Pediatric Infectious Mononucleosis: Clinical Manifestations, Therapeutic Management, and Dietary Protocol During Convalescence

The primary etiologic agent of mononucleosis is the Epstein-Barr virus (human herpesvirus 4, HHV-4), transmitted primarily via oropharyngeal secretions. EBV exhibits selective tropism for human B lymphocytes and pharyngeal epithelial cells. In early childhood, primary infection frequently presents subclinically, conferring lifelong cellular immunity.

The definitive clinical manifestation presents with a classical diagnostic triad:

• Protracted pyrexia: High fever persisting for 10–14 days, frequently unresponsive to initial antipyretics.
• Exudative tonsillopharyngitis: Markedly enlarged tonsils coated with thick confluent grayish-white pseudomembranes.
• Cervical lymphadenopathy: Symmetrical, tender enlargement of posterior cervical and submandibular lymph chains.
• Hepatosplenomegaly: Splenic and hepatic enlargement occurring in over half of cases; peri-orbital edema (Glanzman's sign) is also pathognomonic.

Treatment remains strictly supportive (hydration, rest, and antipyretics such as paracetamol or ibuprofen). Critical clinical caveat: Aminopenicillins (amoxicillin, ampicillin) are strictly contraindicated; administering them during active EBV infection induces a severe pruritic maculopapular rash in 80–90% of cases. Owing to splenomegaly, contact sports and rigorous physical activity must be strictly avoided for 4–6 weeks to avert life-threatening splenic rupture.

Because EBV routinely induces transient hepatic involvement with elevated transaminases (ALT/AST), dietary protocol during recovery must prioritize hepatic sparing:

• Soft-textured, soothing foods (vegetable purees, lukewarm broths, fruit purees) to minimize throat discomfort.
• Elimination of fried foods, saturated animal fats, and industrial fast foods to unload liver metabolism.
• Optimal hydration with electrolyte-balanced fluids, alongside natural vitamin C and zinc sources to facilitate tissue recovery.