Mononucleosis: signs, symptoms, and complications


Mononucleosis (mono) is a viral infection (usually caused by the Epstein-Barr virus) that most often affects adolescents and young adults. Typical symptoms in these age groups are sore throat, fever, swollen cervical glands, enlarged tonsils, and fatigue. In young children, symptoms may be mild or absent. Older people are more likely to have jaundice and may not have a sore throat or swollen glands. People often have a variety of symptom combinations, from mild to severe.

© Get Information on Medicines, 2018

Frequent symptoms

The incubation period for mononucleosis is four to six weeks, which means that you or your child may not develop symptoms for up to a month after being in contact with another infected person.

Most children and adolescents start out slowly with mononucleosis , with mild symptoms such as headache, malaise , and fatigue that usually occur over three to five days.

The following are the classic symptoms of mononucleosis:

  • Severe sore throat
  • Swollen, red tonsils covered with pus
  • Swollen lymph nodes ( lymphadenopathy ) in the neck and armpits, but it is also possible in the groin.
  • Temperatures range from 100 to 103 degrees, which can last for one to two weeks and often peak in the afternoon or early evening.
  • Constant malaise and fatigue, which can be very serious.
  • Muscle pain and headache
  • A pink, measles-like rash is more common after taking antibiotics.
  • Nausea
  • Abdominal pain

The combination of symptoms, their severity, and their duration vary from person to person. The younger the child, the easier and shorter the illness.

An enlarged spleen ( splenomegaly ) or liver may appear after two to three weeks of illness. An enlarged spleen is seen in about half of the cases at some stage of the disease. Jaundice, which causes a yellow tint to the skin and the whites of the eyes, is a sign of liver damage.

Young children may have mild, short-term symptoms that last only a few days. In adolescents and young adults, monotherapy is notorious for its duration, although the usual course for this age group is two to four weeks. Some symptoms, such as fatigue, can last from several weeks to six months.

Rare symptoms

Less common symptoms of mononucleosis include chest pain, cough, shortness of breath, rapid heart rate, hives, stiff neck, nosebleeds, and sensitivity to light. Swollen or inflamed testicles can also develop.

Younger children

In young children, the symptoms of mononucleosis are usually milder than in adolescents and young adults. The baby may have no or mild symptoms. Young children with mononucleosis may be slightly irritable and have less appetite. On the other hand, they may also have mild symptoms of an upper respiratory infection , such as a cough, runny nose, or mild fever .

Some children have unusual or atypical cases of mononucleosis; for example, they develop an enlarged gland, but without a sore throat or fever. Or the only symptoms they have are a sore throat or a high fever. In any case, one of the signs that these symptoms may be related to mononucleosis is that they persist much longer than seems normal.

Monkey often goes unnoticed

You may never know that a child has mononucleosis unless blood tests show they have atypical lymphocytosis or antibodies that indicate mononucleosis. Later, a positive test for the Epstein-Barr virus (EBV) can reveal previous infection. The good news is that there is generally no treatment for mononucleosis other than symptom relief, so the opportunity for medical intervention was not missed.

Older people (40 years or older)

Older people often have a fever that lasts more than two weeks, and other general symptoms, such as swollen glands and a sore throat, may not appear. Your symptoms may last longer. They are more likely to have jaundice and lab tests will show high levels of bilirubin and liver enzymes, and their white blood cell count will not be as high or show as many lymphocytes as in young people .


Mononucleosis complications can develop and be quite serious. They include the following.

  • Anemia: Mononucleosis can cause red blood cells to die and the spleen to remove them from the bloodstream earlier than usual. Your bone marrow may not be able to handle this faster exchange, causing anemia.
  • Hepatitis with jaundice: Liver damage is usually mild, but you shouldn't drink alcohol while you have monosymptoms .
  • Rupture of the spleen : The spleen can become enlarged due to mononucleosis and, although rarely, it can rupture later, an emergency that can cause massive internal bleeding, often life-threatening. With mononucleosis, it is important to avoid contact sports and physical activity, as they can cause this complication. Your spleen is not necessary for good health, but you may be at increased risk for Streptococcus pneumoniae and other germs. if you delete it.
  • Nervous system complications: Although rare, the nervous system can also be affected by mononucleosis. Associated complications include Guillain-Barr√© syndrome, seizures, meningitis, and Bell's palsy.
  • Fulminant EBV infection: rare, but people with weakened immune systems due to HIV, immunosuppressive therapy for organ transplants, or X-linked lymphoproliferative diseases can develop uncontrolled EBV infection and die from mononucleosis .
  • Inflammation of the heart : The most common (although rare) heart complication with monotherapy is inflammation of the sac around the heart, known as pericarditis. This can lead to atrial fibrillation. The virus can also infect the heart muscle and cause myocarditis.

