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Table of Contents
Frequent Symptoms
Complications
Managing Symptoms
When to See a Provider
Next in Mononucleosis Guide
Mononucleosis (“mono”) symptoms include a sore throat, swollen lymph nodes, fever, and fatigue. A cough and respiratory symptoms are less likely with viral infections such as mono. The lack of these symptoms can help differentiate mononucleosis from other infections with similar symptoms.
This article looks at common and uncommon signs of mononucleosis, including possible complications and treatments. It also explains when it is time to see a healthcare provider if you get mono.
© Verywell, 2018
Theincubation periodfor mononucleosis (meaning the time between exposure and the appearance of symptoms) is four to six weeks, When symptoms appear, they tend to come on gradually, causing three to five days of non-specific symptoms like headache,fatigue, andmalaise(a general feeling of unwellness).
Thereafter, the viral infection will manifest with classic symptoms like:
An enlarged spleen (splenomegaly) can develop after two or three weeks in around half of all people. It may only be recognized during a physical exam and will eventually resolve without treatment.
Young Children
Before puberty, mononucleosis tends to cause mild flu-like symptoms, or the infection may be entirelyasymptomatic(without symptoms).
The reason that EBV is so mild in babies and younger children is poorly understood. Some experts theorize that a type of immune cell callednatural killer (NK) cells—which are at highest at birth—might afford children special protection.
Others contend that symptoms are more severe in teens and young adults because they pass larger amounts of the virus—which is transmitted in saliva—through kissing.
It is also possible that some people infected as children may have an exaggerated immune response when re-exposed to the virus. In such cases, the body will have developed an immune defense during the initial,asymptomaticinfection and may overreact when re-exposed to EBV as a teen or young adult.
Irrespective of the cause, EBV infections in children usually cause no symptoms or only mild symptoms that are indistinguishable from other brief childhood illnesses.
Older Adults (40 and Older)
Mononucleosis in older adults is rare and more often associated with a weakened immune system. Older adults often develop a fever lasting longer than two weeks but may not have other classic signs or symptoms. If they do, they tend to be mild and easily dismissed or ignored.
Despite the lack of classic symptoms, older adults with mono are vulnerable to potentially serious complications affecting the spleen, brain, blood, and liver.
Because older adults generally haveweaker immune systems, they may be able to temper the initial infection but not control it. In some people, this can lead to disease progression and complications like severe anemia and liver inflammation.
Complications of mononucleosis are uncommon but can be serious. The risk is greater the older a person gets.
Possible complications include:
Can Mono Get Into Your Lungs?It is rare for mononucleosis to affect the lungs, but there have been rare instances when EBV has disseminated (spread) into the bloodstream and caused inflammation of the lungs, known aspneumonitis.While few cases have been reported in the medical literature. EBV pneumonitis can be especially severe and mostly involves people who are severelyimmunocompromised.
Can Mono Get Into Your Lungs?
It is rare for mononucleosis to affect the lungs, but there have been rare instances when EBV has disseminated (spread) into the bloodstream and caused inflammation of the lungs, known aspneumonitis.While few cases have been reported in the medical literature. EBV pneumonitis can be especially severe and mostly involves people who are severelyimmunocompromised.
It is rare for mononucleosis to affect the lungs, but there have been rare instances when EBV has disseminated (spread) into the bloodstream and caused inflammation of the lungs, known aspneumonitis.
While few cases have been reported in the medical literature. EBV pneumonitis can be especially severe and mostly involves people who are severelyimmunocompromised.
Relieving Symptoms of Mononucleosis
As debilitating as it can be, mononucleosis is usually a self-limiting condition—meaning it will run its course and go away on its own. Treatment is mainly focused on the management of symptoms.
In addition to prolonged rest, a healthcare provider may prescribe:
Antiviral drugsare not recommended for people with simple cases of mononucleosis but may be used to treat EBV complications like hepatomegaly, encephalitis, or hemolytic anemia.
