What Is Mononucleosis?

In most cases, people recover from a bout of mono without any long-term effects. Usually medications will not help speed recovery, though some painkillers may ease symptoms. Knowing what precautions to take during the healing process can go a long way in helping you feel better sooner and avoid complications.

Signs and Symptoms of Mononucleosis

Typical symptoms of mono include:

• Severe fatigue
• Fever
• Muscle aches
• Sore throat
• Swollen lymph nodes
• Headache
• Loss of appetite
• Flat rash all over the body that resembles measles
• Enlarged spleen or liver

Doctors are not sure why teens and adults are hit harder by mono than younger children, but some believe that it may have to do with the differences in their immune systems, says Henry Balfour Jr., MD, a professor emeritus at the University of Minnesota Medical School in Minneapolis. Dr. Balfour believes that the milder reaction to EBV may have to do with the fact that young children have immune systems that are more “naive,” he says. “When you reach adulthood without having had that infection, you’ll be hit harder.”

Because so many symptoms of mono — fatigue, sore throat, and muscle aches, among others — are common to other infections, such as the flu or strep throat, it can be easy to mistake infectious mononucleosis for something else.

“Other things that can mimic mono include cytomegalovirus, toxoplasmosis, strep throat, and HIV,” says Eric Johannsen, MD, an infectious disease professor at the University of Wisconsin School of Medicine and Public Health in Madison.

But if you have a sore throat and a fever for seven days or feel excessively exhausted, it may be a sign that you have mono, especially if you are a teen or young adult who has never had the illness before.

Causes and Risk Factors of Mononucleosis

“People can shed the virus in their oral secretions for several years, and the shedding is intermittent,” says Balfour. “Most people get the virus from someone who’s completely asymptomatic.”

But that’s no reason to panic and avoid contact with anyone and everyone.

• Adenovirus
• Cytomegalovirus
• Hepatitis A, B, or C
• Herpes simplex virus
• HIV
• Rubella
• Toxoplasmosis

How Is Mononucleosis Diagnosed?

If your doctor determines that your symptoms are not typical of mono or decides that more information is needed to make a diagnosis, they may turn to lab tests to rule out other infections or illnesses, including:

• Monospot Test The monospot test is also called the heterophile test. It’s a blood test that checks for antibodies (proteins that form to attack foreign virus or bacteria cells) to EBV. It’s fast, inexpensive, and easy, but it may not detect EBV until the second week of infection and has been shown to produce both false positive and false negative results.

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• EBV Antibody Test Typically done when your doctor suspects mono but a monospot test comes back negative, this type of test can help show whether you have been infected with EBV and if the infection happened recently.

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• Blood Tests These look for elevated levels of lymphocytes (white blood cells), which can indicate infection.
• Throat Culture If your symptoms are being caused not by mono but by strep bacteria, that will show up in this test.

Treatment and Medication Options for Mononucleosis

If the tonsils become so swollen that you have trouble swallowing or breathing, your doctor may prescribe steroids, but only as a last resort, as those medications may actually interfere with healing. “Steroids typically reduce immune system function,” says Johannsen.

Doctors also advise people with mono to avoid any activities or sports that are strenuous or require contact, to avoid rupturing the spleen, which often becomes enlarged as a result of mono.

Prevention of Mononucleosis

It’s important to remember that EBV may be present for months in someone who’s had mono, so even if many of their symptoms — such as fever or sore throat — have improved, they may still be infectious.

Mononucleosis Prognosis

Your fever should subside in about 10 days or so, and your swollen lymph nodes and spleen should return to normal in about a month. And while some symptoms, such as fatigue, may linger for two to three months, most people recover fully without any long-term problems.

Complications of Mononucleosis

While the vast majority of people who become sick with mono get over the illness in two to four weeks, a small subset of people can go on to develop complications.

• Anemia
• Hepatitis with jaundice
• Problems with the nervous system (such as inflammation in and around your brain, loss of function in the nerves that control movement of the muscles in your face, and Guillain-Barré syndrome)
• Swelling or inflammation in the testicles
• Heart rhythm problems

• Difficulty breathing
• Problems swallowing
• Severe headache
• Persistent high fever
• Weakness in your arms or your legs
• Yellowish color in your eyes or your skin
• Stiffness in your neck

Research and Statistics: Who Gets Mononucleosis?

Conditions Related to Mononucleosis

Researchers continue to investigate links between EBV infection and the development of these illnesses, as well as what role genetics and the environment may play in the relationship and how to reduce such risks.

The Takeaway

• Mononucleosis is caused by the Epstein-Barr virus and spreads through saliva.
• Symptoms include sore throat, swollen lymph nodes, and extreme fatigue, which can last for weeks or months.
• There is no medical treatment for mono, but rest and fluids can help you recover more quickly.
• You have to be careful to avoid injuring your spleen, which can become enlarged with the disease.
• You can keep from getting mono by avoiding close contact with someone who’s infected, and researchers are working on several potential vaccines.