Clinical Reference Systems: Pediatric Advisor 10.0
Infectious Mononucleosis (for Teenagers)
- severe sore throat
- large red tonsils covered with pus
- swollen lymph nodes in the neck, armpits, and groin
- fever for 7 to 14 days
- enlarged spleen (in 50% of teens)
- blood smear showing many atypical (unusual) lymphocytes
- positive blood test for mononucleosis.
Mononucleosis (mono) is caused by the Epstein-Barr virus
(EBV). This virus is transmitted in infected saliva through
coughing, sneezing, and kissing. Although mononucleosis can
occur at any age, it occurs more often in 15- to 25-year-
olds, possibly because of more intimate contacts with
others. Contrary to popular belief, mono is not very
contagious. Even people in the same household rarely come
down with it.
Most teens have only mild symptoms for a week. Even those
with severe symptoms usually feel completely well in 2 to 4
Complications are rare and require hospitalization when they
occur. The most common complication is dehydration from not
drinking enough fluids. Breathing may be obstructed by
enlarged tonsils, adenoids, and other lymph tissue in the
back of the throat. On rare occasions, the enlarged spleen
will rupture if the abdomen is hit or strained. Because over
90% of people with mononucleosis will develop a severe rash
if they take ampicillin or amoxicillin, these medications
should be avoided in this condition.
CHRONIC FATIGUE SYNDROME
The symptoms of chronic fatigue syndrome are fatigue,
tiredness, weakness, recurrent pains, and the need for more
sleep. The symptoms are present for at least 6 months.
There is no good scientific evidence to support
mononucleosis as the cause of chronic fatigue syndrome. In
general mononucleosis neither lingers nor gets worse. All
symptoms are gone within 4 weeks after they first appear.
In fact, recent evidence points to a retrovirus as the cause
of chronic fatigue syndrome.
Lab tests of the saliva of people who have chronic fatigue
syndrome have found the Epstein-Barr virus in the saliva.
Tests of their blood have detected antibodies to this virus.
These lab results have caused some confusion about the cause
of chronic fatigue syndrome. However, 10% to 20% of healthy
adults who had mono in the past have the Epstein-Barr virus
in their saliva because the virus periodically reappears
without any symptoms. Also, the number of mononucleosis
antibodies in the blood increases when a person gets new
infections by other viruses. Neither the presence of EBV in
saliva nor mononucleosis antibodies in the blood means that
a person has mononucleosis again.
HOME TREATMENT FOR MONONUCLEOSIS
- Fever and pain medicines
No specific medicine will cure mononucleosis. However,
symptoms can usually be helped with medicines. The pain
of swollen lymph nodes and fever over 102 degrees F
(39 degrees C) can usually be relieved by appropriate
doses of acetaminophen or ibuprofen.
- Sore throat treatment
Sipping warm chicken broth can be helpful. Sucking on
hard candies can also relieve symptoms (butterscotch
seems to be a soothing flavor). Because swollen tonsils
can make some foods hard to swallow, eat soft foods as
long as necessary. To prevent dehydration, be sure that
you drink enough fluids. Milk shakes and cold drinks
are especially good. Avoid citrus fruits. Take a daily
multiple vitamin pill until the appetite returns to
normal. Again, acetaminophen or ibuprofen can be very
You don't need to stay in bed. Bed rest will not
shorten the course of the illness or reduce symptoms.
You can decide how much rest you need. Slow down some
until you no longer have a fever.
- Precautions for an enlarged spleen
Your spleen may be enlarged while you have
mononucleosis. A blow to the abdomen could rupture the
enlarged spleen and cause bleeding. This is a surgical
emergency. Therefore, all teens with mononucleosis
should avoid contact sports for at least 4 weeks.
Athletes especially must restrict their activity until
the spleen returns to normal size (as determined by a
Constipation and heavy lifting should also be avoided
because of the sudden pressures they can put on the
Your physician will check you weekly until your spleen
returns to a normal size.
Infectious mononucleosis is most contagious while you
have a fever. After the fever is gone, the virus is
still carried in the saliva for up to 6 months, but in
small amounts. Overall, mononucleosis is only slightly
contagious from contacts. Boyfriends, girlfriends,
roommates, and relatives rarely get it. The person with
mononucleosis does not need to be isolated. However,
use separate drinking glasses and utensils and avoid
kissing until the fever has been gone for several days.
The incubation period for mononucleosis is 4 to 10 weeks
after contact with an infected person. This means that
if a person does become infected with the virus, the
symptoms will not appear until 4 to 10 weeks after the
CALL YOUR PHYSICIAN IMMEDIATELY IF:
- Breathing becomes difficult or noisy.
- Abdominal pain occurs (especially high on your left
- You start feeling very sick.
CALL YOUR PHYSICIAN WITHIN 24 HOURS IF:
- You can't drink enough fluids.
- Signs of dehydration occur.
- Sinus or ear pain occurs.
- You aren't back to school by 2 weeks.
- Any symptoms remain after 4 weeks.
- You have other questions or concerns.