Intended for healthcare professionals

Clinical Review

Infectious mononucleosis

BMJ 2015; 350 doi: (Published 21 April 2015) Cite this as: BMJ 2015;350:h1825
  1. Paul Lennon, specialist registrar1,
  2. Michael Crotty, general practitioner2,
  3. John E Fenton, professor1
  1. 1Department of Otolaryngology, Head and Neck Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland, and Graduate Entry Medical School, University of Limerick, Ireland
  2. 2General Practice, Synergy Medical Clinic, Sherwood Park, Edmonton, Alberta, Canada
  1. Correspondence to: P Lennon paullennon81{at}

The bottom line

  • Infectious mononucleosis is a clinical diagnosis, caused by Epstein-Barr virus in 90% of cases, although in some patients (pregnancy, high risk HIV population) further investigations are warranted

  • Treatment should be supportive, with steroids given only in cases of airway compromise

  • Treatment with antiviral agents has yet to be shown to be of benefit

  • Patients wanting to return to contact sports before one month should undergo abdominal ultrasonography to rule out splenomegaly

  • Splenic rupture should be considered with any abdominal pain in infectious mononucleosis

Infectious mononucleosis is commonly seen in both the community and the hospital setting. Patients usually present with a sore throat and often presume that an antibiotic is required. It is therefore important to dispel the many myths relating to the condition with appropriate patient education. Knowledge of the clinical course of the disease, as well as potential complications, is paramount. In an information age, difficult questions may arise for a general practitioner, emergency doctor, or trainee in ear, nose, and throat medicine. The aim of this review is to assist those who encounter infectious mononucleosis in the adolescent and adult population.

Sources and selection criteria

We performed an electronic search through Medline, Scopus, Google Scholar, the Cochrane Database of Systematic Reviews, and the Cochrane central register of controlled trials using the search terms “infectious mononucleosis”, “glandular fever”, “Epstein-Barr virus”, “corticosteroids”, and “aciclovir”. The search was limited to articles in English. We excluded studies carried out primarily on children. Priority was given to data from meta-analyses, reviews, and randomised controlled trials. Research on infectious mononucleosis was also given priority over articles exclusively relating to Epstein-Barr virus. We also examined guidelines produced by the US Center for Disease Control and Prevention and the UK National Institute for Health and Care Excellence, as well as clinical trials registries of the United States, United Kingdom, …

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