Antibiotics are not used because they treat bacterial infections, not viral ones. The only exception is if there is a secondary infection liketonsillitis.
When to See a Healthcare Provider
You should see the healthcare provider when you have the symptoms of mononucleosis. This is because EBV infection can mimic many other diseases, includingcytomegalovirus(CMV), HIV,rubella,hepatitis A,Lyme disease, andtoxoplasmosis, among others.
Some of these “copycats” require immediate medical treatment and can lead to severe complications if they aren’t addressed.
Arguably, the greatest concern related to mononucleosis is splenomegaly. Although the rupture of the spleen is rare, healthcare providers will often recommend that you take it easy during recovery and activities or sports that can cause an accidental rupture.
When to Call 911A ruptured spleen is a medical emergency. If you have mononucleosis, call 911 or seek immediate emergency care if you develop symptoms like:Pain across the abdomenTenderness in the upper left abdomenDizziness or lightheadednessPain that radiates to the left shoulderBlurred visionRapid heartbeatsAbnormally pale skinConfusion or changes in your mental state
When to Call 911
A ruptured spleen is a medical emergency. If you have mononucleosis, call 911 or seek immediate emergency care if you develop symptoms like:Pain across the abdomenTenderness in the upper left abdomenDizziness or lightheadednessPain that radiates to the left shoulderBlurred visionRapid heartbeatsAbnormally pale skinConfusion or changes in your mental state
A ruptured spleen is a medical emergency. If you have mononucleosis, call 911 or seek immediate emergency care if you develop symptoms like:
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Summary
Symptoms of mononucleosis include a sore throat, fatigue, malaise, swollen lymph nodes, mild fever, and swollen tonsils. Adolescents, teens, and young adults are more likely to be affected.
Babies and children are less commonly affected and may have few, if any, symptoms. Older adults often lack the “classic” symptoms of mononucleosis but are more susceptible to potentially severe complications like anemia, an enlarged liver, and a ruptured spleen.
Causes and Risk Factors of Mononucleosis
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dunmire SK, Hogquist KA, Balfour HH.Infectious mononucleosis.Curr Top Microbiol Immunol. 2015;390(Pt 1):211-40. doi:10.1007/978-3-319-22822-8_9Centers for Disease Control and Prevention.Epstein-Barr virus and infectious mononucleosis: for healthcare providers.Abbott RJ, Pachnio A, Pedroza-Pacheco I.Asymptomatic primary infection with Epstein-Barr virus: observations on young adult cases.J Virol.2017 Nov 1;91(21):e00382-17. doi:10.1128/JVI.00382-17Centers for Disease Control and Prevention.About Epstein-Barr virus (EBV).Smeltzer JP, Howard MT, Gonsalves WI, Witzig TE.Epstein-Barr virus infection in an elderly nonimmunocompromised adult successfully treated with rituximab.Case Rep Hematol.2014;2014:641483. doi:10.1155/2014/641483Kuri A, Jacobs BM, Vickaryous N, et al.Epidemiology of Epstein-Barr virus infection and infectious mononucleosis in the United Kingdom.BMC Public Health.2020;20:912. doi:10.1186/s12889-020-09049-xNiaxi MR, Iqbal QZ, Michiyev D, et al.Epstein-Barr virus (EBV) induced pneumonitis in an immunocompetent adult: a case report.Respir Med Case Rep.2020;31:101262. doi:10.1016/j.rmcr.2020.101262Lennon P, Crotty M, Fenton JE.Infectious mononucleosis.BMJ.2015;350:h1825. doi:10.1136/bmj.h1825Rezk E, Nofal YH, Hamzeh A, et al.Steroids for symptom control in infectious mononucleosis.Cochrane Database System Rev.2015;11:CD004402. doi:10.1002/14651858.CD004402.pub3National Health Service (UK).Spleen problems and spleen removal.Additional ReadingMononucleosis. