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The utility of liver function tests and abdominal ultrasound in infectious mononucleosis -- A systematic review
  • E Tian Tan,
  • Danielle Wilkinson,
  • Ovie Edafe
E Tian Tan
Barnsley District General Hospital

Corresponding Author:[email protected]

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Danielle Wilkinson
Rotherham General Hospitals NHS Trust
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Ovie Edafe
Sheffield Teaching Hospitals NHS Foundation Trust
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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.
14 Jan 2022Submitted to Clinical Otolaryngology
18 Jan 2022Submission Checks Completed
18 Jan 2022Assigned to Editor
07 Feb 2022Reviewer(s) Assigned
05 Mar 2022Review(s) Completed, Editorial Evaluation Pending
23 Mar 2022Editorial Decision: Revise Major
10 Apr 20221st Revision Received
29 Apr 2022Submission Checks Completed
29 Apr 2022Assigned to Editor
09 May 2022Reviewer(s) Assigned
13 May 2022Review(s) Completed, Editorial Evaluation Pending
26 Jun 2022Editorial Decision: Accept
Nov 2022Published in Clinical Otolaryngology volume 47 issue 6 on pages 611-619. 10.1111/coa.13965