Does infectious mononucleosis (mono) present with a cough?

Does Infectious Mononucleosis Present with a Cough?

Infectious mononucleosis (mono) typically does not present with cough as a primary symptom. The classic presentation includes sore throat, fever, and cervical lymphadenopathy, without significant respiratory symptoms such as cough 1.

Clinical Presentation of Infectious Mononucleosis

The characteristic triad of infectious mononucleosis includes:

• Fever, tonsillar pharyngitis, and lymphadenopathy 1
• Fatigue, which can be profound and may persist for several months 1, 2
• Periorbital/palpebral edema (typically bilateral) in approximately one-third of patients 1
• Splenomegaly in approximately 50% of cases and hepatomegaly in about 10% 1
• Skin rash (usually erythematous and maculopapular) in 10-45% of patients 1

Respiratory Symptoms in Mono

• Sore throat is a predominant symptom, but cough is not typically listed among the characteristic features 3, 1
• The primary respiratory manifestation is pharyngitis, which affects the throat but does not generally cause cough 2
• Unlike viral upper respiratory infections that commonly present with cough, EBV infection primarily affects lymphoid tissue rather than the lower respiratory tract 4

Differential Diagnosis Considerations

When evaluating patients with respiratory symptoms:

• Acute cough is most commonly associated with viral upper respiratory tract infections, but these are distinct from EBV infection 5
• Post-infectious cough can persist for weeks following respiratory infections but is not a typical sequela of mono 5
• If a patient with suspected mono presents with significant cough, clinicians should consider alternative or concurrent diagnoses 5

Diagnostic Approach

• The diagnosis of infectious mononucleosis is supported by the presence of:
  • Atypical lymphocytosis (≥20% or ≥10% with lymphocytosis of ≥50%) 2
  • Positive heterophile antibody test (monospot test) 1, 2
  • If monospot is negative but clinical suspicion is high, serologic testing for antibodies to viral capsid antigens is recommended 1

Management Considerations

• Treatment is mainly supportive, including adequate hydration, analgesics, and antipyretics 1, 2
• Activity should be guided by the patient's energy level, with avoidance of contact sports for at least 8 weeks due to risk of splenic rupture 6
• Patients should be monitored for complications, particularly splenic rupture, which occurs in 0.1-0.5% of cases 1

Key Takeaway

When evaluating a patient with suspected infectious mononucleosis who presents with prominent cough, clinicians should consider alternative or concurrent diagnoses, as cough is not a typical feature of EBV infection 1, 2. The presence of significant cough may suggest another viral infection, bacterial infection, or other respiratory condition 5.