The symptoms of infectious mononucleosis(or mono symptoms) are very diverse. In 2 / 3 of patients the disease begins acutely and provokes in the following symptoms:
- a significant increase in temperature,
- headache,
- weakness,
- muscle and joint pain,
- sleep and appetite disorder,
- there may be light chills alternating with excessive sweating.
From the first days of illness a patient is suffered from throat sore getting worse when swallowing. Hyperplasia of lymph nodes and stertorous nasal breathing are also observed. The aforesaid mono symptoms become clinically apparent and severe while 4-5 days of illness; during the same period increase in liver and spleen size is determined and atypical mononuclear cells appear in the blood.
A subacute onset with prodrome is also possible in some cases: low-grade fever with general malaise and mild upper respiratory tract catarrhal signs are observed.
Some patients’ leading complaint is abdominal pain that is often discovered in the right iliac region. Nausea vomiting, abdominal distention, stool retention or diarrhea is registered sometimes.
The disease can develop without being noticed and the only symptom of mono that makes a patient to visit a doctor is lymph nodes enlargement. However, the most typical symptoms of infectious mononucleosis are: fever, tonsillitis, generalized limphadenopathy and hepatosplenomegaly.
A fever response is highly variable and may persist from 1-2 days to 3 weeks or longer. During the early period of disease 1/3 of patients are suffered from lowgrade fever and with the apparent temperature increase up to 38˚C and above at the end of the first week. More severe and prolonged fever is observed in adults and children. In some patients there may be two- and three-wave fever with apyrexia periods of several days. The average duration of fever is 6-10 days.
Some specific temperature curve typical for infectious mononucleosis does not exist. The body temperature reduces in lytic manner, which coincides with the improvement of general condition and decreasing of other symptoms severity. It should be noted that low-grade fever is often registered after the main wave resolution.
The fever response is combined with other mono symptoms and changes in the throat are the most typical ones. Mild hyperaemia in the throat and tonsillar hyperplasia are observed in many patients during the first days of illness. These changes are often accompanied with a lesion of nasopharynx. It clinically manifests in stertorous nasal breathing and snuffling voice. At the same time there might be considerable swelling of palatine tonsils which may come into contact with each other. If you could see the back of the throat you would notice its edema and hyperemia with signs of lymphoid tissue hyperplasia; in some patients the rear pharynx surface can be covered with thick mucus.
3-4 days later tonsils are getting covered with caseous-like white fur of different size, which is easily removable with a spatula. In some cases such fur can be located within posterior pharynx surface, root of tongue and even the epiglottis. Changes in the throat are accompanied by fever. Pharynx lesion lasts about 10-15 days; angina may resolve faster due to timely and adequate treatment.
The reaction of the pharynx lymphoid tissue in patients with tonsillectomy manifests in form of enlarged lateral ridges and posterior pharyngeal wall granules. Often enlargement of all lymph nodes is observed but cervical lymph nodes are enlarged most of all. Enlarged lymph nodes almost never cause pain.
At the same other groups of lymph nodes may enlarge, namely axillary, inguinal and cubital ones. Lymph nodes enlaggement persists for 1-2 weeks though mild lymphadenopathy is sometimes observed during 1,5-2 months or more.
Increase in liver and spleen size takes place on 3-4th day of illness. Hepatomegaly is accompanied with a feeling of weight in the right hypochondrium, weakness, loss of appetite, nausea and rare vomiting. Moderate hyperbilirubinemia and increase of ALT and thymol are often registered.
