Mononucleosis (‘Mono’) – An Epstein-Barr Virus Infection

Last Updated on July 29, 2021 by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT

How do you get Mononucleosis/How can you get Mononucleosis? Mononucleosis Causes:

Mononucleosis (“Mono”) is a general infection caused by the Epstein-Barr virus (EBV) but can also be caused by other organisms such as cytomegalovirus (CMV).

In the United States, about 50% of all children 5 years of age and nearly 95% of adults have had an EBV infection. Most of these infections cause symptoms similar to those of a cold or other mild viral infections.

Sometimes adolescents and young adults develop different and more severe symptoms from EBV infection.

This disease is called infectious mononucleosis. Infectious mononucleosis is named for the large numbers of white blood cells (mononuclear cells) in the bloodstream. Adolescents and young adults usually catch infectious mononucleosis by kissing or having other intimate contact with someone who has EBV.

‘Mono’ is often called the “kissing disease,” because it is spread mainly by contact with saliva or mucus from someone with mono, and because mono is common in adolescents. It can also be spread by sharing a drinking glass or silverware, or being coughed on by someone who has it.

However, mononucleosis isn’t as contagious as some infections, such as the common cold.

How to tell if you have Mononucleosis? Mononucleosis Symptoms:

Mono may begin slowly with fatigue, a general ill feeling, headache, and sore throat. The sore throat slowly gets worse. Your tonsils become swollen and develop a whitish-yellow covering. The lymph nodes in the neck are frequently swollen and painful.

A pink, measles-like rash can occur and is more likely if you take the medicines ampicillin or amoxicillin for a throat infection. (Antibiotics should NOT be given without a positive Strep test.)

Symptoms of mononucleosis include:

• Drowsiness
• Fever
• General discomfort, uneasiness, or ill feeling
• Loss of appetite
• Muscle aches or stiffness
• Rash
• Sore throat
• Swollen lymph nodes, especially in the neck and armpit
• Swollen spleen

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Less frequently occurring symptoms include:

• Chest pain
• Cough
• Fatigue
• Headache
• Hives
• Jaundice (yellow color to the skin)
• Neck stiffness
• Nosebleed
• Rapid heart rate
• Sensitivity to light
• Shortness of breath

Sometimes, a swollen spleen or liver involvement may develop and heart problems or involvement of the central nervous system occurs only rarely.

How to know if you have Mononucleosis? Mononucleosis Tests:

During a physical examination, the doctor may find swollen lymph nodes in the front and back of your neck, as well as swollen tonsils with a whitish-yellow covering.

The doctor might also feel a swollen liver or swollen spleen when pushing on your belly. There may be a skin rash.

Blood work often reveals a higher-than-normal white blood cell (WBC) count and unusual-looking white blood cells called atypical lymphocytes, which are seen when blood is examined under a microscope. Atypical lymphocytes and abnormal liver function tests are a hallmark sign of the disease.

Relief spells (Rolaids?!) Mononucleosis Treatment:

There is no specific treatment.

People with infectious mononucleosis may be as active as they want. However, because of the risk of rupturing the spleen, heavy lifting and contact sports should be avoided for 1 month, even if the spleen is not noticeably enlarged. Before such activities are resumed, doctors may wish to confirm that the spleen has returned to normal size.

What’s going to happen to me?!!?! Mononucleosis Expectations:

The fever usually drops in 10 days, and swollen lymph glands and spleen heal in 4 weeks. Fatigue usually goes away within a few weeks, but may linger for 2 to 3 months.

Things to be aware of… Mononucleosis Complications:

• Death in persons with weakened immune systems
• Hemolytic anemia
• Hepatitis with jaundice (more common in patients older than 35)
• Inflammation of the testicles (orchitis)
• Neurological complications (rare), including:
  • Guillain-Barre syndrome
  • Meningitis
  • Seizures
  • Temporary facial paralysis (Bell’s palsy)
  • Uncoordinated movements (ataxia)
  • Secondary bacterial throat infection
  • Spleen rupture (rare; avoid pressure on the spleen)

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