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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Mononucleosis

Mono; Kissing disease

Last reviewed: May 15, 2012.

Mononucleosis is a viral infection causing fever, sore throat, and swollen lymph glands, especially in the neck.

See also: Infectious mononucleosis (acute CMV infection)

Causes, incidence, and risk factors

Mononucleosis, or mono, is often spread by saliva and close contact. It is known as "the kissing disease," and occurs most often in those age 15 to 17. However, the infection may develop at any age.

Mono is usually linked to the Epstein-Barr virus (EBV), but can also be caused by other organisms such as cytomegalovirus (CMV).

Symptoms

Mono may begin slowly with fatigue, a general ill feeling, headache, and sore throat. The sore throat slowly gets worse. Your tonsils become swollen and develop a whitish-yellow covering. The lymph nodes in the neck are frequently swollen and painful.

A pink, measles-like rash can occur and is more likely if you take the medicines ampicillin or amoxicillin for a throat infection. (Antibiotics should NOT be given without a positive Strep test.)

Symptoms of mononucleosis include:

Less frequently occurring symptoms include:

Signs and tests

The doctor or nurse will examine you. This may show that you have:

  • Swollen lymph nodes in the front and back of your neck
  • Swollen tonsils with a whitish-yellow covering
  • Swollen liver or spleen
  • Skin rash

Blood tests will be done, including:

Treatment

The goal of treatment is to relieve symptoms. Steroid medicine (prednisone) may be given if symptoms are severe.

Antiviral drugs such as acyclovir have little or no benefit.

To relieve typical symptoms:

  • Drink plenty of fluids.
  • Gargle with warm salt water to ease a sore throat.
  • Get plenty of rest.
  • Take acetaminophen or ibuprofen for pain and fever.

You should also avoid contact sports while the spleen is swollen (to prevent it from rupturing).

Expectations (prognosis)

The fever usually drops in 10 days, and swollen lymph glands and spleen heal in 4 weeks. Fatigue usually goes away within a few weeks, but may linger for 2 to 3 months.

Complications

Complications of mononucleosis may include:

Death is possible in people who have a weakened immune system.

Calling your health care provider

The initial symptoms of mono feel very much like a typical viral illness. It is not necessary to contact a health care provider unless symptoms last longer than 10 days or you develop the following:

  • Abdominal pain
  • Breathing difficulty
  • Persistent high fevers (more than 101.5°F)
  • Severe headache
  • Severe sore throat or swollen tonsils
  • Weakness in the arm or legs
  • Yellow discoloration of your eyes or skin

Call 911 or go to an emergency room if you develop:

  • Sharp, sudden, severe abdominal pain
  • Significant difficulty swallowing or breathing
  • Stiff neck or severe weakness

Prevention

Persons with mononucleosis may be contagious while they have symptoms and for up to a few months afterwards. How long someone with the disease is contagious varies. The virus can live for several hours outside the body. Avoid kissing or sharing utensils if you or someone close to you has mono.

References

  1. Frye R, Bailey J, Blevins AE. Clinical inquiries. Which treatments provide the most relief for pharyngitis pain? J Fam Pract. 2011;60(5):293-294. [PubMed: 21544279]
  2. Weber R. Pharyngitis. In: Bope ET, Kellerman RD, eds. Conn’s Current Therapy 2012. 1st ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 1.
  3. Jenson HB. Epstein-Barr virus. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed.Philadelphia, Pa: Saunders Elsevier; 2011:chap 246.
  4. Schooley RT. Epstein-Barr virus infection. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 385.

Review Date: 5/15/2012.

Reviewed by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Steroids for short‐term symptom control in infectious mononucleosis (glandular fever)Steroids for short‐term symptom control in infectious mononucleosis (glandular fever)
    Glandular fever (infectious mononucleosis) is an infection carried in the saliva. Some people have no symptoms and young adults more commonly suffer symptomatic glandular fever. Common symptoms include fever, sore throat and swollen lymph nodes. The severity and duration of symptoms varies; a few people develop breathing difficulties due to swelling at the back of the throat and other complications requiring hospitalisation. Symptoms can last for months (it is a risk factor for chronic fatigue syndrome). Symptom relief and rest are commonly recommended treatments.
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Figures

  • Mononucleosis, photomicrograph of cells.
    Mononucleosis, photomicrograph of cells.
    Infectious mononucleosis #3.
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    Splenomegaly.
    Infectious mononucleosis.
    Mononucleosis, photomicrograph of cell.
    Gianotti-Crosti syndrome on the leg.
    Mononucleosis - view of the throat.
    Mononucleosis - mouth.
    Antibodies.

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