BRUCE ROSEMAN, M.D.
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BRUCE ROSEMAN, M.D.
NICOLE LIVESCU, R.N.


Synonyms, Key Words, and Related Terms: mono, kissing disease 
eMedicine Consumer Journal, April 26 2002, Volume 3, Number 4

INTRODUCTION 
Infectious mononucleosis (often called simply "mono") is a common viral infection that causes fever, sore throat, and enlarged lymph nodes. The most common complaint is a sore throat. It is commonly caused by Epstein-Barr virus but can be caused by other viruses such as cytomegalovirus (CMV). It is diagnosed most frequently among teenagers and young adults.

The illness generally goes away without much medical help. However, it may last weeks to months. Treatment mainly is to help symptoms and can nearly always be done at home with plenty of rest.

Serious complications rarely occur.

By adulthood, 90-95% of men and women have been infected. Mono usually occurs between the ages of 15-25.
Mono is highly contagious. Not surprisingly, 1-3% of college students contract mono each year. Infection is spread through exposure to body fluids containing the virus. It is most often transmitted via saliva (hence the name "kissing disease"). However, mono can also be spread through blood and genital secretions too.

CAUSES
Epstein-Barr virus is the cause of mononucleosis in more than 90% of the cases. This common organism is a member of the Herpesviridae family of viruses. Once infected, you develop lifelong immunity to further infections from the disease.   SIGNS AND SYMPTOMS  Section 4 of 13     

Fever, severe sore throat, swollen glands, and fatigue are the most common symptoms. Serious symptoms can include abdominal pain, which may suggest an inflamed spleen and liver, and difficulty breathing, which can suggest swollen glands in the throat closing the airway.   HOME CARE  Section 5 of 13     

Home care with plenty of rest and fluids is essential for someone with mono.

Take acetaminophen (Tylenol) or ibuprofen (Advil) for fever and pain control.
Throat lozenges or gargling with warm salt water may soothe the sore throat.
Drink plenty of fluids to avoid dehydration.
Rest in bed and limit activity according to the degree of illness.
Avoid strenuous exercise and contact sports until your doctor allows you to resume them. Your spleen may be enlarged, and vigorous activity may cause it to rupture. Most doctors feel that strenuous activities should be postponed for at least 1 month after the onset of symptoms or until the spleen has returned to its normal size.
WHEN TO CALL THE DOCTOR 
Call your doctor for an appointment if any of the signs or symptoms of mononucleosis appear. It is important for your doctor to diagnose the illness and make sure it is not another medical condition that may require more extensive medical evaluation and treatment.   WHEN TO GO TO THE HOSPITAL
Although a doctor should be consulted for suspected mononucleosis, these signs and symptoms require urgent evaluation.

Difficulty breathing
Difficulty swallowing (severe sore throat)
Abdominal pain (which may signal that the spleen has ruptured)
Bleeding from the gums or easy bruising
Seizures
Severe headaches
Chest pain
Inability to drink fluids that may lead to dehydration

PHYSICIAN DIAGNOSIS     

The doctor will rely on a combination of clinical and laboratory findings to diagnose mononucleosis. The doctor will ask about the course of illness and perform a physical exam.

These blood tests can help confirm the diagnosis:

A complete blood count may show the white blood cell count to be high because of the infection.

Liver function tests are usually high in nearly 90% of people with mono.

Heterophile antibodies are present in about 80-90% of people with mono. They form in response to infection with Epstein-Barr virus as well as other infections.
This test is frequently negative in children younger than 5 years.

The quantitative heterophile antibody test is considered positive with a titer of 40 or greater. This test may take up to 24 hours to perform.

A shorter version—the qualitative heterophile antibody test (Monospot)—is either positive or negative. This test takes minutes to perform, and results are known right away.

Epstein-Barr virus specific antibodies may be used for people with suspected mononucleosis who have heterophile antibody tests that are negative. It can also be used to test for atypical cases of mononucleosis, or in young children who are suspected of having mononucleosis.
PHYSICIAN TREATMENT    

You can treat mononucleosis best at home just by treating the symptoms and with plenty of rest in bed unless complications occur.

Corticosteroids may be prescribed in the rare cases of airway obstruction, hemolytic anemia (an autoimmune process in which red blood cells are destroyed), severe thrombocytopenia (a decrease in platelets, which are clotting components in the blood), hepatitis (inflammation of the liver caused by the virus), and complications involving the heart and nerves.
Antibiotics are not used to treat mononucleosis.

PROGNOSIS      

Mononucleosis runs its course and typically goes away in 2-4 weeks. More than 95% of people recover normally. Complications are uncommon but may be life threatening. Death from mononucleosis is very rare, and most often results if the spleen ruptures or if the airway is blocked or if there are neurological complications.

The spleen (which is an organ that is actually a big lymph node) ruptures in about 0.5% of people with mononucleosis. Approximately 90% of these are male. Rupture usually occurs during the second or third week of the illness. The person is feeling better and resumes strenuous activities and thus endangers him- or herself. In the event of this complication, doctors may surgically remove the spleen.
Airway obstruction occurs in 1 out of every 100 to 1,000 cases of mononucleosis. It may occur at any age but is more common in young children. Corticosteroids may be used to treat this complication.
Autoimmune hemolytic anemia (the body destroys the red blood cells) occurs in 1-3% of people with mononucleosis. It usually becomes clinically apparent during the second or third week of illness. Corticosteroids may be used to treat this complication.
Thrombocytopenia, which is a decrease in platelets in the blood, has been noted in up to 50% of people with mononucleosis. It is usually mild and not life threatening. If severe, corticosteroids may be used to treat this complication.
Hepatitis caused by the Epstein-Barr virus occurs in 80-90% of people with mononucleosis. It is usually mild and goes away by itself.
Neurological complications rarely may occur. These might include seizures, Guillain-Barre syndrome, Bell palsy, transverse myelitis, encephalitis, meningitis, and cranial nerve palsies. Corticosteroids may be used to treat these complications.
Complications involving the heart, lungs, or kidneys rarely occur.
PREVENTION 
Though good personal hygiene makes sense, especially among vulnerable teenagers, Epstein-Barr virus is everywhere, and exposure to it cannot be avoided entirely.

People with mononucleosis do not need to be isolated from others.
Vaccines are currently being tested.
FOLLOW-UP     
Schedule routine visits with your doctor after the initial diagnosis so the doctor can monitor the course of the illness and detect possible complications. Wait for your doctor to give you medical clearance to resume any strenuous activities or contact sports.  

BIBLIOGRAPHY  Section   
Bailey RE: Diagnosis and treatment of infectious mononucleosis. Am Fam Physician 1994 Mar; 49(4): 879-88[Medline].
Cozad J: Infectious mononucleosis. Nurse Pract 1996 Mar; 21(3): 14-6, 23, 27-8[Medline].
Hickey SM, Strasburger VC: What every pediatrician should know about infectious mononucleosis in adolescents. Pediatr Clin North Am 1997 Dec; 44(6): 1541-56[Medline].
Schooley RT: Epstein-barr virus (infectious mononucleosis). In: Mandell, Bennett, Dolan, eds. Principles and Practice of Infectious Diseases. Vol 2. Churchill Livingstone; 2000:1599-1613.


NOTE: 
Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of this journal have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert. FULL DISCLAIMER 
eMedicine Consumer Journal, April 26 2002, Volume 3, Number 4




Mononucleosis
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