Mononucleosis/Epstein-Barr Virus ("EBV")
Basic Information
Epstein-Barr virus infections are caused by the herpes virus, the family of which includes CMV, herpes simplex and the varicella-zoster virus. It is believed that almost all people become infected with EBV at some point in their lives but at least half of the cases are acquired by the age of five years. Both sexes are affected equally, although females tend to become infected two years earlier than males.
It is not known how this human herpes virus is passed but it is generally believed that it is transmitted by intimate contact, i.e. kissing where saliva is passed back and forth. Hence it has been nicknamed the "kissing disease". The virus is not considered highly contagious even though intimate or close contact between people is thought to be necessary for transmission.
The infection is more severe in the elderly; if acquired during childhood, the affects of the illness are considerably more moderate. EBV is often asymptomatic in the young. The virus usually resolves on its own.
EBV is most prevalent in lower socioeconomic groups.
The most common appearance of EBV is infectious mononucleosis, usually seen in patients between fifteen and twenty-five presumably because of intimate or social contact during late adolescence and early adulthood. It can be passed not only through saliva, but also by sharing utensils or even by coughing. Rarely, a blood transfusion can cause the infection.
Mononucleosis affects the liver, lymph glands and respiratory system. The incubation period is anywhere from ten days to two months following exposure.
Symptoms
The classic triad of mononucleosis is:
- inflammation of the pharynx (or tonsils) -- usually the severest symptom
- fever (higher in the evening)
- lymphadenopathy (usually in the neck, groin or under the arms)
Other symptoms include:
- fatigue and malaise (most eminent symptoms)
- rash (associated with the use of ampicillin)
- headache
- muscle aches
- abdominal pain
- occasional jaundice
- enlargement of the spleen and liver
Diagnosis/Treatment
A blood test is the diagnostic tool for mononucleosis.
Treatment depends on the severity of the illness. Most symptoms resolve on their own although fatigue and malaise may last for months before disappearing. Complications are rare but can occur. A ruptured spleen is a rare complication, but if it occurs, a splenectomy is usually indicated. Other unusual but severe complications include hemolytic anemia or an impending airway obstruction due to enlarged tonsils. In these cases the use of steroids may be recommended, often for a short period. Rarely, decreased platelet production or increased platelet destruction or hypersplenism or severe anemia may occur. In these cases transfusions may be warranted. Normally, however, mononucleosis is not treated through pharmacological intervention as recovery usually occurs anywhere from ten days to a few months, although fatigue and malaise may persist for several months after the other symptoms have resolved.
Nonaspirins may be used (i.e. Tylenol or Advil) for aches but aspirins should never be used by anyone under the age of sixteen because of the link with Reye's syndrome (a type of encephalitis).
If you are diagnosed with mononucleosis, bed rest is recommended, at least until fever subsides. When symptoms resolve, you can gradually begin your normal routine. If a sore throat persists, gargle with warm salt water. It is important to pay attention to nutrition and to drink plenty of liquids (soups, juices) -- especially beneficial for a sore throat.
Because of the possibility of a ruptured spleen, contact sports should not be participated in, at least during the first month of illness. Your health care provider should give approval for when it is appropriate for you to begin to engage again in any contact sports.
Do not strain during bowel movements so that you do not injure your enlarged spleen.
Since most cases involve high school or college students, doing schoolwork at home may be arranged.
There is a very rare form of infectious mononucleosis that is chronic and mimics chronic fatigue syndrome. If your mononucleosis does not resolve adequately and is persistent, it is important to follow up with your health care provider. Additionally, your health care provider will want to be certain that your friends and family members understand how this infection is transmitted so that reasonable protective cautions can be taken.
EBV infection is believed to be responsible for primary central nervous system lymphoma in patients with AIDS. Also EBV infection is associated with nasopharyngeal carcinoma and Burkitt's lymphoma in Africa.
If you feel that you have infectious mononucleosis, please see your health care provider promptly.
Additional Resource(s):
- National Institute of Allergy and Infectious Diseases of the NIH 301-496-5717