Infectious Mononucleosis

Glandular Fever

What is Mononucleosis?

Mononucleosis is a contagious disease characterized by fever, sore throat, feelings of ill-health (general malaise), and enlarged lymph nodes. It is caused by the Epstein-Barr virus (EBV), and is usually spread through the saliva, by sharing of contaminated eating utensils, kissing, and other close contact with an infected person. The peak incidence of mononucleosis is in the 15-25 year old age group.

How is it diagnosed?

History is of exposure to a person with mononucleosis, who may or may not yet know they are infected.

Mononucleosis signs and symptoms

  • The illness is characterized by fever, swollen lymph nodes, especially in the neck, sore throat, headache, and malaise.
  • Less common symptoms include loss of appetite, persistent muscle aches and joint pain, chills, and nausea.
  • Most symptoms usually last for two to four weeks, but fatigue and malaise can last for months.

Physical exam may show enlarged tonsils and enlarged lymph nodes, in the neck or anywhere in the body. An enlarged spleen or liver, jaundice, or a rash are occasionally seen.

Tests: The diagnosis of acute infectious mononucleosis is suggested by a high percentage of abnormal lymphocytes (a white blood cell) and a positive Monospot blood test. Definitive diagnosis requires the detection of virus-specific antibodies in the blood; but EBV-specific antibodies are usually not present in chronic or reactivated disease. Blood tests of liver function are abnormal in the majority of cases.

How is mononucleosis treated?

Mononucleosis is treated with rest and symptomatic care. Non-steroidal anti-inflammatory drugs (NSAID) are used to reduce fever. Aspirin should be avoided. Contact sports and strenuous activities may be curtailed if an enlarged spleen is suspected. Other activities are reduced in accordance with the symptoms.

If swelling in the throat threatens to block the airway, high doses of corticosteroids can be used. Steroids may also be used for severe central nervous system involvement (e. g. , Guillain-Barr' syndrome), serious anemia, or low blood platelets.

Medications

Information Brand Generic Label Rating
order Acyclovir Zovirax Acyclovir Off-Label

Activity

  • Rest in bed, especially when you have fever. Resume activity gradually. Rest when you are fatigued.
  • Don't participate in contact sports until at least 1 month after complete recovery.

What might complicate it?

Complications can be grouped by symptoms: hematological or blood related, neurological, respiratory and systemic or generalized. Blood disorders include anemia and selectively-reduced white cell counts. Neurological disorders include seizures, psychosis, cranial nerve palsies, and central nervous system inflammation. Interstitial pneumonia or airway obstruction may develop. When the virus invades the blood, other organs may become inflamed, including the heart, spleen, liver, parotid glands, kidneys, and pancreas.

In rare instances, mononucleosis can recur in an individual. Usually, latent virus is reactivated when the body's immunity is suppressed. This can occur as a result of other infectious illnesses, steroid therapy, lymphoma, leukemia, radiation therapy or generalized malignancy.

Predicted outcome

The prognosis for uncomplicated mononucleosis is very good. Most people will completely recover within six months. Prognosis for complicated disease depends upon the severity of initial EBV infection, the rapidity of diagnosis, and the immune status of the individual. Chronic or recurrent mononucleosis is rare.

Alternatives

Other viral and parasitic diseases can resemble acute mononucleosis. These agents include cytomegalovirus, hepatitis B virus, and Toxoplasma gondii.

Appropriate specialists

Internist and infectious disease specialist.

Seek Medical Attention

  • You or a family member has symptoms of infectious mononucleosis.
  • The following occur during treatment:
    • Fever over 102°F (38.9° C).
    • Constipation, which may cause straining.
    • Severe pain in the upper left abdomen (rupture of the spleen is a medical emergency!).
    • Yellowing of the skin.
    • Swallowing or breathing difficulty from severe throat inflammation.

Last updated 22 December 2011


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