Introduction
Infectious mononucleosis (IM) is a relatively common presentation to the
Ear, Nose and Throat (ENT) department, with patients being admitted for
symptomatic relief and hydration. These are generally young patients
without medical comorbidities. The Epstein-Barr virus (EBV) is the most
common cause of IM, with the remainder due to other viruses including
cytomegalovirus (CMV), toxoplasmosis, and HIV.1
In patients with clinically suspected IM and atypical lymphocytosis, the
diagnosis is generally confirmed with the monospot test. However, there
is a false negative rate in up to 25% of adults in the first week of
symptoms.2
There is abnormality in liver function tests (LFT) in a large proportion
of patients presenting with IM but this is usually
self-limiting.2 Patient admitted to hospital generally
would have standard LFTs as part of initial work up for IM. The utility
of this is unclear, however, it may support diagnosis in the first week
of illness if the monospot test was falsely negative. In addition, in
settings where there is no available screening or definitive tests for
IM, deranged LFTs may support clinical diagnosis taken in conjunction
with clinical symptoms.
Practice varies with regards to follow-up in patients with IM and
abnormal LFTs. Although a self-limiting finding, an initially abnormal
LFTs generally start a cascade for further tests until normal.
Anecdotally, general practitioners are often asked to repeat LFTs at
varying intervals following discharge from hospital to ensure
resolution. There are no guidelines to inform this practice. In
addition, some centres routinely do abdominal ultrasound to evaluate the
liver and spleen in patients with IM and abnormal LFTs; the need for
this practice is unclear.
This systematic review aims to evaluate evidence base on LFTs assessment
and ultrasound abdomen in IM. Specifically, we sought to determine the
proportion of patients with abnormal LFTs, time to resolution of
abnormal LFTs from clinical presentation, findings on abdominal
ultrasound, and occurrence of decompensated liver disease.