Infectious mononucleosis

Infectious mononucleosis is a contagious illness caused by the Epstein-Barr virus that can affect the liver, lymph nodes, and oral cavity. While mononucleosis is not usually a serious disease, its primary symptoms of fatigue and lack of energy can linger for several months.

Infectious mononucleosis, frequently called "mono" or the "kissing disease,"is caused by the Epstein-Barr virus (EBV) found in saliva and mucus. The virus affects a type of white blood cell called the B lymphocyte, producing characteristic atypical lymphocytes that may be useful in the diagnosis of the disease.

While anyone, even young children, can develop mononucleosis, it occurs mostoften in young adults between the ages of 15 and 35 and is especially commonin teenagers. The mononucleosis infection rate among college students who have not previously been exposed to EBV has been estimated to be about 15%. In younger children, the illness may not be recognized.

The disease typically runs its course in four to six weeks in people with normally functioning immune systems. People with weakened or suppressed immune systems are particularly vulnerable to the potentially serious complications of infectious mononucleosis.

The EBV that causes mononucleosis is related to a group of herpes viruses, including those that cause cold sores and chicken pox. Most people are exposed to EBV at some point during their lives. Mononucleosis is most commonly spread by contact with virus-infected saliva through coughing, sneezing, kissing, or sharing drinking glasses or eating utensils.

In addition to general weakness and fatigue, symptoms of mononucleosis may include any or all of the following:

  • Sore throat and/or swollen tonsils
  • Fever and chills
  • Nausea and vomiting, or decreased appetite
  • Swollen lymph nodes in the neck and armpits
  • Headaches or joint pain
  • Enlarged spleen
  • Jaundice
  • Skinrash.

Complications that can occur with mononucleosis include a temporarily enlarged spleen or inflamed liver. In rare instances, the spleen may rupture, producing sharp pain on the left side of the abdomen, a symptom that warrants immediate medical attention. Additional symptoms of a ruptured spleen include light-headedness, rapidly beating heart, and difficulty breathing. Other rare, but potentially life-threatening, complications may involve the heart or brain.The infection may also cause significant destruction of the body's red bloodcells or platelets.

Symptoms do not usually appear until four to seven weeks after exposure to EBV. An infected person can be contagious during this incubation time period and for as many as five months after the disappearance of symptoms. Also, the virus will be excreted in the saliva intermittently for the rest of their lives, although the individual will experience no symptoms. Contrary to popular belief, the EBV is not highly contagious. As a result, individuals living in ahousehold or college dormitory with someone who has mononucleosis have a very small risk of being infected unless they have direct contact with the person's saliva.

If symptoms associated with a cold persist longer than two weeks, mononucleosis is a possibility; however, a variety of other conditions can produce similar symptoms. If mononucleosis is suspected, a physician will typically conduct a physical examination, including a "Monospot" antibody blood test that canindicate the presence of proteins or antibodies produced in response to infection with the EBV. These antibodies may not be detectable, however, until the second or third weeks of the illness. Occasionally, when this test is inconclusive, other blood tests may be conducted.

The most effective treatment for infectious mononucleosis is rest and a gradual return to regular activities. Individuals with mild cases may not requirebed rest but should limit their activities. Any strenuous activity, athleticendeavors, or heavy lifting should be avoided until the symptoms completely subside, since excessive activity may cause the spleen to rupture.

The sore throat and dehydration that usually accompany mononucleosis may be relieved by drinking water and fruit juices. Gargling salt water or taking throat lozenges may also relieve discomfort. In addition, taking over-the-counter medications, such as acetaminophen or ibuprofen, may relievesymptoms, but aspirin should be avoided because mononucleosis has beenassociated with Reye's syndrome, a serious illness aggravated by aspirin.

While antibiotics do not affect EBV, the sore throat accompanying mononucleosis can be complicated by a streptococcal infection, which can be treated with antibiotics. Cortisone anti-inflammatory medications are also occasionally prescribed for the treatment of severely swollen tonsils or throat tissues.

While the severity and length of illness varies, most people diagnosed with mononucleosis will be able to return to their normal daily routines within twoto three weeks, particularly if they rest during this time period. It may take two to three months before a person's usual energy levels return. One of the most common problems in treating mononucleosis, particularly in teenagers,is that people return to their usual activities too quickly and then experience a relapse of symptoms. Once the disease has completely run its course, the person cannot be re-infected.

Although there is no way to avoid becoming infected with EBV, paying generalattention to good hygiene and avoiding sharing beverage glasses or having close contact with people who have mononucleosis or cold symptoms can help prevent infection.

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