Prospective study of the natural history of infectious mononucleosis caused by Epstein-Barr virus

J Am Board Fam Pract. Jul-Aug 2001;14(4):234-42.


Background: Knowledge regarding the clinical characteristics and natural history of acute infectious mononucleosis is based largely on older, often retrospective, studies without systematic follow-up. Differences in diagnosis, methodology, or treatment between historical and current practice might affect an understanding of this illness.

Methods: Using a prospective case series design, we enrolled 150 persons with an acute illness serologically confirmed as Epstein-Barr virus infection. The goal of the study was to assess symptoms, physical examination findings, laboratory tests, and functional status measures during the acute presentation and 1, 2, and 6 months later.

Results: Acutely, infectious mononucleosis was characterized by the symptoms of sore throat and fatigue and substantial functional impairment. Objective physical and laboratory examination findings included pharyngitis and cervical lymphadenopathy, a moderate absolute and atypical lymphocytosis, and mildly elevated transaminase levels. The traditional signs of fever and splenomegaly were relatively uncommon. By 1 month, most symptoms and signs and all laboratory tests had returned to normal. Fatigue, cervical lymphadenopathy, pharyngitis, and functional health status improved more slowly.

Conclusions: In contemporary practice most of the classical illness features of infectious mononucleosis are observed. Symptoms, signs, and poor functioning might be protracted in some patients.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Epstein-Barr Virus Infections / blood
  • Epstein-Barr Virus Infections / physiopathology*
  • Female
  • Follow-Up Studies
  • Herpesvirus 4, Human / isolation & purification*
  • Humans
  • Infectious Mononucleosis / blood
  • Infectious Mononucleosis / physiopathology*
  • Male
  • Middle Aged
  • Physical Examination
  • Prospective Studies