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Mononucleosis

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Infectious mononucleosis (more commonly known as mono) is an illness usually caused by the Epstein-Barr virus, spread through saliva. The length and severity of illness varies between individuals. Some people can even have mono without being aware that they are infected.

Symptoms

Mono is most commonly characterized by the following symptoms:

  • sore throat
  • fatigue
  • swollen glands (enlarged lymph nodes) in the neck and possibly elsewhere

Additional symptoms may also be present, including:

  • fever
  • headache
  • nausea
  • muscle aches
  • rash
  • enlarged spleen (the organ that lies under the left-side of the rib cage)

The time between when a person is exposed to mono and when symptoms appear is around 30 to 50 days. Fever and sore throat usually go away first, but fatigue and lymph node swelling may last for one to two months. Mono is most contagious during this first period, when the fever and sore throat are present.

Diagnosis

Mono can be confirmed by a blood test. When mono is present, a particular type of white blood cell called a reactive lymphocyte is frequently seen in the blood. A “Monospot” blood test may not give positive results until a week or more after symptoms develop.

If the test results don’t show mono at first but mono seems very likely, the test may be repeated. In some cases, a person with mono may not test positive at all.

Treatment

General treatment measures:

  • Drink at least eight ounces of non-caffeinated, non-alcoholic fluids every two hours. If a fever is present, more fluids are needed to replace those lost because of elevated body temperature. Extra fluids can also help soothe a sore throat.
  • Rest more than usual if very tired, and stay in bed while the fever is present. Long-term bed rest or leaving school is rarely necessary.
  • Do not drink alcohol for four to six weeks. Mono affects the liver, which is where alcohol is broken down in the body.
  • Sometimes the spleen can become enlarged or inflamed, so avoid blows or pressure to the chest or abdomen for a month after symptoms begin. Strenuous physical activity, heavy lifting, or a hard impact could rupture the spleen, requiring emergency medical attention.

Sore throat:

Significant throat pain may accompany mono. To soothe a sore throat, try the following:

  • Avoid dry air, if possible. Humidifiers, which add moisture to the air, can make sleeping easier and reduce nasal irritation.
  • Refrain from smoking, which irritates the throat and nasal tissue.
  • Eat a well-balanced diet.
  • Sip hot water mixed with honey and lemon. Honey coats and soothes the throat, while lemon helps clear away mucus.
  • Use phenol-containing lozenges and sprays—these are particularly effective pain relievers for sore throats.
  • Gargle with warm salt water (1 teaspoon salt in 1 cup hot water) three to four times a day. This may help to ease pain and clear throat mucus.

Nasal congestion:

  • Decongestants: Phenylephrine (or pseudoephedrine, which must be purchased directly from the pharmacist) may relieve runny nose and congestion. Pseudoephedrine can cause sleeplessness and decreased appetite.
  • Nasal irrigation: Using an irrigation tool, such as a neti pot and saline solution (e.g., SinuCleanse, Sinus Rinse), removes excess secretions from sinuses and makes breathing through the nose easier.
  • Nasal sprays: Saltwater or saline nasal sprays may ease nasal congestion and make mucus less thick. Do not use medicated over-the-counter nose sprays (such as Afrin) for more than three days. Excessive use of such sprays can cause dependence and may make congestion worse.

Fever and pain:

Much of the discomfort of mono is because of the fever and sore throat. Many painkillers can both ease the throat and reduce a fever. These products are commonly available without a prescription, and can be purchased at any pharmacy.

For acetaminophen, aspirin, and ibuprofen, use according to the label directions to reduce fever and/or pain. If symptoms are severe, alternate acetaminophen (650 mg) and ibuprofen (400 mg) every two hours. If under the age of 19, do not use aspirin, as it can contribute to Reye’s syndrome—a life-threatening illness of the brain and liver that usually follows a viral infection in children or teenagers.

Prescription medications:

  • No prescription medications can treat mono. Mono is a virus, meaning that antibiotics, which kill bacteria, won’t help. Sometimes complications occur, however, and medication may be necessary.
  • If infections such as strep throat or sinusitis occur during mono, antibiotics will be prescribed to treat them.
  • Do not take amoxicillin, as a drug-related rash may occur.
  • In rare cases where the tonsils are very large and could interfere with breathing, a steroid may be prescribed to reduce their size.

Prevention

Since mono is generally spread through saliva (thus the nickname the “kissing disease,”) intimate partners are most at risk for catching mono. Roommates are no more likely to catch mono than anyone else.

Good hygiene, with frequent hand washing, helps prevent many illnesses, including mono. Until the symptoms are gone, do not engage in any activities where saliva may be exchanged, such as:

  • kissing
  • sharing food or drinks
  • using the same eating utensils
  • drinking from the same containers

Wash eating and drinking utensils and dishes in hot, soapy water, and ask others to do the same.

Once an individual has had mono there is usually permanent protection against being infected with that kind of mono again. Mono caused by other viruses, however, could still potentially occur.

When to contact a clinician

Report any pain in the left upper area of your abdomen or in your shoulder immediately.

[HU425 : updated 07/08]