Full text linksAmerican Academy of Family Physicians 1 Michigan State University College of Human Medicine, East Lansing, USA. ebell@msu.edu 1 Michigan State University College of Human Medicine, East Lansing, USA. ebell@msu.edu Infectious mononucleosis should be suspected in patients 10 to 30 years of age who present with sore throat and significant fatigue, palatal petechiae, posterior cervical or auricular adenopathy, marked adenopathy, or inguinal adenopathy. An atypical lymphocytosis of at least 20 percent or atypical lymphocytosis of at least 10 percent plus lymphocytosis of at least 50 percent strongly supports the diagnosis, as does a positive heterophile antibody test. False-negative results of heterophile antibody tests are relatively common early in the course of infection. Patients with negative results may have another infection, such as toxoplasmosis, streptococcal infection, cytomegalovirus infection, or another viral infection. Symptomatic treatment, the mainstay of care, includes adequate hydration, analgesics, antipyretics, and adequate rest. Bed rest should not be enforced, and the patient\'s energy level should guide activity. Corticosteroids, acyclovir, and antihistamines are not recommended for routine treatment of infectious mononucleosis, although corticosteroids may benefit patients with respiratory compromise or severe pharyngeal edema. Patients with infectious mononucleosis should be withdrawn from contact or collision sports for at least four weeks after the onset of symptoms. Fatigue, myalgias, and need for sleep may persist for several months after the acute infection has resolved. Adolesc Med State Art Rev. 2010 Aug;21(2):251-64, ix. Adolesc Med State Art Rev. 2010. PMID: 21047028 Evci C, Akalin H, Heper Y, Yilmaz E, Bakir Ozbey S, Mistik R, Helvaci S, Goral G. Evci C, et al. Mikrobiyol Bul. 2007 Jan;41(1):95-100. Mikrobiyol Bul. 2007. PMID: 17427557 Vine LJ, Shepherd K, Hunter JG, Madden R, Thornton C, Ellis V, Bendall RP, Dalton HR. Vine LJ, et al. Aliment Pharmacol Ther. 2012 Jul;36(1):16-21. doi: 10.1111/j.1365-2036.2012.05122.x. Epub 2012 May 3. Aliment Pharmacol Ther. 2012. PMID: 22554291 Koyama K, Anno T, Urano T, Shigemoto R, Irie S, Kawasaki F, Kawanaka M, Kawamoto H, Kaneto H, Tomoda K. Koyama K, et al. J Med Case Rep. 2021 May 3;15(1):257. doi: 10.1186/s13256-021-02817-2. J Med Case Rep. 2021. PMID: 33941264 Free PMC article. Wu Y, et al. J Int Med Res. 2020 Oct;48(10):300060520924550. doi: 10.1177/0300060520924550. J Int Med Res. 2020. PMID: 33045888 Free PMC article. Jabłońska A, Studzińska M, Szenborn L, Wiśniewska-Ligier M, Karlikowska-Skwarnik M, Gęsicki T, Paradowska E. Jabłońska A, et al. Sci Rep. 2020 Aug 4;10(1):13154. doi: 10.1038/s41598-020-70129-4. Sci Rep. 2020. PMID: 32753695 Free PMC article. Clinical Trial. Byrne A, et al. Medicines (Basel). 2020 Apr 22;7(4):21. doi: 10.3390/medicines7040021. Medicines (Basel). 2020. PMID: 32331303 Free PMC article. Tinoco Racero I, Caro Gómez N, Rodríguez Leal C, López Tinoco E. Tinoco Racero I, et al. Medicine (Madr). 2014 Mar;11(50):2954-2964. doi: 10.1016/S0304-5412(14)70722-X. Epub 2014 Mar 21. Medicine (Madr). 2014. PMID: 32287897 Free PMC article.