The utility of liver function tests and abdominal ultrasound in
infectious mononucleosis -- A systematic review
Abstract
Introduction: A large proportion of patients with infectious
mononucleosis (IM) have abnormal liver function tests (LFT) at
presentation. There is no guideline regarding the management and
follow-up of these patients. Some patients also have abdominal
ultrasound due to deranged LFT, the need for this practice is unclear.
The aim of this systematic review was to evaluate the evidence base on
LFT assessment in IM, time to resolution of derangement, and the role of
abdominal ultrasound. Methods: A systematic search of PubMed, EMBASE and
the Cochrane library was done. Two authors independently screened
records for eligibility using pre-defined criteria. We included both
adult and paediatric populations. Quality assessment of included studies
was done. Results: A total of 3924 patients were included from 32
studies. A combination of typical clinical features, heterophile
antibodies and EBV-specific antibodies were used to ascertain diagnosis.
The following proportion of patients had abnormal LFTs: AST (57%); ALT
(62%); ALP (65%); Bilirubin (16%); GGT (41%). Reported median
(i.q.r.) time to resolution of LFT was 8 (6–12) weeks. Maximum time to
resolution was >6 months. Clinical hepatomegaly and
splenomegaly were found in 35% and 44% of patients respectively.
Enlarged liver and spleen on ultrasound were seen in 16/29 (55%) and
38/38 (100%) of patients respectively. There were no reports of
decompensated liver disease. Conclusion: Derangement in LFTs can persist
over six months from initial presentation in IM. However, this is
self-limiting. The evidence suggests serial liver function assessments
and ultrasound abdomen are not required in immunocompetent patients with
subclinical derangement in LFTs.