Approach
IM is generally a self-limiting condition with no specific treatment. The mainstay of therapy is supportive care.
Supportive care includes good hydration, antipyretics, and analgesics, such as paracetamol and non-steroidal anti-inflammatory drugs. Aspirin should not be given to children because of the possibility of Reye's syndrome.
Rest remains a frequent recommendation, but its true usefulness in the treatment of IM is unknown. It is also recommended that the patient refrains from strenuous physical activity and contact sports in the initial 3 to 4 weeks (up to 8 weeks in some patients) of illness due to the potential for splenic rupture.
Severe disease
Admit patients with severe systemic symptoms of IM and its complications to hospital. Monitor patients for the development of possible complications such as airway obstruction, haemolytic anaemia, and thrombocytopaenia.
Systemic corticosteroids should be reserved for patients with severe airway obstruction, severe thrombocytopaenia (<20,000 platelets/mm³), or haemolytic anaemia.[55] These short-term complications rarely occur but warrant prompt management.
Severe airway obstruction, occurring in 1% to 5% of patients, is caused by enlargement of tonsils and lymph nodes in the oropharynx.[56] Systemic corticosteroids may improve symptoms of obstruction but intubation, tracheotomy, or tonsillectomy may be required in extreme cases.
Severe thrombocytopaenia occurs in less than 1% of cases, although mild thrombocytopaenia is more common. In most patients, it resolves in 4 to 6 weeks and is probably the result of destruction of platelets in the enlarged spleen, or by anti-platelet antibodies. There is no clear relationship between the clinical severity of IM and the platelet count.[57] Systemic corticosteroids could be useful and in immune thrombocytopaenia, intravenous immune globulin (IVIG) has been successful.
Haemolytic anaemia occurs in 1% to 3% of cases, and is likely a result of production of antibodies against red blood cells. It usually occurs during the second and third week of disease and resolves in about 2 weeks.[56] Systemic corticosteroids can hasten resolution.
While corticosteroids are generally reserved for severe complications, some practitioners treat patients with IM with corticosteroids for symptom relief. In one study, corticosteroid treatment provided relief from sore throat in the short term (over 12 hours), but this benefit was lost at 24, 48, and 72 hours.[58] Overall to date, there is insufficient evidence to recommend corticosteroid treatment for symptom control in IM. The corticosteroid treatment trials are few, heterogeneous, and some of poor quality. There is also a lack of research on the side effects, potential adverse effects or complications, particularly in the long term.[59]
How to insert a peripheral venous cannula into the dorsum of the hand.
Use of this content is subject to our disclaimer