Mononucleosis

Mononucleosis General description

Infectious mononucleosis (also known as mono, Filatov’s disease, glandular fever, monocytic angina, Pfeiffer’s disease) is acute viral disease characterized by fever, lesions of the throat, lymph nodes, liver, spleen and peculiar changes in the composition of blood. This disease most commonly caused by Epstein-Barr virus, one of the viruses in the herpes group.

Infectious mononucleosis has a non-traditional name as kissing disease. It came from the ways of its transmission. The virus can be transmitted through saliva (so you can get it after kissing) or cough, sneeze, sharing food or glass. But this disease is not considered as contagious as for example flu.

The most sensitive to mononucleosis are teenagers and young adults. Children usually have only some symptoms and it goes away easily. But generally if mononucleosis was diagnosed, you should be very careful as it may cause other complications as enlarged spleen.

Causes of infectious mononucleosis

The causative agent of infectious mononucleosis Epstein-Barr virus (EBV) – genomic DNA virus of genus Lymphocryptovirus, Gammaherpesvirinae subfamily of the family Herpesviridae. Comparing to other herpes viruses it doesn’t cause death of cells, but instead of this it activates their proliferation.

A minority of cases of mono are caused by human cytomegalovirus (CMV) which is also type of herpes virus. It can be found in human’s fluids like saliva, urine, blood. So, obviously, a person can be infected by this virus through contact with body fluids of the ill body. Cytomegalovirus is most commonly transmitted through kissing, sexual intercourse or from mother to unborn baby. This virus isn’t visible so much and cannot be recognized easily, but it can be very dangerous for infants, transplant recipients, HIV patients and those who have weak immune system. People who have problems with the immune system can be victims of more serious diseases because of CMV, such as pneumonia, inflammations of esophagus, liver, retina, brain. The thing that can appease you is that 90% of people have been infected by CMV during adulthood and gained the immunity to it.

Modes of transmission:

  •        Airborne transmission through saliva
  •        Blood transfusions and organ transplantation through blood
  •        Sexual contact through semen
  •        Giving birth to a child

Symptoms and signs of mononucleosis

The incubation period varies from 5 days to 1,5 months. There is also a possibility to have a prodromal period with no specific symptoms. In these cases, the disease develops gradually, after few days such symptoms can be observed:

  •        body temperature
  •        malaise (general feeling of unwellness)
  •        fever
  •        headache
  •        fatigue
  •        sore throat
  •        stuffy nose
  •        congestion of the mucous membrane of the oropharynx
  •        swollen lymph nodes in the neck and armpits
  •        skin rash
  •        swollen tonsils and spleen

In the acute onset of the disease the body temperature quickly rises.

MononucleosisIn the end of the first week, disease is progressing and yellowish, easily removable raids will appear on the tonsils. Sometimes, these raids may resemble diphtheria. Also, hemorrhagic elements may appear on the mucous membrane of the soft palate.

In some cases it possible to observe a jaundice syndrome – intensified dyspepsia (loss of appetite, nausea), dark urine.

In some cases, there is one more sign as a papular exanthem. It doesn’t have a specific location, not accompanied by itching and quickly disappear without treatment, leaving no skin changes.

Most people get better in 2-4 weeks, but some can suffer from fatigue and weakness few more weeks. Occasionally, the disease may last for 6 months or even longer.

Complications of infectious mononucleosis

The most frequent complication is additional bacterial infections caused by Staphylococcus aureus, streptococcus and others. Also, the most significant complications include otitis, paratonsillitis, sinusitis, pneumonia.

Sometimes infectious mononucleosis can be complicated by some hard conditions as gap of spleen, liver failure, acute liver failure, hemolytic anemia, acute hemolytic anemia, neuritis, tonsillitis.

Moreover, a patient can face some liver issues like hepatitis (liver inflammation) or jaundice. Less common but dangerous complications also may include thrombocytopenia (low amount of platelets), heart problems (inflammation fo heart muscles), meningitis, encephalitis.

During treatment by ampicillin and amoxicillin antibiotics, the skin rash can be observed.

Diagnosing infectious mononucleosis

Different healthcare providers during diagnosing infectious mononucleosis are focusing on symptoms mostly. But usually laboratory tests can prove the clinical picture of a patient. For clarifying general condition doctors can advice to do blood tests. The blood of a patient with infectious mononucleosis may show amount of white blood cells – lymphocytes (if it’s more than normal the disease might be suspected), unusual white blood cells (atypical lymphocytes), and count of neutrophils or platelets, abnormal liver function.

The most common testing tool is antibody test which can provide additional confirmation checking your blood for antibodies to the Epstein-Barr virus. The results should come after one day, but it may not identify the infection if a patient is ill only one week.

For detecting a number of white blood cells or atypical white blood cells doctors will use different serological test, but it won’t confirm mononucleosis though. It used to suggest the possibility of mono.

Treatment

There is no specific way to avoid the mononucleosis, because you can’t protect yourself from kissing, sharing drinks or food or personal stuff with people whom you know very well, but they are still in risk to have mononucleosis.

If you suspect the infectious mononucleosis you should start from home-treating methods like drinking more healthy fluids, getting enough of rest, taking some common medications for pain or fever.

But if you have a possibility to visit a doctor, do it immediately. There are some tips you’ll need before visit:

- write down all symptoms you have

- write down personal information like recent stresses, life changes, daily routine, whatever that disturbs you

-make a list of all pills you are taking

This will help your doctor to be surer about your health condition as in a moment of visit you may feel bad to concentrate.

Specific therapy for treatment infectious mononucleosis is not developed. And antibiotics won’t work against such infection. Patients with light forms of disease can be treated at home by laying in bed, relaxing and drinking a lot of fluids.

The disease may be accompanied by other bacterial infections as streptococcal, sinus, infection of tonsils and, in this case, the antibiotics might be prescribed.

It’s strictly not recommended to take ampicillin or amoxicillin if you have mononucleosis because it may cause a rash.

To reduce fever and pain, you may use paracetamol or ibuprofen. For anti-inflammatory effect prednisone and corticosteroid are used so it can reduce such symptoms as pharyngeal pain or enlarged tonsils.

To ease some of symptoms, your doctor can advise you to take corticosteroid medication such as prednisone.

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