What to Expect with Mono

March 22, 2010

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What to Expect with Mono

by Lynn Cates, M.D., F.A.A.P.
reviewed by Laura Jana, M.D., F.A.A.P.

Most cases of infectious mononucleosis, or mono, resolve completely in a few days--and certainly within a few weeks--with no specific treatment.

In fact, it's unusual to see serious problems related to this common infection. However, the Epstein-Barr virus (EBV) has the ability to affect virtually any organ of the body, and so it can cause a wide variety of complications. To learn more about these, see our article "Beyond Mono: Other Complications of the Epstein-Barr Virus (EBV)."

Mono in young children
Mono often is not even diagnosed in young children because their symptoms are similar to those of other common viral infections (for example, fever, sore throat, and fatigue). They usually don't get very sick, and their symptoms generally resolve within a week. If a young child does develop problems from a mono infection, they often are related to dehydration from fever and decreased appetite.

Mono in older children and adolescents
Older children and teenagers who get mono often become sicker than younger children--that is, the symptoms are more severe, sometimes it is because they have more symptoms, and sometimes it is because the symptoms last longer, also they are more likely to develop complications. Here are some of the things you may see.

Fatigue. In some children, fatigue may be a major complaint. It can last for many weeks, even after all of your child's other symptoms have resolved.

Fever. The fever seen with mono may be high and may last as long as a week or two.

Sore throat. Mono can cause an impressively sore throat, but it usually goes away within a couple of weeks.

Swollen lymph glands. The lymph glands of the neck, and even the back of the head and other parts of the body, may remain noticeably swollen for several weeks or months. Some children, but not all, will experience tenderness in these nodes.

Enlarged liver and spleen. The abdomen may feel or look full, and your healthcare provider may note during a physical exam that your child's liver and/or spleen is bigger than usual. There also may be some abdominal pain and tenderness in the upper abdomen where these organs are located. The swelling of these organs generally is greatest in the second, third, and fourth weeks and may not shrink to normal size for several weeks after the other symptoms have resolved.

Other findings in teens and adults

Rashes. Since the sore throat and fever seen with mono often leads to a mistaken diagnosis of strep throat, children and teens with mono may be given antibiotics, and some are given ampicillin or related drugs.

The vast majority of adolescents and adults with mono who receive ampicillin-like drugs develop a red raised rash over a good portion of the body. Other antibiotics, such as penicillin, also can cause rashes with mono but not as predictably as ampicillin. The rashes may be itchy, but they are not serious and will go away in a few days without any specific treatment. Rashes are not seen as commonly in young children, even when they are given ampicillin-like drugs.

Hepatitis. Mono causes inflammation of the liver known as hepatitis in about 1 out of every 10 people. In most cases, the liver involvement is very mild, but some individuals develop significant hepatitis, accompanied by such symptoms as:
- right-sided abdominal pain
- jaundice, or yellow coloring of the skin and the whites of the eye
- pale stools and dark-colored urine
- gastrointestinal symptoms that might include poor appetite, nausea, vomiting, or diarrhea.

Chronic EBV infections
The symptoms of mono usually don't last longer than six months. Some people are diagnosed with chronic EBV infection when their symptoms last longer than six months, but there typically isn't good laboratory evidence of active EBV infections when these patients are carefully evaluated. If symptoms persist, evaluation for other conditions should be performed.

It should be noted that there is no good scientific evidence that EBV causes Chronic Fatigue Syndrome, or CFS. For more information on CFS, you can contact the Centers for Disease Control and Prevention (CDC) on its toll-free line at (888) 232-3228, then press Ext. 22136 for the CFS menu for more information.

Can you get mono more than once?
Once you have infectious mononucleosis, you don't get it again. However, if someone resumes his normal activities too soon after having had a case of mono, he can have a relapse of symptoms until he has a chance to fully recover.

Once a person has had mono, the virus remains dormant (or inactive) in the body for the rest of his life. Generally it doesn't cause problems unless the individual develops a weakened immune system--for example, if he needs immunosuppression (that is, drugs that decrease his ability to fight infections) in order to receive an organ transplant.

When to ask for advice
You should consult your child's healthcare provider if you are worried about how your child looks, if he develops abdominal pain, his fever doesn't go away in a few days, he isn't able to drink plenty of fluids, or you have any other concerns. It is very important that you work closely with his practitioner until he is completely recovered and can fully resume his usual activities.


RELATED INFORMATION

			Mono (Infectious Mononucleosis): Overview
			Suspecting Mono in Your Teenager
			Suspecting Mono in Your Younger Child
			Mononucleosis

Created August 07, 2001
Reviewed August 08, 2001

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