From the Guidelines
Symptoms of mononucleosis in adults typically include extreme fatigue, sore throat, fever, swollen lymph nodes in the neck and armpits, swollen tonsils, headache, skin rash, and soft, swollen spleen. These symptoms are caused by the Epstein-Barr virus (EBV) and can be diagnosed through laboratory testing, including an elevated white blood cell count with an increased percentage of atypical lymphocytes, as well as the presence of heterophile antibodies or EBV-specific antibodies such as IgG and IgM to viral capsid antigen (VCA) and Epstein-Barr nuclear antigen (EBNA) 1. Adults often experience more pronounced fatigue that can last for weeks or even months, along with body aches and a general feeling of unwellness. Some key points to consider in the diagnosis and management of mono in adults include:
- Liver involvement may occur, causing mild jaundice and elevated liver enzymes in some cases 1
- Unlike children, adults are more likely to develop complications such as significant throat swelling and prolonged fatigue syndrome
- The severity of symptoms usually peaks during the first 2-3 weeks of illness
- Treatment is primarily supportive, including rest, adequate hydration, and over-the-counter pain relievers like acetaminophen or ibuprofen for fever and sore throat
- Adults with mono should avoid contact sports and heavy lifting for at least 4 weeks due to the risk of splenic rupture, as indicated by the presence of EBV DNA, RNA or protein in biopsy tissue 1. If symptoms are severe or persistent, medical attention should be sought, as some symptoms can mimic other serious conditions.
From the Research
Symptoms of Mono in Adults
The symptoms of mono in adults can be severe and prolonged, sometimes causing serious complications 2. The common symptoms of mono in adults include:
- Fever
- Tonsillar pharyngitis
- Lymphadenopathy
- Fatigue, which may be profound but tends to resolve within three months
- Periorbital and/or palpebral edema, typically bilateral, occurs in one-third of patients
- Splenomegaly and hepatomegaly occur in approximately 50% and 10% of cases, respectively
- A skin rash, which is usually widely scattered, erythematous, and maculopapular, occurs in approximately 10 to 45% of cases
Diagnosis and Treatment
The diagnosis of mono in adults is usually made based on a combination of clinical presentation and laboratory tests, including complete blood count with differential and a rapid heterophile antibody test 3. The treatment of mono in adults is mainly supportive, with reduction of activity and bed rest as tolerated, and patients should be advised to avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present 4. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to relieve symptoms, especially in patients with atopic predispositions 2.
Complications and Long-term Consequences
Mono in adults can lead to serious complications, such as spontaneous splenic rupture, which occurs in 0.1 to 0.5% of patients with infectious mononucleosis and is potentially life-threatening 4. Long-term consequences of mono in adults include an increased risk of chronic fatigue syndrome, certain cancers, and autoimmune diseases, such as Hodgkin lymphoma and multiple sclerosis 5, 6, 3.