Mononucleosis

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Exudative pharyngitis in someone with infectious mononucleosis
Cervical lymphadenopathy in someone with infectious mononucleosis
Mononucleosis
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Mononucleosis (also called "Mono", glandular fever, and, colloquially, the "kissing disease"), is a disease most commonly caused by the Epstein-Barr virus (EBV).[1] EBV affects the lymphocytes which are white blood cells involved in the adaptive immune system.[2] Mononucleosis can also be caused by cytomegalovirus (HCMV), a herpes virus most commonly found in body fluids. While CMV can cause mononucleosis, 85% of the cases are associated with EBV.[3] The disease can be seen in many populations and age cohorts, but is most commonly contracted by adolescents and young adults ages 15–35.[4]

Contents

Symptoms [edit]

Mononucleosis is associated with fatigue that can last up to several months. Symptoms are not usually felt until 4–7 weeks after exposure to EBV. While the disease is rarely fatal, occasionally the disease stays in the blood cells, affecting the person for the rest of his or her life.[5] In every case, the person excretes the disease intermittently in saliva throughout their lives. In some cases, most commonly in teenage girls, the disease can lead to chronic fatigue.[6] Research also shows that those infected with mononucleosis are more susceptible to contracting multiple sclerosis.[7]

The main symptoms of mononucleosis include:[8]

  • Sore throat and tonsils
  • Swollen lymph glands (nodes) in the neck and, less commonly, the armpits and groin area
  • Jaundice (yellow skin and eyes)
  • Enlarged spleen, causing abdominal pain

The most apparent effect of mononucleosis on patients is the lack of energy in everyday life. It becomes difficult for patients to function at a high-speed routine, and they need more sleep than when they are healthy. Males and females are equally susceptible to the contraction of mononucleosis; however, whites in the United States are thirty times more likely than African-Americans to become infected.[8] Children may also become infected; however, the symptoms do not affect them as significantly and they recover more quickly from the illness.

Epstein Barr Virus (EBV) [edit]

EBV is a member of the Herpesviridae family of the DNA viruses. It is one of the most commonly found viruses and epidemics throughout the world.[8] Contrary to common belief, EBV is not highly contagious. It can only be contracted through direct contact with an infected person’s saliva. This commonly includes kissing or sharing utensils, toothbrushes, drinks, lip gloss, etc.[9] Some evidence claims that EBV is also commonly transmitted through sexual intercourse.[10] About 95% of the population has been exposed to this virus by the age of 40, but only 15-20% of teenagers and about 40% of exposed adults actually become infected.[11]

Cytomegalovirus (CMV) [edit]

Cytomegalovirus is also a type of herpes virus. It is found in body fluids including saliva, urine, blood, and tears.[3] A person becomes infected with this virus by direct contact with infected body fluids. CMV is most commonly transmitted through kissing and sexual intercourse. It can also be transferred from an infected mother to her unborn child. This virus is often "silent" because the signs and symptoms cannot be felt by the person infected.[3] However, it can cause life-threatening illness in infants, HIV patients, transplant recipients, and those with weak immune systems. For those with weak immune systems, CMV can cause more serious illnesses such as pneumonia and inflammations of the retina, esophagus, liver, large intestine, and brain. Approximately 90% of the human population has been infected with CMV by the time they reach adulthood, but most are unaware of the infection.[12] Once a person becomes infected with CMV, the virus stays in his/her body fluids throughout his or her lifetime.

Diagnosis [edit]

Symptoms such as swollen glands in the neck, sore tonsils, exhaustion, and extended lack of energy are easily recognizable as symptoms of mononucleosis. If these symptoms occur, the patient should go to a physician and be tested for a confirmation of the virus. This virus is tested using the Monospot test, which analyzes the production of heterophile antibodies by looking at a sample of the patient’s blood.[13] An increased number of white blood cells or lymphocytes in the smear of blood can indicate the presence of Mononucleosis. The Monospot test proves positive in 90% of adults with the virus, but many children will display false negatives.[2]

Occasionally, the physician will take an EBV antibody test to determine the presence of EBV, but they are not necessary if symptoms of mononucleosis are apparent and the Monospot test is positive. There are no risks involved in this test; however, it requires the drawing of blood, a process some may find unpleasant or uncomfortable. Methods of diagnosing EBV in children are still being developed.[14]

Treatment [edit]