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/13974-mononucleosis.Epstein-Barr Virus (EBV) and Infectious Mononucleosis. American Pregnancy Association. http://americanpregnancy.org/pregnancy-complications/epstein-barr-virus-ebv-infectious-mononucleosis/.Epstein-Barr Virus and Infectious Mononucleosis. Centers for Disease Control and Prevention. https://www.cdc.gov/epstein-barr/about-mono.html.Kaye KM.Infectious Mononucleosis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/infectious-mononucleosis.Womack J, Jimenez M.Common Questions About Infectious Mononucleosis.American Family Physician. 2015 Mar 15;91(6):372-376.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dunmire SK, Hogquist KA, Balfour HH.Infectious mononucleosis.Curr Top Microbiol Immunol. 2015;390(Pt 1):211-40. doi:10.1007/978-3-319-22822-8_9Centers for Disease Control and Prevention.Epstein-Barr virus and infectious mononucleosis: for healthcare providers.Abbott RJ, Pachnio A, Pedroza-Pacheco I.Asymptomatic primary infection with Epstein-Barr virus: observations on young adult cases.J Virol.2017 Nov 1;91(21):e00382-17. doi:10.1128/JVI.00382-17Centers for Disease Control and Prevention.About Epstein-Barr virus (EBV).Smeltzer JP, Howard MT, Gonsalves WI, Witzig TE.Epstein-Barr virus infection in an elderly nonimmunocompromised adult successfully treated with rituximab.Case Rep Hematol.2014;2014:641483. doi:10.1155/2014/641483Kuri A, Jacobs BM, Vickaryous N, et al.Epidemiology of Epstein-Barr virus infection and infectious mononucleosis in the United Kingdom.BMC Public Health.2020;20:912. doi:10.1186/s12889-020-09049-xNiaxi MR, Iqbal QZ, Michiyev D, et al.Epstein-Barr virus (EBV) induced pneumonitis in an immunocompetent adult: a case report.Respir Med Case Rep.2020;31:101262. doi:10.1016/j.rmcr.2020.101262Lennon P, Crotty M, Fenton JE.Infectious mononucleosis.BMJ.2015;350:h1825. doi:10.1136/bmj.h1825Rezk E, Nofal YH, Hamzeh A, et al.Steroids for symptom control in infectious mononucleosis.Cochrane Database System Rev.2015;11:CD004402. doi:10.1002/14651858.CD004402.pub3National Health Service (UK).Spleen problems and spleen removal.Additional ReadingMononucleosis. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/13974-mononucleosis.Epstein-Barr Virus (EBV) and Infectious Mononucleosis. American Pregnancy Association. http://americanpregnancy.org/pregnancy-complications/epstein-barr-virus-ebv-infectious-mononucleosis/.Epstein-Barr Virus and Infectious Mononucleosis. Centers for Disease Control and Prevention. https://www.cdc.gov/epstein-barr/about-mono.html.Kaye KM.Infectious Mononucleosis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/infectious-mononucleosis.Womack J, Jimenez M.Common Questions About Infectious Mononucleosis.American Family Physician. 2015 Mar 15;91(6):372-376.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Dunmire SK, Hogquist KA, Balfour HH.Infectious mononucleosis.Curr Top Microbiol Immunol. 2015;390(Pt 1):211-40. doi:10.1007/978-3-319-22822-8_9Centers for Disease Control and Prevention.Epstein-Barr virus and infectious mononucleosis: for healthcare providers.Abbott RJ, Pachnio A, Pedroza-Pacheco I.Asymptomatic primary infection with Epstein-Barr virus: observations on young adult cases.J Virol.2017 Nov 1;91(21):e00382-17. doi:10.1128/JVI.00382-17Centers for Disease Control and Prevention.About Epstein-Barr virus (EBV).Smeltzer JP, Howard MT, Gonsalves WI, Witzig TE.Epstein-Barr virus infection in an elderly nonimmunocompromised adult successfully treated with rituximab.Case Rep Hematol.2014;2014:641483. doi:10.1155/2014/641483Kuri A, Jacobs BM, Vickaryous N, et al.Epidemiology of Epstein-Barr virus infection and infectious mononucleosis in the United Kingdom.BMC Public Health.2020;20:912. doi:10.1186/s12889-020-09049-xNiaxi MR, Iqbal QZ, Michiyev D, et al.Epstein-Barr virus (EBV) induced pneumonitis in an immunocompetent adult: a case report.Respir Med Case Rep.2020;31:101262. doi:10.1016/j.rmcr.2020.101262Lennon P, Crotty M, Fenton JE.Infectious mononucleosis.BMJ.2015;350:h1825. doi:10.1136/bmj.h1825Rezk E, Nofal YH, Hamzeh A, et al.Steroids for symptom control in infectious mononucleosis.Cochrane Database System Rev.2015;11:CD004402. doi:10.1002/14651858.CD004402.pub3National Health Service (UK).Spleen problems and spleen removal.
