Mononucleosis (patient information)

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 * Assistant Editor-in-Chief: Ethan Leeman

Overview
Infectious mononucleosis (IM) is a very prevalent viral infection caused by the Epstein-Barr virus, a herpes virus. 90% of adults have been exposed to the mononucleosis, many as little children, when no symptoms or flu-like symptoms are exhibited. In underdeveloped countries, almost everyone is exposed at a very young age, so mononucleosis exists mostly in developed countries.

What are the symptoms of Mononucleosis?

 * Mononucleosis has an incubation period of 4-7 weeks, and symptoms are typically for 2-3 weeks, although fatigue can take longer.


 * The main symptoms of infectious mononucleosis are:
 * sore throat (more common in children)
 * fever
 * fatigue
 * weight loss
 * malaise, general discomfort
 * enlarged lymph nodes (more common in children)
 * enlarged spleen
 * enlarged liver (more common in adults)
 * jaundice (more common in adults)


 * Some rarer and more serious symptoms are:
 * lower levels of platelets and blood cells
 * rupture or hemorrhage of the spleen
 * airway obstruction
 * pneumonitis


 * Cases are almost never fatal.

What causes Mononucleosis?

 * Infectious mononucleosis is spread through immediate contact with saliva, hence the colloquial name "kissing disease." Sharing eating utensils is another way to transmit mononucleosis.


 * Contact through air or blood does not spread mononucleosis.


 * Even long after having been exposed to the virus and any acute symptoms are gone, people still carry the virus. They are typically not at risk of reinfection but are at risk of infecting others. Because so many people have been infected with the virus, prevention from exposure is near impossible.

Who is at highest risk?

 * Mononucleosis is a very prevalent viral infection caused by the Epstein-Barr virus, a herpes virus.


 * 90% of adults have been exposed to the mononucleosis, many as little children, when no symptoms or flu-like symptoms are exhibited.


 * In underdeveloped countries, almost everyone is exposed at a very young age, so mononucleosis exists mostly in developed countries.

When to seek urgent medical care?

 * If you develop symptoms of mononucleosis contact your doctor

Diagnosis

 * During a physical examination, the doctor may find swollen lymph nodes in the front and back of your neck, as well as swollen tonsils with a whitish-yellow covering. The doctor might also feel a swollen liver or swollen spleen when pushing on your belly. There may be a skin rash.


 * Blood work often reveals a higher-than-normal white blood cell (WBC) count and unusual-looking white blood cells called atypical lymphocytes, which are seen when blood is examined under a microscope. Atypical lymphocytes and abnormal liver function tests are a hallmark sign of the disease.


 * A monospot test will be positive for infectious mononucleosis.


 * A special test called an antibody titer can help your doctor distinguish a current (acute) EBV infection from one that occurred in the past.

Treatment options

 * The goal of treatment is to relieve symptoms. Medicines such as steroids (prednisone) and antivirals (such as acyclovir) have little or no benefit.


 * To relieve typical symptoms:
 * Drink plenty of fluids.
 * Gargle with warm salt water to ease a sore throat.
 * Get plenty of rest.
 * Take acetaminophen or ibuprofen for pain and fever.
 * Prednisone is also sometimes to reduce throat inflammation.


 * You should also avoid contact sports while the spleen is swollen (to prevent it from rupturing).


 * Antibiotics should not be used, and almost always if used with mononucleosis can cause a non-allergic rash.

Where to find medical care for Mononucleosis?
Directions to Hospitals Treating Mononucleosis

What to expect (Outlook/Prognosis)?
The fever usually drops in 10 days, and swollen lymph glands and spleen heal in 4 weeks. Fatigue usually goes away within a few weeks, but may linger for 2 to 3 months.

Possible complications

 * Death in persons with weakened immune systems
 * Hemolytic anemia
 * Hepatitis with jaundice (more common in patients older than 35)
 * Inflammation of the testicles (orchitis)
 * Neurological complications (rare), including:
 * Guillain-Barre syndrome
 * Meningitis
 * Seizures
 * Temporary facial paralysis (Bell's palsy)
 * Uncoordinated movements (ataxia)


 * Secondary bacterial throat infection
 * Spleen rupture (rare; avoid pressure on the spleen)

Diseases with similar symptoms
Strep throat