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Learn More About The 7 Most Common Sore Throat Ailments


Infectious Mononucleosis

Low grade fever, headache, fatigue and/or malaise usually precede the development of the sore throat by several days. Prominent sore throat, enlarged lymph nodes in both the front and back of the neck, moderate to high fever, and fatigue occur in most cases. In some cases, the sore throat may be very severe. In other cases, the glandular form, the lymph node enlargement in the neck, seems out of proportion to the sore throat. In the systemic form, fever and fatigue predominate, while the sore throat may be mild or absent.


Figures 1-2. Shows a sheet-like collection of white blood cells that can look like a membrane covering the tonsils.

Figure 2.

Figure 3. The same sheet-like collection of white blood cells on only one tonsil.

Find links to the other common sore throat ailments in our Sore Throat Guide at the bottom of the page.

Normal Throat 

Herpes/Cold Sores

A Normal Throat is pink rather than fire-engine red, and has no sores or ulcers. Size of tonsils will vary, but the tonsils will not be a very different color from the surrounding throat tissue.

Mononucleosis may have a white or grayish film covering each of the enlarged visible tonsils (a.,b.), accompanied by headache, sore throat, fever, and enlarged neck lymph nodes.

Mononucleosis is a viral infection that causes a sore throat. More than 85% of cases are caused by the Epstein-Barr virus (EBV). Most cases of Epstein-Barr virus infection have no symptoms, go undetected, and are termed sub-clinical infection. More than 50% of children have evidence of EBV by the age of six, and more than 95% of 40-year-olds show evidence of prior infection. However, when EBV causes symptoms, the illness is called Infectious Mononucleosis. This occurs most frequently in adolescents and young adults.

The EBV is present in saliva, tears, and respiratory droplets formed when coughing or sneezing. Because intimate contact was felt to be necessary, and because the illness occurs in adolescents and young adults, the term "Kissing Disease" was sometimes used for Infectious Mononucleosis.


The typical patient with Infectious Mononucleosis has sore throat, fever, and enlarged neck lymph nodes. The tonsils may be covered by an exudate that may be white, gray or even gray-green. There may be streaky hemorrhages (petechiae) on the soft palate. A macular red rash may develop, especially if antibiotics have been taken. Many patients will have an enlarged spleen. White blood cell counts may reveal an elevated number of both monocytes and lymphocytes, and the presence of atypical lymphocytes. Your health provider may order a rapid antibody test (Mono Spot Test), or a blood test measuring the antibodies directed against the EBV.


Infectious Mononucleosis may affect many parts of the body. Hepatitis is a common complication. Pneumonia, inflammation of the pancreas, kidney, heart, and central nervous system are much less common. Prolonged severe fatigue is not unusual. Airway obstruction and swallowing difficulty may result from severe throat inflammation.


Enforced rest is the first recommendation. Absolute avoidance of abdominal trauma is important to avoid rupture of a swollen spleen. Pain relief medication is often used for the severe sore throat. The use of glucocorticoid steroids remains controversial, and while they may decrease throat swelling and pain, they do not shorten the course of the illness.