Dunmire SK, Hogquist KA, Balfour HH.Infectious mononucleosis.Curr Top Microbiol Immunol. 2015;390(Pt 1):211-40. doi:10.1007/978-3-319-22822-8_9
Centers for Disease Control and Prevention.Epstein-Barr virus and infectious mononucleosis: for healthcare providers.
Abbott RJ, Pachnio A, Pedroza-Pacheco I.Asymptomatic primary infection with Epstein-Barr virus: observations on young adult cases.J Virol.2017 Nov 1;91(21):e00382-17. doi:10.1128/JVI.00382-17
Centers for Disease Control and Prevention.About Epstein-Barr virus (EBV).
Smeltzer JP, Howard MT, Gonsalves WI, Witzig TE.Epstein-Barr virus infection in an elderly nonimmunocompromised adult successfully treated with rituximab.Case Rep Hematol.2014;2014:641483. doi:10.1155/2014/641483
Kuri A, Jacobs BM, Vickaryous N, et al.Epidemiology of Epstein-Barr virus infection and infectious mononucleosis in the United Kingdom.BMC Public Health.2020;20:912. doi:10.1186/s12889-020-09049-x
Niaxi MR, Iqbal QZ, Michiyev D, et al.Epstein-Barr virus (EBV) induced pneumonitis in an immunocompetent adult: a case report.Respir Med Case Rep.2020;31:101262. doi:10.1016/j.rmcr.2020.101262
Lennon P, Crotty M, Fenton JE.Infectious mononucleosis.BMJ.2015;350:h1825. doi:10.1136/bmj.h1825
Rezk E, Nofal YH, Hamzeh A, et al.Steroids for symptom control in infectious mononucleosis.Cochrane Database System Rev.2015;11:CD004402. doi:10.1002/14651858.CD004402.pub3
National Health Service (UK).Spleen problems and spleen removal.
Mononucleosis. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/13974-mononucleosis.Epstein-Barr Virus (EBV) and Infectious Mononucleosis. American Pregnancy Association. http://americanpregnancy.org/pregnancy-complications/epstein-barr-virus-ebv-infectious-mononucleosis/.Epstein-Barr Virus and Infectious Mononucleosis. Centers for Disease Control and Prevention. https://www.cdc.gov/epstein-barr/about-mono.html.Kaye KM.Infectious Mononucleosis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/infectious-mononucleosis.Womack J, Jimenez M.Common Questions About Infectious Mononucleosis.American Family Physician. 2015 Mar 15;91(6):372-376.
Epstein-Barr Virus (EBV) and Infectious Mononucleosis. American Pregnancy Association. http://americanpregnancy.org/pregnancy-complications/epstein-barr-virus-ebv-infectious-mononucleosis/.
Epstein-Barr Virus and Infectious Mononucleosis. Centers for Disease Control and Prevention. https://www.cdc.gov/epstein-barr/about-mono.html.
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