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more about Mononucleosis

Infectious mononucleosis, kissing disease, glandular fever, or "mono"

  • 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.

  • 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:
    1. Extreme malaise (loss of energy) and a wanting to rest all the time. Fatigue may last for months. 
    2. Sore throat (pharyngitis) that subsides in 7-10 days 
    3. 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. 
    4. Pain or enlargement of the saliva-producing glands of the neck 
    5. Fever and loss of appetite 
    6. 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.

  • 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.

  • 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:

    1. Increased number of white blood cells, in particular the mononuclear type
    2. Abnormal white blood cells (atypical lymphocytes).
    3. 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.

  • 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)

  • 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.

  • 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

  • Most cases are mild and resolve on their own; in a small percentage, other complications may occur.

  • 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.

  • Other causes of pharyngitis (sore throat)
  • Rubella or other viral infections
  • Leukemia or lymphoma
  • Kawasaki syndrome

more about Mononucleosis

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