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Mononucleosis, often called "Mono", is a usually mild self-limiting acute viral infection and, in most cases, does not deserve its bad reputation. While mono is not usually considered a serious illness, it may have serious complications. Usually caused by the Epstein-Barr virus (EBV), it usually runs its course quickly and rarely produces any serious complications. There are, however, other viruses that may produce a mono-like illness. A less common form of mononucleosis is caused by cytomegalovirus (CMV).
Incidence
Mononucleosis is an illness that affects teenagers and young adults, mainly ages 14 to 30, but can occur in children and older adults. It has been estimated that approximately 50% of students have had mono by the time they enroll in college.
Signs & Symptoms
Many times the symptoms are so mild that it is not recognized for what it is: The symptoms of mononucleosis may be the same as many other illnesses, such as "colds" or strep throat. For this reason, it is particularly difficult to diagnose in the early stages of the illness, although the diagnosis is usually based on symptoms and a physical exam. Symptoms usually disappear within 2-4 weeks, with fatigue sometimes lingering longer.
Diagnosis & Tests
Confirmation, if necessary, can be accomplished by either of two blood tests:- EBV causes an increase in a specific type of white blood cell, the atypical lymphocyte. A white blood cell count, WBC, will reflect this change commonly seen in people who have mononucleosis. Diagnostic problems can result because enlarged lymphocytes are common with mono, but can also be a symptom of leukemia. Blood tests can distinguish between the type of white cell seen in leukemia and that with mono.
- The mono spot test identifies an antibody which is present in mononucleosis and is the test most commonly used to tell whether someone has mono or some other ailment. This test may not become positive until one has had symptoms for 5-14 days and may remain positive for months to years. It is important to remember the mono test merely helps to make the diagnosis; it does not indicate the severity of the disease and does not predict how long symptoms will last. This blood test detects the antibodies (proteins) that the body makes to fight EBV or CMV. Because it takes a while for antibodies to develop after infection, your doctor may need to order or repeat the test one to two weeks after you develop symptoms. At that time the test is about 85% accurate.
Other tests your doctor might order include a complete blood count (CBC) to see if your blood platelet count is lower than normal and if lymphocytes are abnormal, and a chemistry panel to see if liver enzymes are abnormal.
Treatment & Prevention
There are no conventional medical treatments to cure mononucleosis, only those that help manage the symptoms. In approximately 20-30% of people with mononucleosis there is a concurrent bacterial throat infection. Any antibiotics prescribed may help with the sore throat, but not the EBV infection.
Relieve pain and fever with analgesics. Contact sports should be avoided while the spleen is enlarged. Cold drinks and frozen desserts are both ways to relieve sore throat symptoms. Doctors also recommend gargling with saltwater (about half a teaspoon salt to 8 ounces of warm water) and sucking on throat lozenges available over-the-counter in pharmacies and other stores. If throat or tonsils are infected, a throat culture should be taken so the doctor can prescribe an appropriate antibiotic. Ampicillin is usually not recommended because it sometimes causes a rash that can be confused with the pink, measles-like rash that 1 out of 5 mono patients develops.
Acetaminophen is preferable to aspirin for pain and fever relief because of the association of the EBV and Reye's syndrome in children. In most cases of mononucleosis, hospitalization is not indicated. It has been shown that those who remain active to the limit of personal comfort get well more rapidly than those who remain in bed.
Prevention
EBV is found in moist, exhaled air, and in nose or mouth secretions. It is not as contagious as many other viruses but may be transmitted through direct contact. This explains its nickname of the "kissing disease". There is a long incubation period of 30 to 50 days from the time one is exposed to the virus to the time one gets sick. In addition, the virus can be transmitted in other ways, such as sipping from the same straw or glass as an infected person - or even being close when the person coughs or sneezes.
Isolation of the patient is not indicated; one can not catch mononucleosis by sitting in the same room with someone who has it, although persons who have had mononucleosis can shed the virus periodically in their saliva for the rest of their lives. Some people can have the virus in their systems without ever having symptoms, and still be infectious.
Prognosis; Complications
Fever usually abates in about 10 days, and swollen lymph glands and spleen heal in 4 weeks. Fatigue usually resolves within a few weeks, but may linger for 2 to 3 months.
