Mononucleosis

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(Infectious Mononucleosis; Mono)

Definition

Mononucleosis is a viral disease characterized by fever, sore throat, swollen lymph glands, and fatigue.
Swollen Glands
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Causes

Mononucleosis is caused by the Epstein-Barr virus (EBV). Found mainly in saliva and mucus, EBV is passed from person to person by intimate behavior, such as kissing.

Risk Factors

Many people get EBV during their lifetime. Factors that increase the likelihood that EBV will develop into mononucleosis include:
  • Contracting EBV after age 10
  • Lowered immune resistance due to other illness, stress, or fatigue
  • Living in close quarters with a large number of people, such as in a college dormitory
One episode of mononucleosis usually produces permanent immunity.

Symptoms

Signs of mononucleosis usually begin 4-7 weeks after you were exposed to the virus. The initial symptoms may be a sense of general weakness that lasts about one week. This is followed by symptoms that may include:
  • High fever
  • Severe sore throat/swollen tonsils
  • Swelling of the lymph nodes
  • Fatigue
  • Loss of appetite
  • Muscle aches
  • Enlargement of the spleen or liver
  • Mild jaundice

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Diagnosis is based on:
  • Symptoms, which can differ according to age; young children may be difficult to diagnose
  • Four primary symptoms:
  • Two primary tests:
    • Blood tests and mono spot tests
    • Throat culture—to check for strep throat, which can resemble mononucleosis and also complicate mononucleosis

Treatment

There is no treatment to cure mononucleosis or to shorten the length of the illness. It usually runs its course in 4-6 weeks, although the fatigue may last longer.
During the first few weeks after diagnosis, patients should avoid contact sports. Inflammation of the spleen from mononucleosis puts individuals at high risk of splenic rupture. This can require surgery. In rare cases, it can be fatal.
Treatment includes:

Relief of Symptoms

Symptoms can be eased by:
  • Taking nonprescription pain relievers to lessen aches and pains and control fever
  • Note: Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of Reye syndrome. Ask your doctor which other medicines are safe for your child.
  • Gargling with warm, salty water to relieve sore throat
Steroids are sometimes used if the swelling in the throat is interfering with breathing. They can also be used if a complication involving low platelet counts or anemia occurs.

Comfort

Follow these comfort measures:
  • Get plenty of rest and fluids
  • Do not lift anything heavy or exercise for at least several weeks after recovery to decrease the risk of rupturing an enlarged spleen
  • Avoid contact or collision sports while you have symptoms or an enlarged spleen
If you are diagnosed with mononucleosis, follow your doctor's instructions.
If you are diagnosed with mononucleosis, follow your doctor's instructions.

Prevention

Most people contract the EBV virus sometime during their lives. Prevention is geared toward decreasing the likelihood that EBV will develop into mononucleosis. Follow these guidelines to decrease your risk:
  • Avoid intimate contact, especially kissing, with anyone who has active mononucleosis.
  • Eat a healthful diet.
  • Avoid excess stress.
  • Get enough rest.

RESOURCES

Centers for Disease Control and Prevention http://www.cdc.gov

National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov

CANADIAN RESOURCES

About Kids Health http://www.aboutkidshealth.ca

The College of Family Physicians of Canada http://www.cfpc.ca

References

Balfour HH Jr, Hokanson KM, et al. A virologic pilot study of valacyclovir in infectious mononucleosis. J Clin Virol. 2007;39:16-21.

Infectious mononucleosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 28, 2013. Accessed June 7, 2013.

Luzuriaga K, Sullivan JL. Infectious mononucleosis. N Engl J Med. 2010 May 27;362(21):1993-2000.

Mononucleosis. Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/mononucleosis.html. Updated November 2010. Accessed June 7, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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