-based procedure. IM-Check had a low sensitivity and was difficult to read. Compared with the reference methods, the sensitivities and specificities of these heterophile antibody test kits were 70-92% and 96-100%, respectively.  Caveats Age group studied: Unknown Type/size: Open study of 100 serum samples Population characteristics: 53 samples from patients with serologically verified primary EB virus infection and 47 from EB-virus-immune or -susceptible patients Outcome measures: Test specificity and sensitivity Citations Elgh F, Linderholm M, Evaluation of six commercially available kits using purified heterophile antigen for the rapid diagnosis of infectious mononucleosis compared with Epstein-Barr virus-specific serology, Clin Diagn Virol 1996 Oct;7(1):17-21 - From PubMed       Treatment        Ten days of combined acyclovir-prednisone therapy is of little value for the treatment of acute infectious mononucleosis.   Caveats Age group studied: 18-30y Type/size: RCT (86 patients) Population characteristics: serologically confirmed acute infectious mononucleosis and primary Epstein­Barr virus (EBV) infection, within 7 days of the onset of symptoms Outcome measures: Oropharyngeal EBV shedding, duration of general illness, sore throat, time lost from school or work, time to regain lost weight Citations Acyclovir­steroid therapy for infectious mononucleosis - Reviewed by the CMA-CPG Database   Similarly: van der Horst C et al, Lack of effect of peroral acyclovir for the treatment of acute infectious mononucleosis, J Infect Dis 1991 Oct;164(4):788-792  - From PubMed   The course of infectious mononucleosis is not improved by ranitidine treatment for 2 weeks.  Caveats Age group studied: Unknown Type/size: RCT (117 patients) Population characteristics: Unknown Outcome measures: Severity and duration of fever, scores of cervical lymph node size and tonsil size, eating problems, fatigue, influence on general condition, the use of analgesics, blood analyses Citations Vendelbo Johansen L et al, Infectious mononucleosis treated by an antihistamine: a comparison of the efficacy of ranitidine (Zantac) vs placebo in the treatment of infectious mononucleosis, Clin Otolaryngol 1997 Apr;22(2):123-125  - From PubMed  Similarly: Knockaert DC et al,  Cimetidine is not more effective than placebo in acute infectious mononucleosis, Acta Clin Belg 1993;48(3):213-214 - From PubMed      Monitoring  No evidence is cited.     Prognosis    No evidence is cited.        Prevention   No evidence is cited.       Patient Education  The following patient education materials are consistent with the available evidence.  Getting Through Mononucleosis - From AAFP Mono - From MSU Student Health Service Infectious Mononucleosis - From NIAID Rev. 7/8/99

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