Mononucleosis

Many people are infected with EBV during childhood. Young children exposed to EBV generally have a mild illness if any at all.

However, if infection is postponed until the teen or young adult years, infectious mononucleosis is a more likely outcome.

EBV is also responsible for a variety of other illnesses, some of them due to reactivation of the virus later in life. This can happen when the immune system has been weakened by disease, cancer treatment, or an organ or bone marrow transplant.

Following are some of the common symptoms of mononucleosis:

• fatigue
• fever
• sore throat
• swollen glands

The symptoms usually come on gradually, and are often confused for those of other illnesses. Conversely, other viruses can also cause mononucleosis-like syndromes. A person with mononucleosis may have enlargement of the liver or the spleen. If this occurs, the person may have abdominal pain or fullness.

Mononucleosis is caused by EBV. EBV is spread primarily through saliva, thus its nickname, the "kissing disease." It can also be transmitted on drinking glasses and utensils, or by coughing or sneezing.

EBC is not as contagious as measles, influenza, or the common cold.

EBV lives in the person's mouth and throat for years after initial infection. Shedding of EBV by healthy individuals, through contact with saliva in some way, accounts for most of the spread to uninfected people.

EBV is prevalent throughout the world. In the United States, 95% of the adults between 35 and 40 years of age have acquired EBV. The best way to prevent mononucleosis is to limit sharing of drinks, lipsticks, and other sources of saliva.

Diagnosis of mononucleosis begins with a medical history and physical exam. Blood tests can detect antibodies produced by the body to fight EBV. Many people, however, have these antibodies without any symptoms.

When a person has had mononucleosis, EBV may recur later in life. The EBV virus has been associated with Burkitt's lymphoma, an uncommon blood cancer. It has also been associated with nasopharyngeal cancer, a cancer that occurs in the back of the throat area. However, EBV is not the only cause of these cancers. It is extremely rare for people infected with EBV to ever develop either of these cancers. Other more common complications of EBV are as follows:

• heart infection
• infection of the brain or spinal cord
• lymph nodes that are so swollen they cause breathing problems
• severe infection in people with weakened immune systems
• a ruptured spleen
• very low blood counts

EBV is spread through contact with the saliva of the infected person.

In an otherwise healthy person without complications, the best strategy for treatment is to get plenty of rest and fluids, and allow the infection to resolve itself. Strenuous exercise or contact sports should be avoided during this time to prevent rupture of the spleen.

Oral corticosteroids, such as prednisone, are sometimes used to treat very large lymph nodes or tonsils. Antiviral agents such as acyclovir (i.e., Zovirax) may sometimes be used in complicated cases.

Although antibiotics are of no help in viral infections, such as EBV infections, ampicillin can be especially problematic if given to a person with mononucleosis as the combination can cause a prominent rash.

Corticosteroids may cause bleeding, increased risk for infection, and bone thinning.

Symptoms of mononucleosis can last for several weeks but usually resolve. However, EBV is sometimes fatal in people with weakened immune systems.

Most cases resolve by themselves. Any new or worsening symptoms should be reported to the healthcare provider.