Cold Symptoms in Mononucleosis
Yes, mononucleosis commonly presents with cold symptoms including nasal congestion, rhinorrhea, and sneezing in addition to the classic triad of sore throat, fever, and fatigue.
Clinical Presentation of Mononucleosis
Classic Symptoms
- Fever (present in most cases)
- Sore throat/pharyngitis (often severe)
- Fatigue (may be profound and persist for months)
- Lymphadenopathy (particularly posterior cervical)
Cold-Like Symptoms
- Nasal congestion and rhinorrhea
- Sneezing
- Cough
The Centers for Disease Control and Prevention recognizes that mononucleosis presents with a constellation of symptoms that overlap with common cold symptoms 1. The hallmark symptoms of the common cold include nasal stuffiness, nasal discharge, sneezing, sore throat, and cough, which can also be present in mononucleosis 2.
Distinguishing Features of Mononucleosis
While mononucleosis shares cold symptoms with upper respiratory infections, several features help distinguish it:
Key Distinguishing Features
- Duration: Symptoms persist longer in mononucleosis (weeks rather than days)
- Severity: More profound fatigue than typical cold
- Lymphadenopathy pattern: Posterior cervical adenopathy is particularly suggestive (positive LR 3.1) 3
- Additional findings: Presence of palatine petechiae (specificity 95%) and splenomegaly (in approximately 50% of cases) 4, 3
Laboratory Findings
- Lymphocytosis (lymphocytes ≥50% of white blood cells)
- Atypical lymphocytes (>10% of total lymphocyte count)
- Positive heterophile antibody test (Monospot)
Symptom Comparison with Common Cold
| Symptom | Mononucleosis | Common Cold |
|---|---|---|
| Nasal congestion | Common | Very common |
| Rhinorrhea | Common | Very common |
| Sore throat | Severe, prolonged | Mild to moderate |
| Fatigue | Profound, may last months | Mild to moderate |
| Fever | High, persistent | Low-grade if present |
| Lymphadenopathy | Prominent, posterior cervical | Mild if present |
| Duration | Weeks to months | 7-10 days |
Clinical Pearls
- Periorbital and/or palpebral edema, typically bilateral, occurs in approximately one-third of mononucleosis patients 4
- A skin rash occurs in 10-45% of cases and is usually maculopapular 4
- The risk of splenic rupture (0.1-0.5% of cases) necessitates avoidance of contact sports for 4-8 weeks 1, 4
- Hepatomegaly occurs in approximately 10% of mononucleosis cases 1
Management Considerations
- Supportive care is the mainstay of treatment
- Adequate hydration, analgesics, and antipyretics for symptom relief
- Rest guided by patient's energy level
- Avoid contact sports or strenuous exercise for 4-8 weeks
- Corticosteroids may be considered for severe pharyngeal edema or respiratory compromise
- Antiviral agents are not recommended for routine treatment
In a study comparing mononucleosis to other upper respiratory infections, patients with mononucleosis were found to be sicker for longer periods, with symptoms of fatigue, night sweats, and painful neck swelling being significantly more common and severe 5.