By: Dr. David Herman
Mononucleosis, a virus spread through secretions, was first described in the 19th century by two doctors who observed patients with symptoms including malaise, abdominal discomfort, and enlarged liver, spleen and lymph nodes. In 1958, a scientist named Burkitt first described the Epstein-Barr virus, which is the virus that causes mononucleosis.
Mononucleosis is a type of herpes virus that is unrelated to herpes simplex I and II and has only humans as its source. The term "mononucleosis" refers to the fact that during the infection, a certain population of the blood’s cells (the mononuclear cells) dramatically increases.
Commonly known as the "kissing disease" because the virus is transmitted through contact with the mucous membranes or through saliva, it is quite common. In fact, 50 percent of the population in the United States and Great Britain have had the virus by the time they reach the age of 5, though it does not tend to cause symptoms when contracted at an early age.
Young children are infected by the saliva of playmates or family members transmitted through coughing and sneezing, and adolescents typically get it through kissing. Ninety to 95 percent of the U.S. population have antibodies for Epstein-Barr virus, which means that at some point in their lives they came in contact with the virus. Every year, there are approximately 45 cases for every 100,000 people in the United States. While people of any age can contract the virus, it is young adults in the 15-24 age range that appear the most susceptible.
Unfortunately, there is no vaccine, although having once had EBV usually provides long-lasting immunity. The incubation period is 10 to 60 days, averaging around one to two weeks for children and adolescents. Coming into contact with the saliva of those known to have the virus is not recommended, as the virus can continue to be excreted for months.
Several weeks after exposure to the virus is when the patient typically shows the first signs of having mono. Initially, he or she will feel tired, have a headache, may experience chills and puffy eyes, and have no desire to eat food. Within a few days, the triad of classic symptoms kicks in: sore throat, fever that could reach between 102 to 104 degrees, and swollen lymph nodes in the neck and armpits.
Because mono is a virus, it does not respond to antibiotic treatment, so the focus is on relieving the symptoms. Rest is essential, as is drinking plenty of liquids. The patient can expect the sore throat and fever to last at least a week and then gradually subside. To soothe a sore throat, the patient should gargle with saltwater or suck on throat lozenges. To help relieve body aches and chills, ibuprofen or acetaminophen can help. Remember to avoid giving children and teens aspirin because of the risk of Reyes syndrome.
Generally, steroids are not recommended as treatment for mono, except in rare instances. Those suffering severe cases of the virus may suffer from enlarged tonsils, also called "kissing tonsils." When the tonsils become so enlarged that they interfere with breathing, steroids are given to reduce the swelling.
The virus causes lymph nodes to swell and in rare instances, the lymph cells infected with it get into the spleen. This causes the spleen to become sore and enlarged and increases the chances for a ruptured spleen, which results in sudden blood loss and shock.
This is why it is very important to be aware of pain in the left side of the abdomen. The pain may be insidious or it may come on abruptly; in either case, it is important to go to the hospital. A CT scan will reveal if the spleen has ruptured or is in danger of doing so. Because of this risk and the fact that the spleen is weakened, adolescents who have had mono are advised to avoid contact sports for three to four months.
Sometimes fatigue may persist for a few months, giving rise to the common misconception that mono is sometimes related to chronic fatigue. There is no association between the Epstein-Barr Virus and Chronic Fatigue Syndrome, and thus the term "chronic mono" is inaccurate.
The most common tests for EBV are blood tests. If a patient comes to the office with a sore throat, fever and swollen glands, 90 percent of the time he or she will have a heterophile antibody present. This is sometimes called the "monospot" because it is such a good indicator of the virus’s presence. Doctors look at the patient’s complete blood count. If it contains more lymphocytes (white blood cells), which are atypical, it is commonly thought to contain mono.
In general, people infected with mononucleosis do fairly well, but rare complications do occur. In addition to the rupture of the spleen, these complications may include blood disorders leading to dramatically lowered numbers of white blood cells, inflammation of the heart muscle (myocarditis), involvement of the central nervous system (aseptic meningitis and encephalitis) and a paralyzing disorder known as Guillain-Barré syndrome.
If your child suffers from a combination of fever, sore throat, enlargement of lymph nodes plus fatigue, check with your doctor. It is important to make sure that the person who contracts mononucleosis gets plenty of rest, especially for the first several weeks, and avoids sharing any forms of mucous or saliva with others.
Dr. David Herman is an infectious disease specialist on staff at The Medical Center at Princeton. Health Matters appears Fridays in the Lifestyle section of The Princeton Packet and is contributed by The Medical Center at Princeton.
