Scott J. Saccomano, PhD, GNP-BC, RN, Lucille R. Ferrara, EdD, RN, MBA, FNP-BC
References
MANAGEMENT OF IM The goals of therapy are to minimize complications and restore the patient to full capacity. Supportive care is the mainstay, including bed rest, fluids, and administration of NSAIDs.
Although the incidence of splenic rupture is 0.5% to 1%,5 activity should be restricted to minimize the risk. Patients are usually advised to restrict activity (especially contact sports) for at least three to four weeks. Strenuous activity should be avoided for three weeks to two months.8,32
A scaffold plan to return to full activity after week 4 should be provided to asymptomatic patients who receive adequate hydration and are unaffected by splenomegaly.32,33 If patients experience respiratory involvement related to tonsillar enlargement and tissue hypertrophy causing increased respiratory obstruction, oral corticosteroids can be used.
Corticosteroids are also appropriate for hematologic complications such as hemolytic anemia and thrombocytopenia. Other than these or respiratory complications, there is insufficient evidence for corticosteroid use as supportive treatment for IM.34 Similarly, data to support the use of antivirals, such as acyclovir, are inconclusive.35
PATIENT EDUCATION Patients should be educated about progression of the disease as well as the timing and length of expected clinical symptoms during the disease course. Patients infected with IM do not need to be isolated but should avoid exposing others to infected oropharyngeal secretions by kissing or sexual contact.5,11 Patients should avoid sharing items that may harbor the EBV, such as drinking containers or eating utensils, particularly during the febrile period.
Individuals must also be advised to curtail active physical activities, specifically strenuous or contact sports, until given clearance by their provider.8
CONCLUSION Once a patient is infected with EBV, the virus remains present for life. EBV infection is dormant in the B-lymphocytes and can occasionally become reactivated. In these cases, the patient becomes infectious, though rarely displaying symptoms of latent B-lymphocyte infection. In certain circumstances, given the right environment in susceptible contacts, the reactivated virus may produce subclinical symptoms, and the virus can be spread to others.
