Symptoms of Mononucleosis (Mono)
Mononucleosis is characterized by fever, sore throat, swollen lymph nodes in the neck, fatigue, and hepatosplenomegaly, with symptoms typically lasting several weeks. 1, 2
Common Symptoms
- Fever: Often persistent or intermittent, can reach as high as 40°C 1
- Sore throat: Typically severe and may include pharyngitis or tonsillitis 3
- Lymphadenopathy: Primarily affecting cervical lymph nodes, but can include posterior cervical or auricular nodes 2
- Fatigue: Often debilitating and may persist for months after acute infection resolves 2
- Hepatosplenomegaly: Enlargement of liver and spleen is common 1, 4
Laboratory Findings
- Blood abnormalities: Elevated white blood cell count with atypical lymphocytosis (≥20% atypical lymphocytes or ≥10% atypical lymphocytes with ≥50% lymphocytosis) 1, 2
- Liver function: Mild elevations in liver function tests are common 1
- Serological markers: Positive heterophile antibody test (Monospot) in most adolescents and adults, though false negatives can occur early in infection 1, 2
- EBV-specific antibodies: Presence of VCA IgM (with or without VCA IgG) in the absence of EBNA antibodies indicates recent primary infection 1
Less Common Symptoms
- Palatal petechiae: Small red spots on the roof of the mouth 2
- Skin rash: Maculopapular rash may occur, especially in patients treated with antibiotics 1
- Neurological symptoms: Headache and rarely more severe neurological complications 1
- Respiratory issues: Interstitial pneumonitis can develop in some cases 1
- Ocular symptoms: Various eye-related complications may occur 1
Complications
- Splenic enlargement: Poses risk of rupture, particularly with physical exertion 5
- Airway obstruction: Severe pharyngeal edema can compromise breathing 2, 3
- Peritonsillar abscess: Can develop as a complication of severe tonsillitis 5
- Hematologic complications: Including anemia, thrombocytopenia, and neutropenia in severe cases 1
- Splenic infarction: A rare complication that can occur due to transient hypercoagulable state 5
Treatment Approach
- Supportive care: The mainstay of treatment includes adequate hydration, analgesics, and antipyretics 2
- Rest: Should be guided by the patient's energy level rather than enforced bed rest 2
- Activity restriction: Patients should be withdrawn from contact or collision sports for at least four weeks to prevent splenic rupture 2
- Corticosteroids: Not recommended for routine treatment but may benefit patients with respiratory compromise or severe pharyngeal edema 2
- Antiviral medications: Acyclovir is not recommended for routine treatment of infectious mononucleosis 2
Special Considerations
- Age differences: While adolescents and young adults typically present with the classic triad of symptoms, children under 10 years often have milder or asymptomatic infections 4
- Duration: Acute symptoms typically last 2-4 weeks, but fatigue may persist for several months 2
- Differential diagnosis: Consider other causes of similar symptoms, including streptococcal infection, cytomegalovirus, toxoplasmosis, and other viral infections when heterophile antibody tests are negative 2
When to Seek Medical Attention
- Severe abdominal pain: May indicate splenic rupture requiring immediate medical attention 5
- Difficulty breathing: Could indicate airway compromise requiring urgent intervention 2, 3
- Persistent high fever: Unresponsive to antipyretics 1
- Severe dehydration: Due to inability to swallow liquids 2
- Prolonged symptoms: Symptoms persisting beyond 4-6 weeks may warrant further investigation 2