Mononucleosis

Definition

Infectious mononucleosis (mono) is often called the kissing disease. The virus that causes mono is transmitted through saliva, so you can get it through kissing, but you can also be exposed through a cough or sneeze, or by sharing a glass or food utensil with someone who has mono. However, mononucleosis isn't as contagious as some infections, such as the common cold.

You're most likely to get mononucleosis with all the signs and symptoms if you're an adolescent or young adult. Young children usually have few symptoms, and the infection often goes unrecognized.

If you have mononucleosis, it's important to be careful of certain complications such as an enlarged spleen. Rest and adequate fluids are key to recovery.

Symptoms

Signs and symptoms of mononucleosis may include:

• Fatigue
• Weakness
• Sore throat, perhaps a strep throat that doesn't get better with antibiotics
• Fever
• Swollen lymph nodes in your neck and armpits
• Swollen tonsils
• Headache
• Skin rash
• Loss of appetite
• Soft, swollen spleen
• Night sweats

The virus typically has an incubation period of four to eight weeks, although in young children this period may be shorter. Signs and symptoms such as fever and sore throat usually lessen within a couple of weeks, although fatigue, enlarged lymph nodes and a swollen spleen may last for a few weeks longer.

When to see your doctor
If you've been experiencing the above symptoms, you may have mononucleosis.

If rest and a healthy diet don't ease your symptoms within a week or two or if your symptoms recur, see your doctor.

Causes

The cause of mononucleosis is the Epstein-Barr virus, although similar signs and symptoms are sometimes caused by cytomegalovirus.

Mononucleosis usually isn't very serious. Most adults have been exposed to the Epstein-Barr virus and have built up antibodies. They're immune and won't get mononucleosis again.

Complications

Enlargement of the spleen
Mononucleosis may cause enlargement of the spleen. In extreme cases, your spleen may rupture, causing sharp, sudden pain in the left side of your upper abdomen. If such pain occurs, seek medical attention immediately — you may need surgery.

Liver issues
Problems with your liver also may occur:

• Hepatitis. You may experience mild liver inflammation (hepatitis).
• Jaundice. A yellowing of your skin and the whites of your eyes (jaundice) also occurs occasionally.

Less common complications
Mononucleosis can also result in the following less common complications:

• Anemia — a decrease in red blood cells and in hemoglobin, an iron-rich protein in red blood cells
• Thrombocytopenia — low count of platelets, which are blood cells involved in clotting
• Inflammation of the heart
• Complications involving the nervous system (meningitis, encephalitis, Guillain-Barre syndrome)
• Swollen tonsils, leading to obstructed breathing

The Epstein-Barr virus can cause much more serious illness in people who have impaired immune systems, such as people with HIV/AIDS or people taking drugs to suppress immunity after an organ transplant.

Enlarged spleen

Enlarged spleen

The spleen is a small organ normally about the size of your fist. But a number of conditions, including liver disease and some cancers, can cause your spleen to become enlarged. ...

Preparing for your appointment

If you suspect you have mononucleosis, you're likely to start by seeing your family doctor. Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, noting any major stresses, recent life changes, your daily routine — including sleep habits — or exposure to anyone with mononucleosis.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For mononucleosis, some basic questions to ask your doctor include:

• What are the likeliest causes of my symptoms or condition?
• Other than the most likely cause, what are other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• I have these other health conditions. How can I best manage them?
• Are there any restrictions that I need to follow?
• Do I need to stay home from work or school? How long should I stay home?
• When can I return to strenuous activities and contact sports?
• Are there any medications I need to avoid with mononucleosis?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

• When did you first develop symptoms?
• Have you been exposed to anyone with mononucleosis?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Tests and diagnosis

Physical exam
Your doctor may suspect mononucleosis based on your signs and symptoms and a physical examination. He or she will be looking for signs like swollen lymph nodes, tonsils, liver or spleen, and considering how these signs relate to the symptoms you describe.

Blood tests

• Antibody tests. If there's a need for additional confirmation, a monospot test may be done to check your blood for antibodies to the Epstein-Barr virus. This screening test gives results within a day. But it may not detect the infection during the first week of the illness. A different antibody test requires a longer result time, but can detect the disease even within the first week of symptoms.
• White blood cell count. Your doctor may use other blood tests to look for an elevated number of white blood cells (lymphocytes) or abnormal-looking lymphocytes. These blood tests won't confirm mononucleosis, but they may suggest it as a possibility.

Treatments and drugs

There's no specific therapy available to treat infectious mononucleosis. Antibiotics don't work against viral infections such as mono. Treatment mainly involves bed rest and adequate fluid intake.

Medications

• Treating secondary infections. Occasionally, a streptococcal (strep) infection accompanies the sore throat of mononucleosis. You may also develop a sinus infection or an infection of your tonsils (tonsillitis). If so, you may need treatment with antibiotics for these accompanying bacterial infections.
• Risk of rash with some medications. Some people with mononucleosis who take amoxicillin or amoxicillin and clavulanate (Augmentin) may develop a rash, but this doesn't mean that they're allergic to the antibiotic. If needed, other antibiotics that are less likely to cause a rash are available to treat infections that may accompany mononucleosis.
• Corticosteroids. To ease some of your symptoms, such as severe swelling of your throat and tonsils, your doctor may prescribe a corticosteroid medication such as prednisone.

Lifestyle and home remedies

In addition to getting plenty of bed rest, these steps can help relieve symptoms of mononucleosis:

• Drink plenty of water and fruit juices. Fluids help relieve fever and sore throat and prevent dehydration.
• Take an over-the-counter pain reliever. Use pain relievers such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) as needed. These medicines have no antiviral properties. The only reason to take them is to relieve pain or a fever. Don't give aspirin to a child under age 16. Aspirin may trigger a rare but potentially fatal disorder known as Reye's syndrome.
• Gargle with salt water. Do this several times a day to relieve sore throat. Mix 1/2 teaspoon salt in 8 ounces (237 milliliters) of warm water.

Wait to return to sports and some other activities
Most signs and symptoms of mononucleosis ease within a few weeks, but it may be two to three months before you feel completely normal. The more rest you get, the sooner you should recover. Returning to your usual schedule too soon can increase the risk of a relapse.

To avoid risk of rupturing your spleen, wait at least one month before returning to vigorous activities, heavy lifting, roughhousing or contact sports. Rupture of the spleen results in severe bleeding and is a medical emergency.

Ask your doctor when it's safe for you to resume your normal level of activity. Your doctor may recommend a gradual exercise program to help you rebuild your strength as you recover.

Coping and support

Mononucleosis can be a prolonged condition, keeping you at home for weeks as you recover. But be patient with your body as it fights the infection.

For young people, having mononucleosis will mean some missed activities — classes, team practices and parties. Without doubt, you'll need to take it easy for a while. Students need to let their schools know they are recovering from mononucleosis and may need special considerations to keep up with their work.

If you have mononucleosis, you don't necessarily need to be quarantined. Many people are already immune to the Epstein-Barr virus because of exposure as children. But plan on staying home from school and other activities until you're feeling better.

Seek the help of friends and family as you recover from mononucleosis. College students should also contact the campus student health center staff for assistance or treatment, if necessary.

Prevention

Mononucleosis is spread through saliva. If you're infected, you can help prevent spreading the virus to others by not kissing them and by not sharing food, dishes, glasses and utensils until several days after your fever has subsided and even longer, if possible.

The Epstein-Barr virus may persist in your saliva for months after the infection. There's no vaccine to prevent mononucleosis.