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Mononucleosis Causes, Symptoms and Treatment

The infectious mononucleosis is a disease caused by the Epstein-Barr virus . Mononucleosis mainly affects teenagers and young adults, but it can also affect children.

The mononucleosis most often manifests as sore throat , a very great fatigue and a feeling of weakness throughout the body. The degree of fatigue can vary a lot from person to person. Some hard-hit people have to stop for a few weeks.

It is also called kissing disease , because most of the time, the virus is transmitted by saliva. However, kisses are far from always in question and sick people generally do not know how they got the disease.

Mononucleosis owes its name to the fact that the virus causes a proliferation of mononuclearwhite blood cells (lymphocytes, which have only one nucleus) in the blood.

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Cause of Mononucleosis

Mononucleosis is caused by infection with the Epstein-Barr virus. It is an extremely common virus that is transmitted through saliva, but does not always cause infection. It is even harmless in the majority of cases, and we “colonize” without even being aware of it. As early as age 5, 50% of individuals carry the Epstein-Barr virus. At age 40, the percentage is 90%. These antibodies can be detected in the blood of these people . Once infected, the person keeps the virus in his body all his life, without necessarily having symptoms.

However, in some cases, without knowing why, the first infection with this virus causes mononucleosis.

Have you had mononucleosis without knowing it?

It’s possible. Most of the time, when Epstein-Barr virus infection occurs in young children, the symptoms are so mild that they go unnoticed. In addition, they can be easily confused with many other small sore throats experienced during early childhood. On the other hand, when the first contact with the virus occurs in adolescence or early adulthood , the infection is accompanied by 1 in 2 of mononucleosis. The symptoms are usually much larger. It is unclear why some develop it and some do not. One thing is certain, though: if you have had mononucleosis, you will not catch it a second time .

Evolution of the disease

After its introduction into the body, the virus proliferates first in the mouth. He then goes to the ganglia and the blood. It lasts 4 to 6 weeks between the moment the virus enters the body and the onset of symptoms: this is the incubation period .

Acute symptoms last from 2 to 3 weeks. A state of fatigue can however persist for a few months. Then, the virus remains “hidden” in the immune system without causing symptoms.


The Epstein-Barr virus is very contagious, but still less than a cold because it does not cause sneezing. It is transmitted by saliva , so by kisses, exchanges of utensils, soiled objects, or from mother to child. It can be contracted during a blood transfusion or organ transplant, but this is very rare.

An infected person is contagious from the moment she is infected. It is so during the incubation period  4 to 6 weeks before the onset of symptoms. Once cured, the person remains contagious for several months. The risk of contagion is however higher in the first weeks of the disease.

Possible complications

Although it induces the proliferation of certain blood cells, mononucleosis is a benign disease . Complications are rare, but can still be very serious. The most serious complication is the rupture of the spleen (a small organ located in the left part of the abdomen and which plays a role in the purification of the blood). The infection can cause swelling of the spleen (splenomegaly). This can then break spontaneously or after a shock, even slight. This rarely occurs (0.5% to 1% of cases), but the risk is real. That’s why demanding sports and contact sports are contraindicated to people who have mononucleosis(see Medical Treatments section). When the spleen is swollen, acute pain localized above and to the left of the abdomen is felt. This situation requires emergency treatment. Rupture of the spleen causes bleeding in the abdominal cavity and pain throughout the abdomen. It can be deadly and surgery is necessary.

In some cases, the virus induces a significant increase in tonsillar volume , which can obstruct the airways and cause significant breathing difficulties (respiratory distress).

The liver , nervous system and red blood cells can also be the target of complications ( hepatitis , jaundice, encephalitis, meningitis , haemolytic anemia , etc.).

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Other diseases associated with the Epstein-Barr virus

This virus is involved in the appearance of Burkitt’s lymphoma , a type of cancer that forms in white blood cells. This lymphoma is rare in the West, but endemic in Africa. In the West, it occurs only in people whose immune systems are very weak (for example, those who have received anti-rejection drugs after an organ transplant or chemotherapy). In Asians, Epstein-Barr virus infection is implicated in nasopharyngeal cancer .

