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What is infectious mononucleosis ("mono")?

Infectious mononucleosis, "mono," "kissing disease," and glandular
fever are all terms popularly used for the very common illness caused
by the Epstein-Barr virus (EBV). This common viral infection causes
fever, sore throat, and enlarged lymph nodes. The illness generally goes
away without medical help. However, it may last from weeks to months.
Treatment is mainly to ease symptoms, usually at home, with plenty of
rest and fluids.
Infectious mononucleosis (“kissing disease”) is a
very common illness caused by the Epstein-Barr virus (EBV).




What is the Epstein-Barr virus?

EBV is a member of the herpesvirus family and causes more than 90%
of cases of mononucleosis. EBV is a double-stranded DNA virus named
for the English virologists professor Sir Anthony Epstein and Yvonne M.
Barr. The designation "mononucleosis" refers to an increase in a special
type of white blood cells (lymphocytes) in the bloodstream relative to
the other blood components as a result of the EBV infection.
EBV is a double-stranded DNA virus named for the English
virologists professor Sir Anthony Epstein and Yvonne M. Barr.





What is the cause of mono?

The EBV that causes mono is found throughout the world. By the
time most people reach adulthood, an antibody against EBV can be
detected in their blood. In the U.S., up to 95% of adults 35-40 years of
age have antibodies directed against EBV. This means that most people,
sometime in their lives, have been infected with EBV. While there are
other illnesses falling under the broad classification of mononucleosis
that cause similar symptoms and an increase in blood lymphocytes, the
form caused by the EBV is by far the most common.

Most people, sometime in their lives, have
been infected with EBV, the virus that causes mono.





What are the risk factors for mono?

The EBV can infect anyone. By adulthood, 90%-95% of men and women
have been infected with EBV; infections most often occur in people 5-25
years of age. Not surprisingly, 1%-3% of college students contract mono
each year, as it is most often transmitted via saliva (hence the name
“kissing disease”). However, mono can also be spread through blood and
genital secretions.
By adulthood, 90%-95% of men and women have been infected
with EBV, with infection most often occurring in people 5-25 years of age.





How is mono spread?

Mono is usually spread by person-to-person contact. Saliva is the
primary method of transmitting mono. Infectious mononucleosis developed
its common name of "kissing disease" from this prevalent form of
transmission among teenagers. A person with mono can also pass on the
disease by coughing or sneezing, causing small droplets of infected
saliva and/or mucus to be suspended in the air and inhaled by others.
Sharing food or beverages from the same container or utensil can also
transfer the virus from one person to another, since contact with
infected saliva may result.

Mono is usually spread by person-to-person
contact with saliva as the primary method of transmission.





How long is mono contagious?

Most people have been exposed to the virus as children, and as a
result of the exposure, they have developed immunity to the virus. It is
of note that most people who are exposed to the EBV don't ever develop
mononucleosis. The incubation period for mono, meaning the time from the
initial viral infection until the appearance of symptoms, is between
four and six weeks. During an infection, a person is likely able to
transmit the virus to others for at least a few weeks.
During an infection, a person is likely able to
transmit the virus to others for at least a few weeks.





Reactivations of mono

Research has shown that, depending on the method used to detect
the virus, anywhere from 20% to 80% of people who have had mononucleosis
and have recovered will continue to secrete the EBV in their saliva for
years due to periodic "reactivations" of the viral infection. Since
healthy people without symptoms also secrete the virus during
reactivation episodes throughout their lifetime, isolation of people
infected with EBV is not necessary. It is currently believed that these
healthy people, who nevertheless secrete EBV particles, are the primary
reservoir for transmission of EBV among humans.
Approximately 20%-80% of people who have had mono will continue
to secrete the EBV in their saliva for years due to periodic "reactivations."






What are the symptoms of mono?

The initial symptoms of mono are a general lack of energy
(malaise), loss of appetite, and chills. These initial symptoms can last
from one to three days before the more intense symptoms of the illness
begin. The more common intense symptoms include a severe sore throat,
fever, and swollen glands (lymph nodes) in the neck area. It is
typically the severe sore throat that prompts people to contact their
doctor.
The initial symptoms of mono are a general
lack of energy (malaise), loss of appetite, and chills.

What are the signs of mono?

