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Mononucleosis: Infectious Mononucleosis
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Mononucleosis is a common infectious viral disease transferred in saliva or kissing. It is ... called "glandular fever" outside the USA, or other names such as "mono" and "infectious mononucleosis". The cause is a virus called the Epstein-Barr virus.
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In most cases of infectious mononucleosis, the clinical diagnosis can be made from the characteristic triad of fever, pharyngitis, and lymphadenopathy lasting for 1 to 4 weeks. Serologic test results include a normal to moderately elevated white blood cell count, an increased total number of lymphocytes, greater than 10% atypical lymphocytes, and a positive reaction to a "mono spot" test. In patients with symptoms compatible with infectious mononucleosis, a positive Paul-Bunnell heterophile antibody test result is diagnostic, and no further testing is necessary. Moderate-to-high levels of heterophile antibodies are seen during the first month of illness and decrease rapidly after week 4. False-positive results may be found in a small number of patients, and false-negative results may be obtained in 10% to 15% of patients, primarily in children younger than 10 years of age. True outbreaks of infectious mononucleosis are extremely rare.
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Infectious mononucleosis is caused by the first infection with the Epstein-Barr virus... called herpes virus 4. It is one of the most common human viruses and is endemic throughout the world. EBV is a member of the herpes family of DNA viruses. This family of viruses includes those that cause cold sores, chickenpox, and shingles. Most people are infected with multiple strains of EBV. The different EBV strains are found in separate parts of the body: the circulating lymphocytes (white blood cells), cell-free blood plasma, or the oral cavity.
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After an initial prodrome of 1-2 weeks, the fatigue of infectious mononucleosis often lasts from 1-2 months. The virus can remain dormant in the B cells indefinitely after symptoms have disappeared, and resurface at a later date. Many people exposed to the Epstein-Barr virus do not show symptoms of the disease, but carry the virus. This is especially true in children, in whom infection seldom causes more than a very mild cold which often goes undiagnosed. Children are typically just carriers of the disease. This feature, along with mono's long (4 to 6 week) incubation period, makes epidemiological control of the disease impractical.
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Classic symptoms of infectious mononucleosis are fever, sore throat, and swollen lymph glands. Sometimes, liver involvement may develop, causing nausea, vomiting, decreased appetite, abdominal pain, and/or yellowing of the skin or whites of the eyes (jaundice). A swollen spleen may cause abdominal pain and places the person at risk for splenic rupture, which requires emergency treatment. Heart problems or involvement of the central nervous system occur(s) only rarely, and infectious mononucleosis is almost never fatal. There are no known associations between active EBV infection and problems during pregnancy, such as miscarriages or birth defects. Although the symptoms of infectious mononucleosis usually resolve in 1-2 months and rarely last more than four months, EBV remains latent in a few cells in the throat, blood, and immune system for the rest of the person’s life.
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Like the common cold, infectious mononucleosis is caused by a viral infection. The virus responsible for mono is called the Epstein-Barr virus, abbreviated EBV. EBV is a very common virus worldwide, and studies show that up to 95% of the U.S. population has been infected with EBV at some point in their lives. EBV infection, especially if it occurs early in childhood, does not always cause illness, or it may cause a very mild illness that is not distinguishable from colds or other mild illnesses of childhood. However, when infection first occurs during the teen years or in young adulthood, infectious mononucleosis will develop in up to 50% of cases.
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Infectious Mononucleosis