Infectious Mononucleosis

Infectious mononucleosis (IM) is a common clinical syndrome caused by the Epstein-Barr Virus (EBV). IM is seen in ages 5–25 years, most commonly among those aged 16–20 years (Becker and Smith, Sports Health 6:232–238, 2014). It is estimated almost the entire population (90%) will be infected with EBV, although many are not aware of having been infected due to the variable presentation of symptoms it can cause (Becker and Smith, Sports Health 6:232–238, 2014). Patients commonly present with sore throat, fever, and fatigue. Posterior cervical lymphadenopathy, palatal petechiae, tonsillar hypertrophy, rash, and tonsillar exudate are common physical exam findings. Splenomegaly is present in a majority of patients (Putukian et al., Clin J Sport Med 18:309–315, 2008), but is often not detected on physical exam. Splenic rupture is rare but given the associated morbidity of the complication, sports restrictions are recommended for student athletes with IM. Timing of return to play after IM remains controversial, but students will require at least 3–4 weeks of restriction from sports.