Infectious Mononucleosis

Mononucleosis is an acute infectious disease that causes fever, sore throat, and cervical lymphadenopathy, the hallmarks of the disease. It also causes hepatic dysfunction, increased lymphocytes and monocytes, and development and persistence of heterophil antibodies. The disease primarily affects young adults and children, although in children, it's usually so mild that it's often overlooked.

The prognosis is excellent, and major complications are uncommon.

Causes

Mononucleosis is often transmitted by saliva. While it is known as "the kissing disease," occurring most often in 15- to 17-year-olds, the infection may occur at any age.

Mono may begin slowly with fatigue, malaise, headache, and sore throat. The sore throat becomes progressively worse, often with enlarged tonsils covered with a whitish-yellow covering. The lymph nodes in the neck are frequently enlarged and painful.

Symptoms and Signs

The common symptoms of mono are:

• Fever, which may range from 101 °F to 104 °F, and chills.
• Sore throat
• Swollen all over the body, especially the lymph nodes in the neck.
• Swollen tonsils.
• Headache or body aches.
• A lack of energy and fatigue.
• Loss of appetite.
• Pain in the upper left part of the abdomen, which may indicate that the spleen has become enlarged.

Diagnostic tests

The following abnormal laboratory test results confirm infectious mononucleosis:

• An increase in white blood cell (WBC) count of 10,000 to 20,000/mm³ during the second and third weeks of illness. Lymphocytes and monocytes account for 50% to 70% of the total WBC count; 10% of the lymphocytes are atypical.
• A fourfold increase in heterophil antibodies (agglutinins for sheep red blood cells) in serum drawn during the acute phase and at 3- to 4-week intervals.
• Antibodies to EBV and cellular antigens shown on indirect immunofluorescence. Such testing usually is more definitive than heterophil antibodies but may not be necessary because the vast majority of patients are heterophil-positive.
• Abnormal liver function studies.

Treatment

Infectious mononucleosis isn't easily prevented, and it's resistant to standard antimicrobial treatment. Thus, therapy is essentially supportive: relief of symptoms, bed rest during the acute febrile period, and aspirin or another salicylate for headache and sore throat.

If severe throat inflammation causes airway obstruction, steroids can relieve swelling and prevent a tracheotomy. Splenic rupture, marked by sudden abdominal pain, requires splenectomy. About 20% of patients with infectious mononucleosis also have streptococcal pharyngotonsillitis and should receive antibiotic therapy for at least 10 days.

Prevention

The infection is probably spread by saliva and close contact. People may be contagious while they have symptoms and for up to a few months afterwards. The virus can live for several hours outside the body. Avoid kissing or sharing utensils if you or someone close to you has mono. The exact period that people are contagious varies.

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