From the Guidelines
Mononucleosis (mono) symptoms typically include extreme fatigue, sore throat, fever, swollen lymph nodes in the neck and armpits, swollen tonsils, headache, skin rash, and soft, swollen spleen, as noted in the 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM) 1.
Common Symptoms
- Extreme fatigue
- Sore throat
- Fever
- Swollen lymph nodes in the neck and armpits
- Swollen tonsils
- Headache
- Skin rash
- Soft, swollen spleen Many people also experience loss of appetite and muscle aches. The severity of symptoms varies widely between individuals, with some experiencing mild discomfort while others have debilitating fatigue.
Diagnosis and Treatment
Symptoms usually appear 4-6 weeks after exposure to the Epstein-Barr virus (EBV), which causes most mono cases, and can be diagnosed using a Monospot test or EBV-specific serologic testing 1, 2. Fatigue can persist for weeks or even months after other symptoms resolve. Treatment focuses on managing symptoms with rest, adequate hydration, and over-the-counter pain relievers like acetaminophen or ibuprofen for fever and sore throat. Avoiding contact sports is crucial until fully recovered to prevent rupturing the enlarged spleen. Most people recover completely without specific antiviral treatment, as the immune system naturally fights off the infection. If symptoms are severe or persistent, medical evaluation is recommended to rule out complications or other conditions.
From the Research
Symptoms of Mono
- Fever, tonsillar pharyngitis, and lymphadenopathy are the characteristic triad of symptoms of infectious mononucleosis 3
- Fatigue may be profound but tends to resolve within three months 3
- Periorbital and/or palpebral edema, typically bilateral, occurs in one-third of patients 3
- Splenomegaly and hepatomegaly occur in approximately 50% and 10% of cases, respectively 3
- A skin rash, which is usually widely scattered, erythematous, and maculopapular, occurs in approximately 10 to 45% of cases 3
- Peripheral blood leukocytosis is observed in most patients; lymphocytes make up at least 50% of the white blood cell differential count 3
- Atypical lymphocytes constitute more than 10% of the total lymphocyte count 3
- Nocturnal fever, general fatigue, pharyngitis, and lymphadenopathy are also common symptoms of infectious mononucleosis 4
- Sore throat, cervical lymph node enlargement, fatigue, and fever are typical symptoms of infectious mononucleosis, usually seen in adolescents and young adults and lasting several weeks 5
- Posterior cervical lymphadenopathy is a characteristic symptom of infectious mononucleosis 6
Diagnosis and Treatment
- The classic test for infectious mononucleosis is the demonstration of heterophile antibodies 3
- The monospot test is the most widely used method to detect the serum heterophile antibodies of infectious mononucleosis 3
- Serologic testing for antibodies to viral capsid antigens is recommended when confirmation of the diagnosis of infectious mononucleosis is required in patients with mononucleosis-like illness and a negative mono-spot test 3
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may dramatically improve the deteriorating symptoms quickly after the initiation in patients with atopic predispositions 4
- Treatment of infectious mononucleosis is supportive; routine use of antivirals and corticosteroids is not recommended 6
- Current guidelines recommend that patients with infectious mononucleosis not participate in athletic activity for three weeks from onset of symptoms 6