There are also certain complications to be aware of for certain groups of people:


In young children, airway obstruction due to enlarged tonsils is possible and may require hospitalization. Your pediatrician may mistake mononucleosis symptoms for a bacterial infection (such as strep throat) and prescribe antibiotics such as ampicillin, amoxicillin, or a related penicillin. -like antibiotics. These antibiotics will not work due to the mono-viral infection. Also, children sometimes develop severe skin rashes as a result of taking these medications .

Pregnant and lactating women

Epstein-Barr virus infectious mononucleosis appears to have little or no effect on pregnancy outcome, although there is some possible correlation with preterm delivery and low birth weight .

Some women experience a reactivation of EBV during pregnancy. Epstein-Barr can be passed to a newborn during childbirth. However, babies are often asymptomatic when infected with EBV, so this is not a health problem. Breast milk can contain the virus, but it is not clear if it can cause an infection in a baby.

When to contact a healthcare provider

If symptoms of mononucleosis appear, you should see your doctor to diagnose and rule out other conditions for which other treatments may be recommended. Do not rely on self-diagnosis.

Besides EBV, other viruses can cause symptoms similar to mononucleosis. These include cytomegalovirus (CMV), adenovirus, human immunodeficiency virus (HIV), rubella, hepatitis A, and human herpesvirus-6. The Toxoplasma gondii parasite can also cause symptoms similar to mononucleosis. If you are pregnant or could become pregnant, some of these conditions can be dangerous for you or your baby. Additional tests may be prescribed to determine the cause of your monosymptoms.

Guide to Talking to Your Doctor About Mononucleosis

Get our printed guide to your next doctor's appointment to help you ask the right questions.

Once diagnosed, you can get other medical conditions. For example, you can get strep throat in addition to mononucleosis . If you or your child have a severe and prolonged sore throat or swollen tonsils that make it difficult to breathe or swallow, see your doctor. Strep throat can be diagnosed with a rapid strep test. Antibiotics are needed to treat sore throats and prevent complications. You should also see your doctor if you have any difficulty breathing due to enlarged tonsils.

Signs of an Emergency

Signs of a ruptured spleen include sudden, sharp pain in the upper left abdomen. You should go to the hospital right away and call 9-1-1. A ruptured spleen usually requires a blood transfusion and may require splenectomy surgery to remove the spleen and control internal bleeding.

Mononucleosis symptoms usually improve after four to six weeks. If they continue, you should see your doctor as you may actually be dealing with a different problem. Your healthcare provider may perform additional tests to determine the cause of your symptoms.

Frequently asked questions

  • Mono generally goes through three distinct phases :

    • Incubation: You are infected with the Epstein-Barr virus (EBV), which causes mononucleosis but has no symptoms yet.
    • Acute : You have active symptoms.
    • Convalescent : Acute symptoms have disappeared, but you still feel tired and weak.

  • When you first become infected with the Epstein-Barre virus, it is unlikely that you will feel anything different, as symptoms may appear after a few weeks. When they do, you may feel like you have a typical viral infection until you develop a severe sore throat and your tonsils become red and stained with white pus .

  • No. Children with EBV infection rarely develop symptoms. Among young people between 18 and 22 years old, 75% have classic monosymptoms, 15% have symptoms not usually associated with the disease, such as abdominal pain, nausea and vomiting, and 10% are asymptomatic.

  • In the end, but it takes time. Mononucleosis is a viral infection , so there is no medicine to treat it; it must run its own course. You can speed up your recovery by getting plenty of rest and drinking plenty of fluids.

Related Articles
Choosing foods to diet after a heart attack

All cardiovascular specialists agree that a healthy diet is important to reduce the risk of coronary artery disease (CHD) Read more

Different types of hysterectomies.

A hysterectomy is the surgical removal of all or part of a woman's uterus . Hysterectomy is usually done Read more

Esthetician: experience, specialties and training

An esthetician is a person who specializes in cosmetic skin care. Cosmetologists (sometimes called estheticians ) are not medical Read more

Benefits, Side Effects, Dosages, and Interactions.

CBD oil is an extract from Cannabis indica or Cannabis sativa , the same plants that produce marijuana when Read more