Mononucleosis: Symptoms, Recovery Time and When to Be Seen

What it involves

MedlinePlus describes mononucleosis as a viral infection that causes fever, sore throat, and swollen lymph glands, most often in the neck. The Epstein-Barr virus is the usual cause. It is often spread through saliva, which earned it the nickname the kissing disease.

Who this is for

• Teens and young adults with a sore throat, fever, and tiredness that have lasted more than a week
• Patients with painful swollen glands in the neck or armpit along with deep fatigue
• Patients who were told their sore throat was strep but are not improving on treatment
• Patients who play contact sports and want to know when it is safe to return

What to expect

• Questions about how the illness began, fever, rash, appetite, and any close contact with someone ill
• An exam of the throat, neck glands, and the belly, since the spleen can swell
• Blood tests the provider chooses, which MedlinePlus says can include a white cell count and a mono test
• Advice on rest, fluids, pain relief, and when to avoid contact sports or heavy lifting

How it usually starts

MedlinePlus says mono often begins slowly, with tiredness, a general ill feeling, headache, and a sore throat that gradually gets worse. The tonsils swell and may develop a whitish-yellow coating, and glands in the neck can become swollen and painful. It occurs most often in adolescents and young adults but can happen at any age. The sore throat guide explains how it is told apart from strep.

Symptoms listed

MedlinePlus names these common symptoms of mono:

• Fever, drowsiness, and a general sense of being unwell
• Sore throat and swollen lymph nodes, most often in the neck and armpit
• Muscle aches, stiffness, and loss of appetite
• A rash, which is more likely if amoxicillin or ampicillin was taken for the throat

The rash and antibiotics

MedlinePlus points out that a pink, measles-like rash is more likely when someone takes ampicillin or amoxicillin for a throat infection, and that antibiotics should generally not be given without a test showing strep or another bacterial infection. Mono is a virus, which antibiotics do not treat, so a test is what separates the two. The swollen lymph nodes guide covers the glands themselves.

How it is confirmed

MedlinePlus says a provider checks for swollen glands, swollen tonsils, an enlarged liver or spleen, and a rash. Blood tests include a white blood cell count, a Monospot test that is positive in infectious mononucleosis, and an antibody test that can tell a current infection from a past one. The complete blood count guide explains the white cell number.

Treatment is about comfort

MedlinePlus says the goal is relief of symptoms. It lists plenty of fluids, rest, warm salt-water gargles, and acetaminophen or ibuprofen for pain and fever. It says antiviral medicine has little or no benefit, and that a steroid may be given when symptoms are severe. If the spleen is swollen, it advises avoiding contact sports to prevent it from rupturing.

How long it lasts

According to MedlinePlus, fever usually settles in about 10 days and swollen glands and spleen heal in about four weeks. Tiredness often fades within a few weeks but can linger two to three months, and nearly everyone recovers fully. Long fatigue has its own page, the fatigue guide.

When it is an emergency

MedlinePlus says to call 911 or go to an emergency room for sharp, sudden, severe belly pain, a stiff neck with severe weakness, or trouble swallowing or breathing. A visit is advised for symptoms past 10 days, a fever above 101.5 degrees, a severe headache, yellow skin or eyes, or weakness in the arms or legs.

Sources

• MedlinePlus — Mononucleosis
• MedlinePlus — Infectious Mononucleosis health topic