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Abstract: Infectious mononucleosis (IM) is a common illness in children and young adults caused primarily by the Epstein-Barr Virus (EBV). Transmission occurs primarily through sharing oral secretions, thus IM is known as the "kissing disease." Common clinical manifestations include fever, pharyngitis, posterior cervical lymphadenopathy, and splenomegaly. Atypical lymphocytosis and transaminase elevations are common, and the diagnosis of IM is confirmed with laboratory findings of a positive heterophile antibody ("Monospot"), polymerase chain reaction, or antibodies specific to EBV. Individuals with acute IM may be quite symptomatic and not feel well enough to participate in sports. Splenic enlargement is common, with rupture a relatively rare occurrence, typically occurring within a month of symptom onset, but this risk complicates sports participation, and is often the reason for restricting activity. The management of IM is primarily supportive, with no role for antivirals or corticosteroids. The variability of clinical presentation and the risk of splenic rupture in patients with IM present clinicians with challenging return to play/return to sport (RTS) decisions. This position statement updates the Evidence-Based Subject Review on Mononucleosis by the American Medical Society for Sports Medicine published in 2008 and reviews the epidemiology, clinical manifestations, laboratory assessment, and management including RTS for the athlete with IM. This statement also addresses complications, imaging, special considerations, diversity and equity considerations, and areas for future clinical research. Understanding the evidence regarding IM and sport is essential when communicating with athletes and their families and incorporating shared decision-making in the RTS decision., Competing Interests: Dr. Putukian is a consultant and Chief Medical Officer for Major League Soccer, serves as senior advisor for the NFL Head, Neck & Spine Committee, and as a team physician for US Soccer. She has written a chapter for UpToDate, and serves on several other committees and as a research advisor but has no conflicts of interest to report. The Publications Committee of AMSSM contacted the lead author (MP) of the original Evidence-Based Subject Review on Mononucleosis and the Athlete10 with the request to chair and update the 2008 Position paper to a Society Position Stand; a co-author on the 2008 paper (CAM) was chosen as co-chair. A call for nominations that included the AMSSM membership at large, the AMSSM Diversity Special Interest Group and the AMSSM Women in Leadership Group was performed, and the Chair and Co-chair selected the writing group that included one or more representatives from each group, an outside consultant who provided expertise in imaging, and the services of an outside librarian. The lead author created a Project Plan that included the proposed outline and writing group which was approved by the AMSSM Board of Directors. One of the selected writing group members decided to withdraw from participating based on time commitments. All final authors have disclosed financial and other relevant conflicts of interest, if any, related to the research and written presentation of their work., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To determine the utility of monospot testing in the diagnosis of mononucleosis in the collegiate student-athlete clinical setting., Design: Retrospective cohort study., Setting: National Collegiate Athletic Association Division I sports medicine clinic., Patients: All varsity student athletes who had a monospot test and Epstein-Barr virus (EBV) titers obtained from January 1, 2016, through March 31, 2020, (n = 199) were included., Independent Variables: Monospot, EBV antibody titers, and liver transaminase results., Main Outcome Measures: Using EBV titers indicating acute or recent infection as the gold standard for diagnosing infectious mononucleosis (IM), the reliability of a positive monospot test and elevated liver transaminases for the diagnosis of IM were examined., Results: The monospot test had a sensitivity and specificity of 80.0% and 90.6%, respectively, with a positive predictive value of 36.4% and a negative predictive value of 98.5% in this cohort. All athletes diagnosed with IM also had elevated liver transaminases., Conclusions: The specificity of the monospot test is lower than previously reported in the literature, and a positive test is not sufficient to diagnose mononucleosis in this clinical setting. Positive monospot results should be confirmed with EBV antibody testing. Elevated transaminase levels are highly correlated with acute IM and could play a supporting role in the diagnosis., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The risk of myocardial damage after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been controversial. The purpose of this study is to report the incidence of abnormal cardiovascular findings in National Collegiate Athletic Association (NCAA) Division I student-athletes with a history of SARS-CoV-2 infection., Design: This is a case series of student-athletes with SARS-CoV-2 infection and their subsequent cardiac work-up, including troponin level, electrocardiogram, and echocardiogram. Additional testing was ordered as clinically indicated., Setting: This study was conducted at a single NCAA Division I institution., Participants: Student-athletes were included if they tested positive for SARS-CoV-2 by PCR or antibody testing [immunoglobulin G (IgG)] from April 15, 2020 to October 31, 2020., Intervention: Cardiac testing was conducted as part of postinfection screening., Main Outcome Measures: This study was designed to quantify abnormal cardiovascular screening results and cardiac diagnoses after SARS-CoV-2 infection in Division I collegiate athletes., Results: Fifty-five student-athletes tested positive for SARS-CoV-2. Of these, 14 (26%) had a positive IgG and 41 (74%) had a positive PCR test. Eight abnormal cardiovascular screening evaluations necessitated further testing including cardiac magnetic resonance imaging (cMRI). Two athletes received new cardiac diagnoses, one probable early cardiomyopathy and one pericarditis, whereas the remaining 6 had normal cMRIs., Conclusions: These data support recent publications which recommend the de-escalation of cardiovascular testing such as cardiac MRI or echocardiogram for athletes who have recovered from asymptomatic or mildly symptomatic SARS-CoV-2 infection. Continued follow-up of these athletes for sequelae of SARS-CoV-2 is critical., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)