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Patient education: Infectious mononucleosis (mono) in adults and adolescents (Beyond the Basics)

Patient education: Infectious mononucleosis (mono) in adults and adolescents (Beyond the Basics)
Literature review current through: Jan 2024.
This topic last updated: Jul 27, 2023.

INFECTIOUS MONONUCLEOSIS OVERVIEW — Infectious mononucleosis, also known as "mono" or the "kissing disease," is an infection that typically causes fever, sore throat, fatigue, and/or enlarged lymph nodes in the neck. It most commonly occurs in adolescents and young adults.

In general, mononucleosis is not considered a serious illness. However, mononucleosis can lead to significant loss of time from school or work due to profound fatigue and, on rare occasions, can cause severe or even life-threatening illness.

This topic will discuss the symptoms, diagnosis, and treatment of mononucleosis in adolescents and adults.

HOW DID I GET MONO? — Infectious mononucleosis is caused by the Epstein-Barr virus (EBV). EBV can spread through contact with saliva from an infected person; for example, you can get it through kissing, sharing eating utensils with, or drinking from the same glass as someone who is infected with the virus.

Many people are exposed to EBV at some point during childhood, although they may not realize it at the time. For adolescents and young adults who were not infected as a child, exposure often results from contact with an infected person's saliva. After a person has been exposed, the virus remains in their body for the rest of their life. This condition is called "viral latency," meaning it is dormant or inactive and not causing symptoms. People spread the infection to others without realizing it through intermittent shedding of the virus through their saliva. In addition, it may also be possible to spread the virus through other bodily fluids, such as semen or vaginal secretions.

MONO SYMPTOMS — Most young children infected with Epstein-Barr virus (EBV) do not develop symptoms. In contrast, people first exposed to EBV as adolescents or adults are more likely to develop a symptomatic infection due to how their immune systems respond to the virus at these older ages.

Common symptoms — It may take four to eight weeks after initially acquiring the virus for the first symptoms (such as body aches, headache, and low-grade fever) to appear. The most common mono symptoms include:

Fever (temperature greater than 100.4°F or 38°C)

Sore throat

Enlarged lymph nodes in the neck (and sometimes elsewhere in the body)

Fatigue, which may be severe and can occasionally last for more than a month

Some people have all of these symptoms, while others have only one or two symptoms, such as sore throat or fever and enlarged lymph nodes. Young children and older adults may have only a fever and muscle aches.

Enlargement of the spleen — The spleen is an organ in the left upper abdomen, just under the diaphragm (figure 1). It becomes enlarged in about half of people with mono. Due to the spleen enlarging, doctors recommend avoiding contact sports or heavy lifting for a few weeks. This advice is given to prevent the rare complication of splenic rupture causing hemorrhage that can occur after trauma but can also happen spontaneously. Symptoms of rupture include sudden, sharp pain in the abdomen, especially on the left side. Sometimes the left shoulder hurts; this is due to "referred pain" from blood irritating the diaphragm.

Splenic rupture is a potentially life-threatening complication that requires immediate medical treatment. Therefore, any severe abdominal pain in someone with mono is an emergency that requires urgent evaluation. (See 'When can I go back to work or school?' below.)

HOW IS MONO DIAGNOSED? — Mono may be suspected based on a person's symptoms and physical examination. Blood tests are done to confirm the diagnosis. However, one commonly used blood test for diagnosis in North America, known as the Monospot, can be falsely negative during the first weeks of symptoms. Your doctor might also order tests for other infections with similar symptoms, especially when initial testing is negative.

MONO TREATMENT — The goal of mono treatment is to ease the symptoms while the immune system contains the virus. Antibiotics (which are used to treat bacterial infections) are not helpful because a virus causes mono. No antiviral medications are known to treat or cure Epstein-Barr virus effectively.

Pain and fever — Sore throat, muscle aches, and fever can be treated with nonprescription medications, such as acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Motrin, Advil). The liver breaks down acetaminophen. For this reason, it is important to closely follow the dosing instructions or your healthcare provider's instructions to take this medication safely. Acetaminophen and ibuprofen are also recommended for use in children. Aspirin should not be given to young children with mono because of possible liver complications.

Rest — Mono can cause severe fatigue, although most people recover within two to four weeks. For some, significant tiredness lasts for weeks to months. Early in the infection, it is important to get adequate rest, although complete bed rest is unnecessary.

Diet — Feeling ill often causes a loss of appetite. This is normal and usually improves as the infection resolves. It is essential, even if you have no appetite, to drink an adequate amount of fluids. This is especially true if you take ibuprofen for pain or fever because ibuprofen can affect kidney function if you become dehydrated. You are drinking adequate fluids if your urine is a pale yellow color.

WHEN CAN I GO BACK TO WORK OR SCHOOL? — People with mono, who develop an enlarged spleen are at risk of splenic rupture until the spleen returns to normal size. This can take a few weeks or longer. Although you can return to school or work when you are feeling better, it's important to avoid activities that can cause injury to the spleen.

Experts generally recommend that athletes not participate in contact or vigorous sport activities for at least the first three to four weeks of the illness. Your health care provider should determine when it is safe for you to participate in strenuous activities or contact sports.

When you begin participating in sports activities again, we recommend starting slowly, increasing activity gradually. Even highly trained athletes may not feel as fit after mono as before the illness.

WHEN WILL I FEEL BETTER? — Most people who suffer from infectious mono recover entirely without long-term complications. Symptoms usually begin to improve within one to two weeks.

WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients and selected articles written for health care professionals are also available. Some of the most relevant are listed below.

Patient-level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and prefer short, easy-to-read materials.

Patient education: Mononucleosis (The Basics)
Patient education: Swollen neck nodes in children (The Basics)
Patient education: Cytomegalovirus (The Basics)
Patient education: When to worry about a fever in adults (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

This topic currently has no corresponding Basic content.

Professional-level information — Professional-level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, containing multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with medical terminology and want to read the same materials their doctors are reading.

Clinical manifestations and treatment of Epstein-Barr virus infection
Overview of diagnostic tests for cytomegalovirus infection
Epidemiology, clinical manifestations, and treatment of cytomegalovirus infection in immunocompetent adults
Evaluation of acute pharyngitis in adults
Infectious mononucleosis

Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. 2024© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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