Infectivology Xagena

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Infectious mononucleosis: systemic corticosteroid therapy

Corticosteroids are used often in the treatment of infectious mononucleosis, and for reasons beyond usual criteria.

Systemic corticosteroid therapy ( SCT ) in the treatment of infectious mononucleosis has long been controversial, with conflicting results from different studies.
The most consistently agreed on indication for SCT in the treatment of mononucleosis has been for complications involving severe airway compromise.

Scott K. Thompson, of the University of Rochester Medical Center, Rochester, and colleagues analyzed the records of patients diagnosed with infectious mononucleosis from January 1998 to March 2003. Details of each patient's symptoms at the first visit, diagnosis, treatment and outcome were analyzed.

Systemic corticosteroid therapy was used in 44.7 percent of patients ( 92 of the 206 individuals included in the analysis ), the researchers report.

Evaluation of treatment indications for systemic corticosteroid therapy showed that 8.0 percent of the study population qualified by traditional criteria for the use of corticosteroids, seven patients for "airway concern" and one patient for another indicated complication. " Factors associated with the observed increase in corticosteroid use included a history of repeat visits, inpatient admission, and otolaryngology consultation," the authors write.

"Despite consistent and uniform acceptance in the medical literature that systemic corticosteroid therapy in the setting of infectious mononucleosis should be reserved for patients with impending airway obstruction, corticosteroids continue to be used on a much broader scale at this tertiary care institution," the authors conclude. "

This observation suggests that clinicians see value in systemic corticosteroid therapy for treatment of infectious mononucleosis beyond the classically accepted reasons. Moreover, despite previous reports of possible adverse consequences of systemic corticosteroid therapy in infectious mononucleosis, review failed to demonstrate any such trend.

Source: Americam Medical Association, 2005