Mononucleosis

Mononucleosis - Mono

What is Mono?

"Mono" or infectious mononucleosis is characterized by fever, sore throat, and significant lymph node swelling. It is caused by the Epstein-Barr virus (EBV). When tested, approximately 95% of adults have been found to have been exposed to this virus at some time in the past, although many are not aware of having been infected. Some infections are very mild or even asymptomatic.

Mono is not highly contagious through routine contact and is rarely passed from one family member to another. However, because EBV is present in saliva, the disease can be spread by intimate oral contact, hence the term, the “kissing disease.” It can also be spread by sharing food, drinks or utensils.

Mono is an illness that gets better without any particular medical treatment; your body’s immune system usually fights off the infection without serious complications. However, despite the brevity of the acute stage, fatigue and lethargy can last for 2 to 3 months. Antibodies will develop which probably protect you from re-infection

Signs and Symptoms:

Early signs and symptoms can include:

• sore throat
• intermittent fever as high as 103°
• headache
• muscle aches and pains
• swollen lymph glands in the neck, the armpits, and groin
• fatigue
• rash

The liver and spleen are also involved. Infection in these organs often causes no symptoms but may cause nausea, decreased appetite, and abdominal pain.

The average incubation period ranges from 4 to 8 weeks. Then early symptoms usually persist for 7 to 10 days. Although most people with mono require more sleep, they do not need to stay in bed continuously. The length of recovery varies among individuals depending on the severity of the disease. Most patients feel normal three weeks after the onset of symptoms. In some, complaints such as fatigue and lack of energy last for weeks or months.

Diagnosis:

Diagnosis is based on your symptoms, results of your physical exam, and often results of laboratory tests. Positive test results may not occur until a week or more after symptoms have developed. Additional tests such as a complete blood count (CBC) and liver function tests may be ordered. Once mono is diagnosed, there is no need for follow-up testing in majority of cases. Positive Mono tests can remain positive for at least six weeks, and in some cases even longer. Subsequent testing within this time period is usually unnecessary and costly. Follow-up testing may be indicated for abnormal liver function tests or low platelet counts.

Complications:

The most significant involves the liver and spleen, which can be affected by the virus. The spleen may become enlarged up to 60% of the time and is vulnerable to injury. In extreme cases your spleen may rupture, causing sharp, sudden pain in the left, upper side of the abdomen. If this happens seek medical attention immediately, it can be a life-threatening condition. The liver may become inflamed, causing a mono hepatitis.

Treatment and Self-Care Tips:

Rest:

• No exercise during the early illness or while you have fever.
• Once you are feeling better, you can gradually return to low-impact or low-intensity activities (stationary biking, walking) as tolerated. Do not use weights or do any “gut crunching” exercises. If you overexert too early your fatigue could worsen, your spleen could rupture (see above), and your recovery will be slower.
• You should not participate in any running, contact sports, wrestling/roughhousing, skating/skateboarding, or free weightlifting for at least 4 weeks from the diagnosis date.
• If you have an enlarged spleen or liver, you should be re-evaluated by a provider before returning to normal activities.

Do not use Tylenol (acetaminophen) because of its effect on the liver.

Do not use Aspirin.

Take Ibuprofen (Motrin or Advil) every 6-8 hours for fever and discomfort unless a health care provider advises against these medications.

Do not drink alcohol, especially if your liver is enlarged or you have jaundice (yellow skin or eyes). Avoid alcohol for six weeks because of its effect on the liver.

Increase your daily fluid intake, and eat at least two "good" meals a day.

Practice good hygiene, including regular hand washing. Do not share food or drink and refrain from kissing for three to six weeks.

How is Mono Treated?

Most people recover completely without any medication. Infrequently, in severe cases, a cortisone derivative may be prescribed to reduce the local swelling of the throat, lymph nodes, liver and spleen. Your clinician may order a throat culture to detect the presence of streptococcal bacteria (strep), since strep throat may co-exist with mono.

An antibiotic may be prescribed to treat the secondary bacterial infection. The antibiotic is not a cure for mono; because it is caused by a virus and viruses do not respond to antibiotics.

Emergencies

In an emergency go to Mount Nittany Medical Center or call 911 for an ambulance.

Test Results and Advice Nurse

Send a secure message to the advice nurse via myUHS or call 814-865-4UHS (4847) (Press 3). 

Appointments 

Schedule an appointment online or by calling the UHS.  

This content is reviewed periodically and is subject to change as new health information becomes available. This information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. 11/2022