Diagnostic of Mononucleosis

The doctor first makes a sampling of secretions in the throat to distinguish between infectious mononucleosis and bacterial pharyngitis (sore throat or sore throat ).

The monotest (or monospot) and other blood tests are sometimes used to confirm the diagnosis of mononucleosis. This excludes the possibility that the symptoms are caused by another disease (cytomegalovirus or CMV infection, toxoplasmosis , etc.).

For those who have had unprotected sex or intercourse, it may be appropriate to be screened for the Human Immunodeficiency Virus ( HIV ). Indeed, the first symptoms of HIV infection may resemble those of mononucleosis .

Symptoms of infectious mononucleosis

  • tiredness extreme.
  • Swelling and tenderness of the ganglia of the neck and armpits. Some lymph nodes can also swell in other parts of the body (especially the groin area).
  • Bouts of fever up to 40.5 ° C (105 ° F) and are often accompanied by chills.
  • A pronounced sore throat (which can go, to the extreme, to the inability to swallow).
  • Headaches.
  • A loss of appetite.
  • Sometimes, general muscle pain.
  • A rash may appear, most often after taking antibiotics.
  • An increase in the volume of the spleen is sometimes noticeable by the doctor (by feeling the abdomen).

The fever and sore throat last from 2 to 3 weeks, but fatigue can persist for several months.


Important . In case of acute pain located at the top and left of the abdomen, consult a doctor without delay. This could mean that the spleen is swollen and likely to rupture.


People at risk for Mononucleosis

Teenagers and young adults, although the disease can occur at any age.

Risk factors

The symptoms of mononucleosis would be greater in societies where hygiene measures are predominant. In fact, the infection is transmitted later in life (during adolescence rather than during childhood). However, when it is contracted at a young age, the infection causes much less symptoms and even goes unnoticed.

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Can we prevent?
There is no way to prevent  infectious mononucleosis . There is no vaccine against the  Epstein-Barr virus either .

People whose health is very fragile and who have never had mononucleosis have an interest in taking various measures when they rub shoulders with people with mononucleosis or who have had it in the previous months.

To avoid contagion

  • Avoid kisses on the mouth with the person with mononucleosis.
  • Be careful not to exchange with an infected person cooking utensils, glasses and dishes (and clean them well).
  • Do not share food.
  • Wash your hands thoroughly.
  • Protect yourself from sneezing.

Medical treatment of infectious mononucleosis

There is no specific treatment to cure mononucleosis . It is a mild disease that usually disappears after 4 to 8 weeks, although fatigue can persist for several months. The goal of treatment is to provide supportive care until recovery.

Some tips for a good recovery

  • Observe a good rest period (some people will need to leave school or work for a few days or weeks) and gradually resume their previous activities. Otherwise, the recovery period may be longer.
  • Drink plenty of water, broths and juices to prevent dehydration .
  • To relieve sore throat , gargle with a solution of salt water (½ tsp salt in a glass of water) several times a day. Drink and eat cold or even frozen foods.
  • Adopt a balanced diet to help the body get back on top of the virus


  • Give up demanding sports and contact sports for at least 2 months to prevent spleen rupture . The spleen remains fragile even if it is not inflated.
  • Avoid lifting heavy objects for at least 2 months to prevent rupture of the spleen.


If necessary, medications can help treat complications or relieve symptoms, if they are important.

Analgesics. To relieve fever, headache, sore throat and body aches, your doctor may recommend taking acetaminophen (Tylenol) tablets or anti-inflammatories that also have an analgesic effect, such as ibuprofen (Advil, Motrin).
Caution: Aspirin is not recommended in cases of viral infections for children under 16 years of age, as it can cause Reye’s syndrome , a rare but often fatal condition.

Antibiotics. About 20% of people affected by mononucleosis develop a bacterial infection of the throat, sinuses or tonsils at the same time. Some types of antibiotics, such as ampicillin and amoxicillin, however, should be avoided because they can cause a skin reaction all over the body in people who have mononucleosis. A cutaneous reaction to an antibiotic that occurs during a mononucleosis does not necessarily mean that the person is allergic to it.

Corticosteroids. The corticosteroids are recommended only for treating abnormal increase in the size of the tonsils (which might obstruct the airway), or to treat other serious complications. There is no need to systematically take.

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