| Infectious Mononucleosis is the best-known clinical syndrome caused by Epstein-Barr virus (EBV). It is characterized by complaints consisting primarily of fatigue, malaise, fever, sore throat, lymph node and splenic enlargement, and mild liver involvement. The syndrome occurs most commonly in adolescents and young adults. It is also known as glandular fever, Filatov's disease, kissing disease, and Pfeiffer's disease. Transmission of infectious mononucleosis is by direct contact with saliva from a previously infected person. In young children infection usually occurs from exchange of saliva from child to child, such as occurs between children in out-of-home childcare. Infection in adolescence or as an adult is usually from salivary transfer. Nonintimate contact, environmental sources, or fomites (transfer by nonanimate objects) do not contribute to the spread of this virus. EBV is shed in oral secretions for 6 months or longer after acute infection and then intermittently for life. After the primary infection, EBV remains within the person for life and is intermittently shed from the mouth. It may be reactivated if the infected person's immune system is ever suppressed. Clinical manifestations: The incubation period for infectious mononucleosis is 2 to 5 weeks. The majority of cases in infants and young children have no symptoms or they appear to be upper respiratory infections. After the incubation period, adolescents and young adults develop malaise, headache, fever, abdominal pain, nausea, myalgia (muscular pain), sore throat, and lymph node enlargement lasting from 1 to several weeks. This prodromal period may last 1 to 2 weeks. Tonsils and cervical lymph nodes may be quite enlarged, painful, and tender and gradually increase in size until the patients seek medical care. The spleen may enlarge rapidly causing left upper quadrant abdominal discomfort and tenderness. The duration of the illness is variable. The acute phase lasts about 2 weeks after which patients are generally able to resume usual activities, but may find that full resolution of the fatigue takes several more weeks. About 50% can return to school or work within 2 weeks. Malaise or weakness may recur over several months. Rashes occur in 3 to 15 % of the patients and are more common in patients receiving penicillin treatment. Almost all normal people completely recover from acute infectious mononucleosis within 3 to 4 months. Treatment is largely supportive. Rest is important during the period of acute symptoms and a slow return to normal activity is commonly advised. Acetaminophen (Tylenol) may be used for fever and pain. This is preferable to aspirin because of the rare association of the EBV virus with Reye's Syndrome. Steroids are only used when obstructing tonsils may cause airway obstruction. Because of the risk of splenic rupture, heavy lifting and contact sports should be avoided for 2 months after onset, even if there is no splenomegaly. |
| Infectious Mononucleosis |
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