Mononucleosis, or mono, is a viral infection that causes fever, sore throat, and swollen lymph glands, most often in the neck.
Mono; Kissing disease; Glandular fever
Mono is often spread by saliva and close contact. It is known as "the kissing disease." Mono occurs most often in people ages 15 to 17, but the infection may develop at any age.
Mono is usually linked to the Epstein-Barr virus (EBV). Rarely, it is caused by other viruses, such as cytomegalovirus (CMV).
Mono may begin slowly with fatigue, a general ill feeling, headache, and sore throat. The sore throat slowly gets worse. Your tonsils become swollen and develop a whitish-yellow covering. Often, the lymph nodes in the neck are swollen and painful.
A pink, measles-like rash can occur, and is more likely if you take the medicine ampicillin or amoxicillin for a throat infection. (Antibiotics should NOT be given without a test that shows you have a strep infection.)
Common symptoms of mono include:
- General discomfort, uneasiness, or ill feeling
- Loss of appetite
- Muscle aches or stiffness
- Sore throat
- Swollen lymph nodes, most often in the neck and armpit
Less common symptoms:
- Chest pain
- Jaundice (yellow color to the skin and whites of the eyes)
- Neck stiffness
- Rapid heart rate
- Sensitivity to light
- Shortness of breath
Exams and Tests
Your health care provider will examine you. The exam may find:
- Swollen lymph nodes in the front and back of your neck
- Swollen tonsils with a whitish-yellow covering
- Swollen liver or spleen
- Skin rash
Blood tests will be done, including:
- White blood cell (WBC) count - will be higher than normal
- Monospot test - will be positive for infectious mononucleosis
- Antibody titer - tells the difference between a current and past infection
The goal of treatment is to relieve symptoms. Steroid medicine (prednisone) may be given if symptoms are severe.
Antiviral drugs, such as acyclovir, have little or no benefit.
To relieve typical symptoms:
- Drink plenty of fluids.
- Gargle with warm salt water to ease a sore throat.
- Get plenty of rest.
- Take acetaminophen or ibuprofen for pain and fever.
You should also avoid contact sports if your spleen is swollen (to prevent it from rupturing).
The fever usually drops in 10 days, and swollen lymph glands and spleen heal in 4 weeks. Tiredness usually goes away within a few weeks, but it may linger for 2 to 3 months.
Complications of mononucleosis may include:
- Anemia, which occurs when red blood cells in the blood are destroyed earlier than normal
- Hepatitis with jaundice (more common in patients older than 35)
- Swollen or inflamed testicles
- Nervous system problems (rare), such as Guillain-Barré syndrome, meningitis, seizures, damage to the nerve that controls movement of the muscles in the face (Bell's palsy), and uncoordinated movements (ataxia)
- Spleen rupture (rare; avoid pressure on the spleen)
- Skin rash (uncommon)
Death is possible in people who have a weakened immune system.
When to Contact a Medical Professional
The early symptoms of mono feel very much like any other illness caused by a virus. You do not need to contact a health care provider unless your symptoms last longer than 10 days or you develop:
- Abdominal pain
- Breathing difficulty
- Persistent high fevers (more than 101.5°F)
- Severe headache
- Severe sore throat or swollen tonsils
- Weakness in your arms or legs
- Yellow color in your eyes or skin
Call 911 or go to an emergency room if you develop:
- Sharp, sudden, severe abdominal pain
- Stiff neck or severe weakness
- Trouble swallowing or breathing
People with mono may be contagious while they have symptoms and for up to a few months afterwards. How long someone with the disease is contagious varies. The virus can live for several hours outside the body. Avoid kissing or sharing utensils if you or someone close to you has mono.
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Schooley RT. Epstein-Barr virus infection. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 385.
Weber R. Pharyngitis. In: Bope ET, Kellerman RD, eds. Conn's Current Therapy 2012. 1st ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 1.
Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.