Disease: Mononucleosis

What Is Mononucleosis?

You’ve heard of mono — the “kissing disease” — but what exactly is it?

Often called the "kissing disease" or "mono," infectious mononucleosis is a contagious, Epstein-Barr virus (EBV) infection.

EBV can be transmitted through saliva or mucus when kissing, coughing, sneezing, or sharing drinking and eating utensils.

About 85 to 90 percent of American adults have developed antibodies to EBV by the time they are 40 years old. Having those antibodies indicates the person has had an EBV infection at some time, whether or not they ever had symptoms.

About 30 to 50 percent of the time, EBV causes mono in an infected person.

It's especially common among teenagers and young adults. In fact, according to the Centers for Disease Control and Prevention (CDC), more than 25 percent of teenagers and young adults will develop mono.

Causes of Mononucleosis

EBV is the most common cause of mono, but other viruses can also cause it, such as the human cytomegalovirus.

Typically, viruses linked to mono spread through bodily fluids, especially saliva. Blood and semen also transmit these viruses during sexual contact, blood transfusions, or organ transplants.

Symptoms of Mononucleosis

Signs and symptoms of mono usually arise 4 to 6 weeks after you're infected with EBV. Young children may show signs sooner. Complaints include:

  • Fatigue
  • Not feeling well
  • Sore throat
  • Strep throat that doesn’t get better after taking an antibiotic
  • Fever
  • Swollen lymph nodes in your neck and armpits
  • Swollen tonsils
  • Headache
  • Skin rash
  • Soft, swollen spleen

A fever and sore throat caused by mono will usually get better within a couple of weeks, while fatigue, enlarged lymph nodes, and a swollen spleen may linger a few weeks longer.

Diagnosis of Mononucleosis

Your health care provider may suspect mono based on your signs and symptoms and a physical exam.

Blood tests can provide further evidence of an infection. A complete blood count, for example, provides some clues, including abnormal-looking white blood cells, too many of them, or too few neutrophils or platelets.

Abnormal measures of liver function are another indicator of mono.

The Monospot test checks your blood for EBV antibodies. While the results are available within a day, the test may not detect an infection during the first weeks of the illness. Therefore, the Monospot test may be repeated weekly for a while.

Your doctor may also order a different antibody test that takes longer for results but detects an EPV infection within the first week or two of symptoms.

Treatment of Mononucleosis

There is no specific treatment for mono. (Antibiotics, of course, don’t treat viral infections.)

Resting and drinking plenty of fluids is the best way to aid your recovery. However, the following may help ease your symptoms:

  • Over-the-counter (OTC) pain relievers, such as ibuprofen or acetaminophen, for fever and muscle aches
  • Sucking on throat lozenges, drinking cold beverages, or eating frozen desserts, such as popsicles, for a sore throat
  • Gargling with one-half teaspoon of salt in 8 ounces of warm water a few times throughout the day for a sore throat
  • Prescription corticosteroid medication, such as prednisone, for severe sore throat, swollen tonsils, and hepatitis caused by mono

You should avoid intense exercise, heavy lifting, or contact sports for at least 4 to 6 weeks, or until you fully recover.

That's because if you have a swollen spleen, there is a small risk that it will rupture during strenuous activity.

Treating Secondary Infections Caused by Mononucleosis

People with mono sometimes develop another, or secondary, bacteria-caused infection such as streptococcal (strep) infection of the throat, sinus infection (sinusitis), or infection of the tonsils (tonsillitis).

If you develop a secondary, bacterial infection, your doctor may prescribe antibiotics to treat it. (Experts recommend avoiding amoxicillin and other penicillin derivatives because they may cause a rash.)

How to Prevent Mononucleosis

Since there isn’t a mono vaccine, the best way to avoid catching the infection from someone who has it is by not kissing or sharing drinks, food, or personal items, like toothbrushes, with them.

Sources:

  • Mononucleosis; Mayo Clinic
  • Mononucleosis; Cleveland Clinic
  • About Infectious Mononucleosis; Centers for Disease Control and Prevention
  • Epstein-Barr Virus/Mononucleosis: National Institutes of Health

What Is the Epstein-Barr Virus?

By age 35, almost everyone has been infected with Epstein-Barr virus, the most common cause of infectious mononucleosis.

One of the most common human viruses in the world, the Epstein-Barr virus (EBV) is a virus in the herpes family of viruses.

By age 35, almost everyone has antibodies to EBV, indicating they’ve been infected with the virus at some point in their life — whether or not they ever had symptoms.

EBV and Mononucleosis

EBV is the most common cause of infectious mononucleosis, also known as "the kissing disease" or "mono."

Its characteristic symptoms are fatigue, headache, fever, sore throat, and swollen lymph nodes.

About 30 to 50 percent of the time EBV causes mono, but many EBV infections go unnoticed either because they don't cause symptoms or the discomforts are easily confused with other signs of infections.

Teenagers and young adults are especially vulnerable: At least 25 percent of them will develop mono.

How is EBV Spread?

