Mononucleosis

Written by Shannon Johnson | Published on June 26, 2012
Medically Reviewed by George Krucik, MD

What is Mononucleosis?

Mononucleosis, commonly known as “mono” or “the kissing disease” refers to a group of symptoms usually caused by the Epstein Barr virus (EBV). This infection is infamous for its symptoms of fatigue and the length of time it can last.

According to the Physician’s Desk Reference, 90 to 95 percent of adults everywhere have signs of EBV in their blood because the virus is so common (PDR). This means almost every adult has had an EBV infection. However, this does not mean that everyone has had mono.

Many people develop EBV infections as children after age 1. In very young children, symptoms are usually nonexistent or so mild that they are not recognized as mono. And, once you have an EBV infection, you are not likely to get another one. So a child who gets EBV will probably be immune to mono for the rest of his or her life.

However, there are plenty of children in the United States and other developed countries do not get these infections in their early years. And, if they are exposed to the virus later in life, mono usually develops. According to the U.S. Centers for Disease Control and Prevention, mono occurs 35 to 50 percent of the time when an adolescent or young adult is infected with EBV (CDC). For this reason, mono affects mainly high school and college students.

Fortunately, most cases of mono are mild and resolve easily with minimal treatment.

How Can I Catch Mononucleosis?

Infectious mono is spread by saliva. You can become infected by kissing or sharing food, dishes, or eating utensils with someone who has mono. It usually takes four to eight weeks for symptoms to develop after you are infected.

The best way to prevent mono is to avoid coming into contact with other people’s saliva. If you are infected, take precautions to avoid infecting anyone else.

High-Risk Groups for Mononucleosis

The following groups have a higher risk for getting mono:

  • young people between the ages of 15 and 25
  • students
  • interns
  • nurses
  • caregivers
  • people on immune system–suppressing drugs

Anyone who regularly comes into close contact with large numbers of people is at an increased risk for mono. This is why high school and college students frequently become infected.

The Symptoms Associated With Mononucleosis

The following are the most common symptoms of mono:

  • fever
  • sore throat that gets worse
  • swollen glands (lymph nodes) in the neck, underarms, and groin
  • fatigue

Additional mono symptoms include:

  • white patches (pus) on tonsils
  • tender and enlarged spleen (an organ in the upper left side of your abdomen)
  • loss of appetite
  • headaches
  • sore muscles
  • night sweats

Mono is hard to distinguish from other common viruses such as the flu. If your symptoms do not improve after one or two weeks of home treatment such as resting, getting enough fluids, and eating healthy foods, see your doctor.

How Is Mononucleosis Diagnosed?

Because other, more serious viruses such as hepatitis A can cause symptoms similar to mono, your doctor will work to rule out these possibilities.

Initial Exam

Once you visit the doctor, he or she will normally ask how long you have had symptoms. If you are between age 15 and 25, your doctor might also ask if you have been in contact with any individuals who have mono. The CDC lists age as one of the main factors for diagnosing mono along with the most common symptoms: fever, sore throat, and swollen glands (CDC).

Your doctor will take your temperature, and check the glands in your neck, armpits, and groin. Your doctor might also check the upper left part of your stomach to determine if your spleen is enlarged.

The Monospot Test

Lab tests are the second part of a doctor’s diagnosis. One of the most reliable ways to diagnose mononucleosis is the monospot test. This blood test looks for antibodies—these are proteins your immune system produces in response to harmful elements. However, it does not look for EBV antibodies. Instead, the monospot test determines your levels of another group of antibodies your body is likely to produce when you are infected with EBV. These are called heterophile antibodies.

The results of this test are the most consistent when it is done between two and four weeks after symptoms of mono appear. At this point, you would have sufficient amounts of heterophile antibodies to trigger a reliable positive response.

This test is not always accurate, but it is easy to do, and results are usually available within one hour.

EBV Antibody Test

If your monospot test comes back negative, your doctor might order an EBV antibody test. This blood test looks for EBV-specific antibodies. According to the Mayo Clinic, this test can detect mono as early as the first week you have symptoms, but it takes longer to get the results.

Complete Blood Count

Sometimes your physicians will request a complete blood count (CBC). This blood test will help your doctor determine how severe your illness is by looking at your levels of various blood cells. For example, a high white blood cell count often indicates mono.

What Are the Treatment Options for Mono?

Treatment for mononucleosis is very basic. It involves addressing your symptoms.

For the most part, this entails at-home treatment including:

  • getting a lot of rest
  • drinking a lot of fluids (water is best)
  • gargling with warm salt water for sore throat
  • eating warm chicken soup
  • using over-the-counter pain medication
  • taking prescription corticosteroids to help reduce throat and tonsil swelling

Nothing can cure mono. In fact, you can continue to test positive for the virus for the rest of your life after symptoms resolve. Some people even continue to spread the virus off and on during their lives.

If your symptoms get worse or you experience intense abdominal pain, contact your physician. One of the complications of mono is ruptured spleen, which is a life-threatening situation. A ruptured spleen will usually occur between four and 21 days after you begin to have symptoms. If your spleen ruptures, you will need emergency surgery to remove it.

How Long Does It Take to Recover from Mono?

Mononucleosis can be a debilitating disease. The majority of people who have mononucleosis recover within two to four weeks, and 50 percent can return to regular activities in two weeks. However, a study reported in the Physician’s Desk Reference found that 38 percent of a group of high school and college students took more than two months to recover after being diagnosed with mono (PDR).

In the same study, 12 percent of the students had not fully recovered six months later. The good news is that once you have gotten mono, you usually do not have to worry about becoming sick with it again.

During your recovery, make sure to avoid contact sports or any other strenuous activity.

Risks and Complications Associated With Mononucleosis

If you have been diagnosed with mononucleosis, you may be at risk for developing other, more serious diseases. For instance, an association has been found between Hodgkin’s disease and mono. People who have mono sometimes suffer from secondary infections such as strep throat, sinus infections, or tonsillitis. Other conditions often seen with mono include:

  • hepatitis
  • jaundice: yellowing of skin and eye whites
  • anemia: lack of red blood cells
  • heart inflammation
  • low platelet count, which can cause excess or spontaneous bleeding
  • meningitis: inflammation of the brain stem
  • encephalitis: inflammation of the brain
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