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 acetaminophen and nonsteroidal anti-inflammatory drugs. Aspirin should not be given to children because of the possibility of Reye 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 people with IM for the development of possible complications such as airway obstruction, hemolytic anemia, and thrombocytopenia.
Systemic corticosteroids should be reserved for patients with severe airway obstruction, severe thrombocytopenia (<20,000 platelets/mm³), or hemolytic anemia.[60] 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.[61] Systemic corticosteroids may improve symptoms of obstruction but intubation, tracheotomy, or tonsillectomy may be required in extreme cases.
Severe thrombocytopenia occurs in less than 1% of cases, although mild thrombocytopenia 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 antiplatelet antibodies. There is no clear relationship between the clinical severity of IM and the platelet count.[62] Systemic corticosteroids could be useful and in immune thrombocytopenia, intravenous immune globulin (IVIG) has been successful.
Hemolytic anemia 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.[61] Systemic corticosteroids can hasten resolution.
While corticosteroids are generally reserved for severe complications, some practitioners treat patients 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.[63] 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.[64]
How to insert a peripheral intravascular catheter into the dorsum of the hand.
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