Typically, EBV spreads through bodily fluids, especially saliva and other mucous fluids. Blood and semen can also transmit the virus during sexual contact, blood transfusions, and organ transplants.

You can get EBV by sharing drinking glasses, eating utensils, or toothbrushes with a person who has the virus.

There’s no proof that disinfecting such objects will stop the spread of EBV. It’s thought that the virus can survive as long as the contaminated object remains moist.

A person who’s infected with EBV for the first time can spread the virus for weeks without realizing they're infected. Once you've had an infection, EBV stays inactive and dormant in your body.

However, if the virus reactivates, you can potentially spread it to others, no matter how much time has passed since your initial infection.

Symptoms of EBV

When symptoms of EBV occur, they usually go away in 2 to 4 weeks. However, some people may feel fatigued for several weeks or even months.

Symptoms of EBV infection may include the following:

  • Fatigue
  • Fever
  • Inflamed throat
  • Swollen lymph nodes in your neck
  • Enlarged spleen
  • Abdominal pain caused by a swollen liver
  • Rash

Diagnosis of EBV

Since symptoms of EBV resemble those of other illnesses, an infection can be difficult to diagnose.

However, there are blood tests that can confirm whether or not you’ve been infected with EBV.

Treatment of EBV

There is no treatment for EBV, but the following can help relieve symptoms:

  • Drinking lots of fluids
  • Getting plenty of rest
  • Taking over-the-counter (OTC) medications for pain and fever

While there is no vaccine for EBV infection, you may prevent getting it by avoiding kissing or sharing drinks, food, or personal items (such as toothbrushes) with a person who has it.

Complications of EBV

In addition to mono, EBV infection can lead to a number of other illnesses and complications, especially in people with compromised immune systems. These complications include:

Complications of EBV affecting the nervous system include:

  • Viral meningitis, which involves swelling of the tissues that cover the brain and spinal cord
  • Brain swelling
  • Eye nerve swelling
  • Spinal cord swelling
  • Paralysis of facial muscles
  • Paralysis on one side of the body
  • Guillain-Barre syndrome
  • Sudden uncoordinated muscle movement
  • Sleep disorders
  • Psychoses

Complications of EBV affecting the hematologic (blood-forming) system include:

  • Negative effects on blood and bone marrow, creating an excessive number of white blood cells
  • Weakened immune system, leading to other infections

Cancer and EBV

Cancers associated with EBV infection include:

  • Burkitt lymphoma (lymphatic system cancer)
  • Nasopharyngeal carcinoma (upper throat cancer)
  • Hodgkin disease and non-Hodgkin lymphoma (lymphatic system cancers)
  • Post-transplant lymphoproliferative disorder (too many white blood cells after an organ transplant)
  • Tumors, including soft tissue cancers and T-cell lymphomas

Other Conditions and EBV

EBV infection can also cause the following:

  • Pneumonia
  • Lung tissue scarring
  • Pancreas swelling
  • Heart muscle swelling
  • Raised, white patches on the tongue
  • Pus-filled tissue near the tonsils
  • Sinus infection (sinusitis)
  • Inflammation of the liver (hepatitis)
  • Lymph node swelling
  • Bacterial infection of the mastoid bone of the skull just behind the ear
  • Salivary gland swelling and injury
  • Blockage of the air passages in the nose and throat

Sources:

  • Mononucleosis; Mayo Clinic
  • About Epstein-Barr Virus (EBV); Centers for Disease Control and Prevention
  • Epstein-Barr Virus/Mononucleosis; National Institutes of Health

Complications of Mononucleosis

Mono can lead to an enlarged spleen, hepatitis, and other health problems.

While infectious mononucleosis itself may not be a severe infection, mono can lead to serious complications.

The Epstein-Barr virus (EBV) that usually causes mono can be especially dangerous for people with impaired immune systems, including those with HIV/AIDS or who have recently had an organ transplant.

Mononucleosis and an Enlarged Spleen

Mono can enlarge your spleen, causing it to rupture in rare cases.

When rupture occurs, you may feel sharp, sudden pain in the left side of your upper abdomen.

A ruptured spleen requires medical attention immediately, and surgery may be necessary.

Mononucleosis and Liver Problems

Mono can lead to hepatitis (inflammation of the liver) and possibly jaundice (yellow skin, mucus membranes, eyes, or all three).

Jaundice occurs because the inflamed liver is processing too much bilirubin (a yellowish pigment) from red blood cells.

Other Mononucleosis Complications

The following conditions are less common complications of mononucleosis than spleen and liver problems, but they can occur:

  • Anemia (less than a normal amount of red blood cells or iron-rich hemoglobin)
  • Thrombocytopenia, or too few platelets (the blood cells involved in clotting)
  • Myocarditis (inflammation of the heart muscle)
  • Nervous system conditions, such as meningitis, encephalitis, and Guillain-Barre syndrome
  • Tonsillitis (swollen, inflamed tonsils), which can block breathing

Sources:

  • Mononucleosis; Mayo Clinic
  • Jaundice causes; National Institutes of Health

Source: http://www.everydayhealth.com

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