There is no specific treatment or therapy for mononucleosis. Patients with serious cases are advised to rest in bed and refrain from activity for 1–2 weeks after symptoms appear.[15] Patients with milder cases are simply advised to avoid strenuous activities and athletic events until symptoms decrease which is normally around two months. They are also strongly advised to avoid contact sports and bicycle riding to reduce the risk of rupturing the enlarged spleen caused by this virus. A blow to the abdomen from a friend or peer, sporting equipment, or bicycle handlebars could rupture the spleen, causing severe bleeding and can be life threatening.[16] To relieve the sore throat, patients should drink water, non-citrus fruit juices, and eat bland foods. Acetaminophen has also been shown to help along with high fluid intake.[17] Gargling with warm water and salt or with mouthwash may also relieve pain. Often mononucleosis is accompanied by a streptococcal infection (known as strep throat), which can be treated with antibiotics. Antibiotics taken with mononucleosis can result in a severe skin rash and swelling, and should only be taken if prescribed by a physician. Normal function should return after 4–6 weeks; however, it may take up to 2–3 months to fully recover pre-disease activity levels.[16]

References [edit]

  1. ^ Henle, Werner; Henle, Gertrude; Horwitz, Lucy. “Epstein-barr virus specific diagnostic tests in infectious mononucleosis.” Human Pathology, (1974). 551-565.
  2. ^ a b DeMoranville, Victoria "Infectious Mononucleosis Test." The Gale Encyclopedia of Nursing and Allied Health. (2002): 1270-1272. Online.
  3. ^ a b c Larsen, Laura. Sexually Transmitted Diseases Sourcebook. Health Reference Series Detroit: Omnigraphics, Inc., 2009. Online.
  4. ^ Montgomery, Susan J; Carson De-Witt, Rosalyn. The Gale Encyclopedia of Children's Health: Infancy through Adolescence. Vol. 2. Detroit: Gale, 2006. Online.
  5. ^ "Infectious Mononucleosis" Susan J Montgomery and Rosalyn Carson-DeWitt, Gale of Encyclopedia of Children’s Health- Infancy through Adolescence.
  6. ^ Jafari, Naghmeh; Broer, Linda; Hoppenbrouwers, Ilse A; van Duijn, Cornelia M; Hintzen, Rogier Q. "Infectious mononucleosis-linked HLA class I single nucleotide polymorphism is associated with multiple sclerosis." Multiple Sclerosis, (2010): 1303-07.
  7. ^ By: Zaadstra, B. M.; Chorus, A. M. J.; van Buuren, S.; Kalsbeek, H.; van Noort, J. M. "Selective association of multiple sclerosis with infectious mononucleosis." multiple sclerosis, (2008). 307-313.
  8. ^ a b c Alic, Margaret. The Gale Encyclopedia of Medicine. Vol. 3. 2nd ed. Detroit: Gale, 2005. Online.
  9. ^ http://www.mayoclinic.com/health/mononucleosis/AN00661
  10. ^ Thompson, Marie. The Gale Encyclopedia of Science. Vol. 2. 3rd ed. Detroit: Gale, 2004. Online.
  11. ^ Schonbeck, John and Frey, Rebecca. The Gale Encyclopedia of Medicine. Vol. 2. 4th ed. Detroit: Gale, 2011. Online.
  12. ^ Carson-DeWitt and Teresa G. The Gale Encyclopedia of Medicine. Vol. 2. 3rd ed. Detroit: Gale, 2006.
  13. ^ World of Microbiology and Immunology. Ed. Brenda Wilmoth Lerner and K. Lee Lerner. Vol. 2. Detroit: Gale, 2003. Online.
  14. ^ Dohno, Sumitaka; Maeda, Akihiko; Ishiura, Yoshihito; Sato, Tetsuya; Fujieda, Mikiya; Wakiguchi, Hiroshi. "Diagnosis of infectious mononucleosis caused by Eppstein-Barr virus in infants." Pediatrics International, (2010). 536-540.
  15. ^ Taber, Clarence. Taber's Cyclopedic Medical Dictionary. Rochester: Lawyer's Co-operative Pub. Co, 1988. Online.
  16. ^ a b Carlson, Karen. Harvard Guide to Women's Health. Cambridge: Harvard University Press, 1996. Online.
  17. ^ Luzuriaga, Katherine; Sullivan, John L. "Infectious Mononucleosis." New England Journal of Medicine, (2010). 1993-2000.
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