Mononucleosis is not a bad word, and it's not necessarily a bad diagnosis to receive. Infectious mononucleosis is caused by the Epstein Barr virus and can produce a spectrum of clinical symptoms. Mono is common in the 16-24-year-old age range, especially in colleges or the military where close living quarters are common. Eighty percent of people who have infectious mono will have a viral-like syndrome, frequently with sore throat, fever, headache, fatigue, and swollen lymph nodes in the neck. In the belief that they have a cold, many of these people will not seek medical attention and, thus, will have mono that goes undiagnosed. In fact, the vast majority of people over 40 years old test positive (using a special test) for having had mono sometime in their life; many of these people never knew they were infected.

Mono gets a bad rap because of the complications that 20 percent of people may experience. Complications may include such severe swollen glands in the neck that breathing or eating is compromised. Mono can also affect the lining around the brain, producing an encephalitis-like picture. Mono can inflame the liver, producing a hepatitis. The spleen can become enlarged. Because of the tight capsule around the spleen, enlargement can produce pain and the danger of rupturing, even with minor trauma. (If you had an enlarged spleen with your mono infection you would be asked to refrain from contact sports.) Mono has also been associated with fatigue varying from a few weeks to a few months. Mono gets its bad reputation because people with severe complications of mono get more notoriety.

People with symptoms mentioned above--such as sore throat, fever, and swollen glands--often seek medical care. On exam it is impossible to tell mono apart from any number of other viral causes of sore throat, fever, and swollen glands. A quick blood test called the mono-spot tests for the body's response to the mono virus and can identify mono as the cause of your viral syndrome. However, this test can take five to seven days to become positive after having the mono syndrome so you may not be offered the test when you initially present symptoms. Other tests such as a throat culture may be done to ensure that you do not have a treatable source of sore throat and fever (such as strep throat.) Specifically identifying your viral syndrome as mono virus will not necessarily change your treatment.

For most viruses we have no antibiotic-like drugs, and so you are given recommendations for supportive care--that is, things to make you feel better while your own body's immune system fights the virus. These things might include an anti-inflammatory medication such as ibuprofen, salt water gargles, popsicles, and getting more rest and more fluids than usual. If your symptoms became so severe as to compromise your breathing or eating you might be given corticosteroids to help with the swelling and complications, whether your virus is called mono or not. (In fact, there are several other viruses that can cause mono like syndrome.

Mono is spread by intimate means, which accounts for the name "kissing disease." People may carry the virus and transmit it to other people for up to six months after the acute phase of the disease. The virus is very fragile and lives microseconds out of the body!

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