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Mononucleosis: Causes, Symptoms & Treatment

Mononucleosis is an infectious disease caused by the Epstein-Barr virus, primarily affecting teenagers and young adults with symptoms such as fever, sore throat, and swollen lymph nodes.

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Things worth knowing about "Mononucleosis"

Mononucleosis is an infectious disease caused by the Epstein-Barr virus, primarily affecting teenagers and young adults with symptoms such as fever, sore throat, and swollen lymph nodes.

What is Mononucleosis?

Mononucleosis, commonly referred to as infectious mononucleosis or glandular fever, is an acute infectious disease caused primarily by the Epstein-Barr virus (EBV). EBV belongs to the herpesvirus family and is found worldwide. The disease most frequently affects teenagers and young adults. Due to its transmission through saliva, it is often called the kissing disease.

Causes and Transmission

In the vast majority of cases, mononucleosis is caused by the Epstein-Barr virus (EBV). In rare cases, a similar illness may be triggered by the cytomegalovirus (CMV) or other pathogens.

Route of transmission: The virus is primarily spread through saliva, for example through kissing, coughing, or sharing drinks and utensils.
Incubation period: The time between infection and the onset of symptoms is typically 4 to 6 weeks.
Contagiousness: Infected individuals can shed the virus for months, even after symptoms have resolved.

Symptoms

Symptoms of mononucleosis can vary depending on age and individual immune response. In young children, the infection is often mild or asymptomatic. In teenagers and young adults, a more pronounced clinical picture is typical:

High fever (often above 38.5 °C / 101.3 °F)
Severe sore throat with tonsillitis, often with whitish-gray coatings on the tonsils
Swollen lymph nodes, particularly in the neck, but also in the armpits and groin
Extreme fatigue and malaise, which may persist for weeks or months
Enlargement of the spleen and liver (splenomegaly and hepatomegaly)
Skin rash, which frequently occurs after taking ampicillin or amoxicillin
Headaches and body aches

Diagnosis

Diagnosis of mononucleosis is based on a combination of clinical examination and laboratory tests:

Blood count: A characteristic finding is an elevated white blood cell count with a high proportion of atypical lymphocytes (virocytes).
Rapid test (Monospot test): Detects heterophile antibodies in the blood; quick and simple, but less reliable in children under 4 years of age.
EBV-specific antibodies: Serological tests to detect antibodies against various EBV antigens (VCA-IgM, VCA-IgG, EA, EBNA).
Ultrasound: Used to assess spleen or liver enlargement.

Treatment

A specific antiviral therapy against EBV is generally not necessary. Treatment of mononucleosis is therefore primarily symptomatic:

Physical rest: Bed rest and avoidance of strenuous activity are especially important due to the risk of splenic rupture when the spleen is enlarged.
Fever and pain relievers: Paracetamol (acetaminophen) or ibuprofen to relieve fever, sore throat, and body aches. Aspirin (acetylsalicylic acid) should be avoided in children and adolescents due to the risk of Reye syndrome.
Adequate fluid intake: Staying well hydrated to support the immune system.
Corticosteroids: In severe cases (e.g., risk of airway obstruction due to severely enlarged tonsils), a physician may prescribe corticosteroids.
No antibiotics: Since the disease is viral, antibiotics are ineffective. Aminopenicillins (ampicillin, amoxicillin) are actually contraindicated, as they frequently cause a skin rash in these patients.

Complications

Most cases are benign and resolve completely. However, in rare cases, complications may occur:

Splenic rupture: A rare but serious rupture of the enlarged spleen, which constitutes a medical emergency.
Prolonged fatigue: In some cases, exhaustion and weakness may persist for several months.
Neurological complications: Rare, such as encephalitis or meningitis.
Hematological complications: Such as hemolytic anemia or thrombocytopenia.

References

World Health Organization (WHO): Epstein-Barr virus and infectious mononucleosis. www.who.int
Longo DL et al. - Harrison's Principles of Internal Medicine, 21st Edition, McGraw-Hill Education, 2022.
Ebell MH - Epstein-Barr virus infectious mononucleosis. American Family Physician, 2004; 70(7):1279-1287.

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