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Infectious mononucleosis, kissing disease, glandular fever, or "mono"
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- Mono is a viral disease (i.e., caused by a virus) that usually affects people between the ages of 10-35. Mono spreads from one person to another through the exchange of saliva (i.e., by kissing, sharing a toothbrush or eating utensil). Sneezing and coughing can also spread the virus that causes mono.
- It occurs during infancy and early childhood in developing countries and among low socioeconomic populations.
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- Most EBV infections are clinically silent when they occur in children younger than 4 years of age.
- After exposure, the virus goes through an incubation period (multiplies) that lasts 4-8 weeks. 1-3 days after incubation ends, the following symptoms may develop:
- Extreme malaise (loss of energy) and a wanting to rest all the time. Fatigue may last for months.
- Sore throat (pharyngitis) that subsides in 7-10 days
- Enlarged lymph glands (where the cells of the immune system are located) in the neck, under the arms, or under the chin (90% of cases) may last 3-4 weeks.
- Pain or enlargement of the saliva-producing glands of the neck
- Fever and loss of appetite
- Pink rash may develop all over the body (3%-15% of cases). This is most commonly seen in those who have received antibiotics such as ampicillin for a sore throat.
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- Epstein-Barr virus (EBV) is related to the herpes virus family. Most people in the world (95% of the United States' adult population) have been infected by age 40, and have developed antibodies (protective proteins secreted by the cells of the immune system) toward EBV.
- EBV first infects the saliva-producing glands, then spills over to the blood. EBV can also stay dormant inside the B lymphocytes (cells of the immune system) for years without causing any symptoms.
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- History of exposure to someone with mono
- Medical exam may show:
- Fever, enlarged lymph nodes in the neck, reddish throat, whitish film over the tonsils, and an enlarged spleen
- Blood tests may show:
- Increased number of white blood
cells, in particular the mononuclear type
- Abnormal white blood cells
(atypical lymphocytes).
- Destroyed red blood cells or
decreased platelets (particles that help in clotting the
blood)
- Abnormal liver function may be detected.
- Antibodies against EBV are identified using tests called mono spot and heterophile antibody tests.
- Throat cultures may help to rule out strep throat.
- EBV can be found in the saliva for months.
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- Children (get it from family members who kiss or feed them)
- Adolescents and adults exposed to infected family members
- Patients with weakened immune systems (i.e., AIDS, cancer, or malnutrition)
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- Tylenol for fevers
- Aspirin or ibuprofen given for pain
- Antiviral treatments with acyclovir to decrease viral replication
- Steroids are often given (fewer than 2 weeks) for complications such as airway obstruction, destroyed red blood cells, or decreased platelets, Seizure, and meningitis.
- Throat lozenges or sprays (Chloroseptic) can ease a sore throat
- Rest and avoid sports (enlarged spleen can rupture)
- Vitamins and minerals (including vitamin C, zinc, adrenal or thymus extract)
- Fluids (10-15 glasses of water a day). Teas and juices are helpful. Try to avoid caffeine, smoking, or alcohol.
- Steroids often if the swollen throat blocks the airway and makes breathing difficult.
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- Spleen (the organ in the left upper portion of abdomen)
enlargement in 50% of cases.
- Myositis or muscle pain
- Inflammation of the sac covering the heart (pericarditis)
or the heart muscle (myocarditis)
- Inflammation of the liver (hepatitis) can cause jaundice
(yellowing of the skin) or icterus (yellowing of the
white portion of the eyes).
- Inflammation of the brain (encephalitis) can cause
confusion and coma
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Most
cases are mild and resolve on their own; in a small percentage, other complications may occur.
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Get plenty of rest and contact your physician. Avoid strenuous exercise and kissing others. You can get information by calling the Center for Disease Control at 1-888-232-3228.
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- Other causes of pharyngitis (sore throat)
- Rubella or other viral infections
- Leukemia or lymphoma
- Kawasaki syndrome
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