Infectious Mononucleosis

Definition

Infectious mononucleosis is a highly contagious disease caused by the

Epstein-Barr virus (EBV) and spread primarily by contact with the saliva

of an infected person. Although the disease is sometimes known as the

kissing disease because of the role of saliva in spreading the infection,

mononucleosis can also be spread through blood and genital secretions

(although these forms of transmission are very rare).

Description

EBV is a very common virus worldwide; most people become infected

with it at some point in their lives. Many people become infected with

the virus and never develop noticeable symptoms. Those who do develop

symptoms typically experience about two weeks of fever, sore throat, and

swollen lymph nodes in the neck, throat, or armpits. Although mononucleosis

is not a major threat to health, it is a common cause of absence

from school or work in teenagers and young adults because it can lead

to weeks or months of fatigue and lowered energy.

Demographics

In the United States, mononucleosis is most common in teenagers and

young adults; it is more common in younger children in developing

countries. People in any age group can get the disease if they are exposed,

however. As many as 95 percent of American adults between thirty-five

and forty years of age have been infected, although not all of these have

had the symptoms of the illness. When infection with EBV occurs

during adolescence or young adulthood, it causes infectious mononucleosis

between 35 and 50 percent of the time.

Males and females are equally likely to get mononucleosis, as are

people of all races and ethnic groups.

Causes and Symptoms

Infectious mononucleosis is caused by the Epstein-Barr virus, or EBV.

The virus is normally transmitted by contact with the saliva of an

infected person; it is not ordinarily transmitted through the air. The virus

takes about four to six weeks to incubate, and thus infected persons can

spread the disease to others over a period of several weeks. After entering

the patient

a certain type of white blood cell produced in the bone marrow. The

infected B cells are then carried into the lymphatic system, where they

affect the liver and spleen and cause the lymph nodes to swell and

enlarge. The infected B cells are also responsible for the fever, swelling of

the tonsils, and sore throat that characterize mononucleosis.

After the symptoms of mononucleosis go away, the EBV virus remains

in a few cells in the patient

life. The virus occasionally reactivates and may appear in samples of

the person

transmitted (given) to a susceptible person. Mononucleosis does not cause

any problems during pregnancy, such as miscarriages or birth defects.

The primary symptoms of mononucleosis are fever, sore throat, and

swollen lymph nodes in the throat, armpit, or neck. Other common

symptoms include:

’s throat tissues or blood for the rest of the person’s’s saliva, it does not cause new symptoms of illness, it may be

•

Swelling or enlargement of the spleen or liver

•

General discomfort and mild muscle aches

•

Sleepiness and fatigue

•

Loss of appetite

•

Skin rash

•

Swollen tonsils or a yellowish coating on the tonsils

•

Less common symptoms of mononucleosis that some patients

experience include:

Night sweats

•

Headache

•

Stiff neck

•

Sensitivity to light

•

Shortness of breath and chest pain

•

Nosebleed

•

Hives

•

Jaundice

Diagnosis

The diagnosis of mononucleosis is usually based on the results of blood

tests combined with the doctor

neck. The doctor will also tap on or feel the patient

whether the liver and spleen have become enlarged.

A patient infected by EBV will have an increased number of certain

white blood cells in the blood sample called atypical lymphocytes, and

antibodies to the Epstein-Barr virus. These antibodies can be detected

by a test called the monospot test, which gives results within a day but

may not be accurate during the first week of the patient

type of blood test for EBV antibodies takes longer to perform but gives

more accurate results within the first week of symptoms.

’s illness. Another

Treatment

There is no cure for mononucleosis because it is caused by a virus; it

cannot be treated by antibiotics. Treatment consists of self-care at home

until the symptoms go away. Patients should rest in bed if possible and

drink plenty of fluids. Non-aspirin pain relievers like Advil or Tylenol

can be taken to bring down the fever and relieve muscle aches and pains.

Throat lozenges or gargling with warm salt water may help ease the discomfort

of a sore throat.

Because mononucleosis can affect the spleen, patients should avoid

vigorous exercise or contact sports for at least one month after the onset

of symptoms or until the spleen returns to its normal size. This precaution

will lower the risk of rupture of the spleen.

Prognosis

Mononucleosis rarely causes serious complications. In most patients, the

fever goes down in about ten days, but fatigue may last for several weeks

or months. Some people do not feel normal again for about three

months. A patient who feels sick longer than four months, however,

should go back to the doctor to see whether they have another disease

or disorder in addition to mononucleosis. In some cases, the patient is

diagnosed with chronic fatigue syndrome or CFS. The Epstein-Barr virus

does not cause CFS; however, it appears to make some patients with

mononucleosis more susceptible to developing chronic fatigue syndrome.

One way to speed complete recovery from infectious mononucleosis

is to get plenty of rest early in the disease; the more rest patients get at the

beginning, the more quickly they recover.

Severe complications of mononucleosis are unusual but may include

rupture of the spleen, which occurs in 0.5 percent of patients

of them males who returned to sports too quickly. Airway obstruction

may develop in one patient per thousand, most often a small child.

This complication can be treated with steroid medications. Between 1 and

3 percent of patients may develop a form of anemia that can also be

treated with steroids.

Prevention

There is no vaccine that can prevent mononucleosis. In addition, the fact

that many people can be infected with the virus and transmit it to others

without having symptoms of the disease means that mononucleosis is

almost impossible to prevent. The best precautionary measure is for

patients who have been diagnosed with mono to avoid kissing, or other

close personal contact with, others and to wash their drinking glasses, food

dishes, and eating utensils separately from those of other family members

or friends for several days after the fever goes down. It is not necessary for

people with mono to be completely isolated from other people, however.

Because the Epstein-Barr virus remains in the body after the symptoms

of mononucleosis go away, people who have had the disease should

not donate blood for at least six months after their symptoms started.

The Future

As of 2008 researchers were working on a vaccine against EBV. In

December 2007 the

developed in Belgium shows promise in preventing mononucleosis. The

vaccine must undergo further clinical trials, however, before it can be

definitely shown to be effective and licensed for use in the United States.

Journal of Infectious Diseases reported that a vaccine

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