In addition to a fever from 102 F-104 F, the most common signs of
mono are a very reddened throat and tonsils and swollen lymph glands
(nodes) in the neck. The tonsils have a whitish coating in at least
one-third of the cases. The spleen (sometimes referred to as the body's
biggest lymph node), an organ found in the left upper abdomen underneath
the rib cage, becomes enlarged or swollen in about 50% of patients with
mono. An enlarged liver may also occur. About 5% of patients have a
splotchy red rash over the body, which has a similar appearance to the
rash of measles.
The most common signs of mono are a very reddened throat
and tonsils along with swollen lymph glands (nodes) in the neck.




How is mono diagnosed?

A diagnosis of mono is suspected by the doctor based on the
patient's symptoms and signs. Mono is confirmed by blood tests that may
also include tests to exclude other possible causes of the symptoms,
such as tests to rule out Strep throat. Early in the course of mono,
blood tests may show an increase in one type of white blood cell
(lymphocyte). Some of these increased lymphocytes have an unusual or
"atypical" appearance when viewed under a microscope, which suggests
mono.
More specific blood tests, such as the monospot and heterophile
antibody tests, can confirm the diagnosis of mono. These tests rely on
the body's immune system to make measurable antibodies against the EBV.
Unfortunately, the antibodies may not become detectable until the second
or third week of the illness. A blood chemistry test may reveal
abnormalities in liver function.

The diagnosis of mono is suspected by the doctor based on the
patient's symptoms and signs and confirmed through blood tests.



What is the usual course and treatment of mono?

In most cases of mono, no specific treatment is necessary. The
illness is usually self-limited and resolves in much the same way as
other common viral illnesses. Treatment is directed toward the relief of
symptoms. Available antiviral drugs have no significant effect on the
overall outcome of mono and may actually prolong the course of the
illness. For the most part, supportive or comfort measures are all that
is necessary. Acetaminophen can be given for fever and any body- or
headaches. A sufficient amount of sleep and rest is important. The
throat soreness is worst during the first five to seven days of illness
and then subsides over the next seven to 10 days.
In most cases of mono, no specific treatment is
necessary although a sufficient amount of sleep and rest is important.



Are there any long-term effects of mono?

A feeling of fatigue or tiredness may persist for months following
the acute phase of the illness. It is recommended that patients with
mono avoid participation in any contact sports during the first six to
eight weeks following the onset to prevent trauma to the enlarged
spleen. Patients can continue to have virus particles present in their
saliva for as long as 18 months after the initial infection. When
symptoms persist for more than six months, the condition is frequently
called "chronic" EBV infection.
Fatigue or tiredness may persist for months, and virus particles may
be present in the saliva for as long as 18 months after the initial infection.




What are the complications of mono?

A common, but usually not serious, complication of mono is a mild
inflammation of the liver or hepatitis. This form of hepatitis is rarely
serious and rarely requires treatment. The enlargement of the spleen
that occurs with mono makes traumatic rupture of the spleen a possible
complication. Fortunately, the more severe complications of mono are
quite rare, and mono is very rarely fatal in healthy people. The rare
severe complications include destruction of red blood cells (hemolytic
anemia) and inflammation of the sac surrounding the heart
(pericarditis), the heart muscle itself (myocarditis), and the brain
(encephalitis). Mono tends to be more aggressive in patients with
abnormal immune systems, such as people with AIDS or those who are
taking medications that suppress immune function. The EBV has been
associated with some types of cancers, most commonly lymphomas. As well,
some studies have linked EBV to the development of at least one subtype
of Hodgkin's disease.
While there can be complications, fortunately, the more severe
complications of mono are quite rare and are very rarely fatal in healthy people.





Infectious Mononucleosis At A Glance

• Infectious mononucleosis is a contagious illness caused by the Epstein-Barr virus (EBV).
  
• The infection can be spread by saliva, and the incubation period for mono is four to six weeks.
  
• Most adults have laboratory evidence (antibodies against the EBV)
  indicative of a previous infection with EBV and are immune to further
  infection.
  
• Symptoms include fever, fatigue, sore throat, and swollen lymph nodes.
  
• Diagnosis is confirmed by blood tests.
  
• Mono can cause liver inflammation (hepatitis) and enlargement of the spleen.
  
• People who have had mono can continue to shed virus particles in
  their saliva during reactivations of the viral infection throughout
  their lifetime.
  
• Vigorous contact sports should be avoided in the illness and recovery phase to prevent rupture of the spleen.
  
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