Mononucleosis, or mono as it’s more commonly referred to, is an infection that’s primarily caused by the Epstein-Barr virus (EBV). Symptoms in teens and adults tend to be worse than those in younger individuals. Symptoms are similar to those of a cold or the flu, including fever, severe sore throat, muscle aches, and extreme exhaustion. (1,2) Doctors aren’t sure exactly why, but children tend to have milder mono symptoms than adults. Some children who get mono experience nothing more than a slight fever and brief loss of appetite, and seem a little more tired than usual. Some doctors suspect some cases of mono in young children likely go undiagnosed because symptoms are so mild and are mistaken for those of a cold or the flu. “The younger you are, the harder to tell if it’s EBV,” says Eric Johannsen, MD, associate professor of infectious disease in the Department of Medicine at the University of Wisconsin’s School of Medicine and Public Health in Madison, who specializes in EBV. “Some people have very mild illness. But in others who are immunocompromised, mono can be potentially life-threatening.” If you are experiencing symptoms, particularly if they last longer than a week, it’s a good idea to see your doctor, who can determine if you do have mononucleosis and rule out other problems. Typically doctors don’t prescribe specific drugs to treat mono, but there are steps you can take to help minimize symptoms, and there are important precautions to take to ensure a smooth recovery. Another reason it’s important to get diagnosed if you do have mono is so you can take precautions to avoid spreading it, as the virus is contagious — and you’ll continue to be contagious for a long time after symptoms go away.
Swollen lymph nodes on your neckInflamed tonsilsSwollen liver or spleenFeverPinkish skin rash resembling measles that’s all over the body
RELATED: 11 Fascinating Facts About Body Temperature In many cases, no further tests are needed to make a diagnosis of mono. In other cases, your healthcare provider may also order lab tests to get more information and rule out other illnesses that may be causing your symptoms. Such lab tests can be useful in identifying the cause of illness in people with atypical mono symptoms or in those who have another infection that can be caused by EBV. These tests may include:
Mononucleosis Spot Test
The mononucleosis spot test, or monospot test (a type of heterophile test), checks your blood for antibodies that are produced in response to EBV infection. It’s relatively inexpensive, fast, and easy to perform; it’s a simple blood test and results can come back in a day. But there are a few drawbacks: It may not detect the infection until the second week of illness, so the results may come back as negative even if you have mono if the test is done too soon after you’ve been infected. Plus, studies have also shown that the test can yield false positives, according to a 2015 review article. (3,4) (The antibodies detected by a monospot test can be caused by conditions other than mono, such as hepatitis, toxoplasmosis, or lymphoma, for instance.) And it’s especially not effective in diagnosing mono in young children. (5,6)
EBV Antibody Test
This antibody test can help determine whether you have ever been infected with the EBV virus and also reveal how recent the infection was. (3) EBV antibody testing is usually done when you have symptoms but you test negatively for mono according to a monospot test. (7) Results take longer for an EBV antibody test, but (unlike the monospot test) it can detect mono within the first week of symptoms. (6)
Blood Tests
Your doctor may also review your blood work to look for an elevated number of lymphocytes (a type of white blood cell) or abnormal lymphocytes, which may indicate an infection. (6) These tests won’t confirm that you have mono, but a higher than normal number of lymphocytes or the presence of abnormal lymphocytes can be an indication that you have the illness. (6) In most cases, mononucleosis runs its course and your symptoms will go away on their own in about two to four weeks, though you may feel tired for a few more weeks after that. Like the virus that causes chickenpox, the EBV virus will most likely stay dormant in your body without causing any problems after symptoms subside. To recover from mono without complication, your doctor will likely recommend: (1,2,6,8,9):
Lots of liquids (water, soup, broth) to prevent dehydrationTea with honey, gargling with salt water, or cough drops to soothe your sore throatEating healthy foods to keep your strength up and your immune system healthyAvoiding any strenuous or high-impact exercise or activities for at least a month after your symptoms have gone away, to reduce your risk of rupturing your spleen, a life-threatening emergency that needs to be treated right awayOver-the-counter medication, such as acetaminophen (Tylenol) or ibuprofen (Advil) for fever and pain
While some adults might use aspirin to reduce pain in general, children and teens should never take aspirin in this case. For younger people, taking such medication when recovering from a viral infection has been linked to an increased risk of Reye’s syndrome, a very serious illness that can cause liver and brain damage. (10) It’s important to keep in mind that getting plenty of rest and avoiding exhausting activity is key to healing when you have mono — usually for at least a month after symptoms start to go away. (6) Your doctor will also likely advise that you avoid vigorous activities and contact sports during this time to avoid the risk of rupturing your spleen (as mono causes it to enlarge), which can result in severe, life-threatening bleeding. While it may be tempting to get out of bed once you start to feel better, the reality is that trying to get back into normal routines before being fully healed can backfire and delay recovery or cause further complications, especially for teens and adults who tend to be hit harder by mono infections, explains Octavio Ramilo, MD, chief of infectious disease at Nationwide Children’s Hospital in Columbus, Ohio. “Teens who have been infected need to rest,” he says. In rare cases, a patient may have a streptococcal (strep) infection, tonsillitis, or a sinus infection at the same time as mononucleosis. In those instances, antibiotics may be required to treat those bacterial infections. (But antibiotics are not effective in treating mono in the absence of these other bacterial infections.) (1,4,6) In some rare cases, doctors may prescribe antiviral drugs, especially for patients who develop chronic mono, or chronic active Epstein-Barr virus infection, which is when the EBV infection causes mono symptoms that persist and progress longer than is typical; or for patients who experience other complications after a mono infection (also a rare occurrence). Antiviral drugs like acyclovir (Zovirax) and valacyclovir (Valtrex) have been shown to improve symptoms of chronic mono in some patients. (1,6,9,12) Still, for most patients, the most important part of recovering from mono is resting and giving yourself time off before returning to normal activities.
