A Brief Recap of Infectious Mononucleosis in Athletes
A) Weekly ultrasound until the spleen is less than 7 cm
B) 3 weeks from the onset of symptoms
C) Until the spleen is no longer palpable
D) 6 weeks from the onset of symptoms
Figure 1. Illustration of mononucleosis symptoms (courtesy of everydayhealth.com)
Answer is B, 3 weeks from symptom onset. This is controversial. The incidence of splenic rupture is 01%-0.5% in the general population and poorly understood in the athletic population. The majority of cases of splenic rupture occur within the first 31 days, although they can occur as late as 7 weeks (Sylvester, 2019). Physicians should consider allowing athletes to begin light, non-contact activity around 3 weeks with the goal of returning to full contact somewhere between 31 days and 6 weeks (Putukian 2008). There is no evidence supporting use of sonographic size of the spleen or palpation of the spleen to guide return to play.