Mononucleosis also known as “Mono” or “Kissing disease” is a viral infection causing fevers, sore throat, and swollen lymph glands. It is typically caused by the Epstein-Barr virus (EBV). Mononucleosis is often transmitted by saliva. While it is known as “the kissing disease,” occurring often in 15- to 17-year-olds, the infection may occur at any age. We have seen many children get exposed to and contract Mono by the fourth year of life.
What is mononucleosis?
Mononucleosis, also known as “mono” or “the kissing disease”, is a viral infection that causes fevers, sore throats, and swollen lymph glands.
Mono may begin slowly with fatigue, malaise, headache, and sore throat. The sore throat becomes progressively worse, often with enlarged tonsils covered with a whitish-yellow covering. The lymph nodes in the neck are frequently enlarged and painful. A pink, measles-like rash can occur and is more likely if the patient is given an antibiotic for a throat infection (Antibiotics will NOT be given without a positive Strep test). The symptoms of Mono gradually subside on their own over a period of weeks to months.
Mononucleosis Symptoms
Mononucleosis symptoms develop about four to six weeks after the time of exposure and can range between mild and severe. Many of those who contract mononucleosis take time off of work or school due to fatigue and general discomfort/illness.
- Fever
- Sore throat
- Enlarged lymph nodes, especially in the neck and armpit
- General discomfort, uneasiness, or ill feeling
- Drowsiness and fatigue
- Loss of appetite
- Muscle aches or neck stiffness
- Enlarged spleen
- Jaundice (yellow cast to skin) or a red measles like rash
- Headache and sensitivity to light
- Chest pain
Diagnosing & Testing for Mononucleosis
During a physical examination, your child’s pediatrician will examine your child’s neck to look for enlarged lymph nodes in the front and back, as well as look in the back of the mouth to find swollen tonsils which may have a whitish covering. An examination of your child’s abdomen is important to find an enlarged liver or spleen, indications of mononucleosis. A general examination to find a skin rash will also be done to confirm the physical indications of infectious mononucleosis.
Laboratory findings often include an elevated white blood cell count, and the characteristic finding of atypical lymphocytes — unusual-appearing white blood cells that are seen when blood is examined under a microscope. Abnormal liver function tests are also characteristic.
Common tests for EBV include:
- A Monospot (positive for infectious mononucleosis). It is not a very sensitive test.
- Epstein-Barr Virus Antigen (for EBV)
- Epstein-Barr Virus Antibody Titers can help distinguish acute infection from past infection with EBV
Ways to Treat Mononucleosis
Most patients recover within 2-4 weeks without medication. Younger children often don’t have symptoms, while some older patients may have fatigue for up to 6 weeks or more. Because mononucleosis is a viral infection, there is no antibiotic that can help. Steroid medication may be considered for patients with severe symptoms.
To relieve typical mononucleosis symptoms:
- Take acetaminophen or ibuprofen for pain and fever.
- Gargle with warm salt water for sore throat.
- Throat lozenges can also help relieve sore throat pain.
- Get plenty of rest.
- Drink plenty of fluids.
- Avoid contact sports while the spleen is enlarged (to prevent it from rupturing).
Expectations (Prognosis)
The fever usually drops in 10 days, and swollen lymph glands and spleen heal in 4 weeks. Fatigue usually resolves within a few weeks, but may linger for 2 to 3 months.
When To Call Your Pediatrician
The initial symptoms of Mono feel very much like any typical viral illness. It is not necessary to contact us unless symptoms last longer than 10 days or your child develops the following:
- Severe sore throat or swollen tonsils
- Difficulty breathing
- Abdominal pain
- Severe headache
- Persistent high fevers (more than 101.5°F)
- Yellow discoloration of your eyes or skin
- Weakness in the arm or legs
Call 911 or go to an emergency room if your child develops:
- Sharp, sudden, severe abdominal pain
- Significant difficulty swallowing or breathing
- A stiff neck or severe weakness
Preventing Mononucleosis
Saliva and close contact probably spread the infection. Children may be contagious while they have symptoms and for up to a few months afterwards. The virus can live for several hours outside the body. Avoid kissing, sharing lip balm, drinking glasses, toothbrushes, or utensils if you or someone close to you has Mono. The exact period that people are contagious varies.
Children, teens, and adults can all contract mononucleosis. Because the virus is spread through saliva and close contact, we’ve seen it in children as young as 4-years old.
While both are viruses that cause an irritation to the throat, fever, and ulcers in the throat, mono is NOT the same as hand foot and mouth disease. Hand foot and mouth causes small blisters on the hands and feet, along with ulcers in the throat.
| Symptom | Mononucleosis | Hand Foot & Mouth |
| Fever | Yes | Yes |
| Sore Throat | Yes | Yes |
| Loss of Appetite | Yes | Yes |
| Extreme Tiredness | Yes | |
| Enlarged Lymph Nodes | Yes | |
| Sore Muscles & Stiffness | Yes | |
| Enlarged Spleen | Yes | |
| Ulcers in the Throat, Mouth and Tongue | Yes | |
| Rash with Vesticles (small blisters) | Yes |
Finding a Pediatrician Near You
Choosing the right pediatrician is a crucial step in ensuring the health and well-being of your child. A good pediatrician provides essential care, support, and guidance as your child grows and develops, helping to address any health concerns along the way.
Are you looking for a trusted pediatrician to support your child's health journey? Look no further than Pediatric Affiliates of Hampton Roads. Our experienced and compassionate team is dedicated to providing personalized, high-quality care for children of all ages. Schedule an appointment today and give your child the excellent care they deserve. Book now and take the first step toward securing your child's bright and healthy future.