Possible complications include:
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Signs, symptoms & indicators of Infectious Mononucleosis - Mono:
Conditions that suggest Infectious Mononucleosis - Mono:
Infectious Mononucleosis - Mono could instead be: | | | | | Infections |  Infectious Mononucleosis (CMV) | Mononucleosis-like disease may be caused by the cytomegalovirus (CMV) as well as the classic mononucleosis of the Epstein-Barr virus (EBV). Both viruses are members of the herpes virus family. Mononucleosis caused by EBV is the most frequently encountered type and is responsible for approximately 85% of infectious mononucleosis cases. Sore throat is less common in people who have CMV mono than in those infected with EBV. |
 Pharyngitis ("Strep Throat")| | If your throat is sore, having a throat culture is usually a good idea for several reasons. First, the symptoms of mono and strep infection (including that caused by Strep-A, a particularly serious form of strep) are very similar. Second, strep throat or other throat infections can develop at any time during or shortly after infectious mononucleosis infection. In any case, it is important that throat infections be diagnosed as soon as possible and treated with antibiotics that can kill the organism responsible for the infection. |
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Recommendations and treatments for Infectious Mononucleosis - Mono:
KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link |  | | Strongly counter-indicative |  | | May do some good |  | | May have adverse consequences |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Antibody (Antibodies)
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Ataxia (Ataxic)
Failed muscular coordination, irregular muscular action.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Bell's Palsy
One-sided facial paralysis of sudden onset and unknown cause. The mechanism is presumed to involve swelling of the nerve due to immune or viral disease, with ischemia and compression of the facial nerve in the narrow confines of its course through the temporal bone.
Complete Blood Count (CBC)
A set of measurements that are generally determined by specially designed machines that analyze the different components of blood in less than a minute. The values generally included are:- White blood cell count (WBC). The number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 cells per cubic millimeter. This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 - 10.8 x 10^9 cells per liter.
- Automated white cell differential. A machine-generated percentage of the different types of white blood cells, usually split into granulocytes, lymphocytes, monocytes, eosinophils, and basophils.
- Red cell count (RBC). The number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4.2 - 5.9 million cells per cubic millimeter. This can also be referred to as the erythrocyte count and can be expressed in international units as 4.2 - 5.9 x 10^12 cells per liter.
- Hemoglobin (Hb). The amount of hemoglobin in a volume of blood. Normal range for hemoglobin is different between the sexes and is approximately 13 - 18 gm/dl for men and 12 - 16 for women (international units 8.1 - 11.2 millimoles/liter for men, 7.4 - 9.9 for women).
- Hematocrit (Hct). The ratio of the volume of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45 - 52% for men and 37 - 48% for women.
- Mean cell volume (MCV). The average volume of a red cell. This is a calculated value derived from the hematocrit and red cell count. Normal range is 86 - 98 femtoliters.
- Mean cell hemoglobin (MCH). The average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 - 32 picograms.
- Mean cell hemoglobin concentration (MCHC). The average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32 - 36%.
- Red cell distribution width (RDW). A measurement of the variability of red cell size. Higher numbers indicate greater variation in size. Normal range is 11 - 15.
- Platelet count. The number of platelets in a volume blood. Platelets play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 - 400,000 per cubic millimeter (150 - 400 x 10^9 per liter).
Cytomegalovirus (CMV)
A member of the herpes virus family which may induce the immune-deficient state or cause active illness, such as pneumonia, in a patient already immune-deficient due to chronic illness, such as cancer or organ transplantation therapy.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Epstein Barr Virus (EBV, Epstein-Barr Virus)
A virus that causes infectious mononucleosis and that is possibly capable of causing other diseases in immunocompromised hosts.
Hemolytic Anemia
Anemia caused by excessive destruction of red blood cells.
Hepatitis
Inflammation of the liver usually resulting in jaundice (yellowing of the skin), loss of appetite, stomach discomfort, abnormal liver function, clay-colored stools, and dark urine. May be caused by a bacterial or viral infection, parasitic infestation, alcohol, drugs, toxins or transfusion of incompatible blood. Can be life-threatening. Severe hepatitis may lead to cirrhosis and chronic liver dysfunction.
Herpes
A small group of capsid-forming DNA viruses, sometimes divided into Type I (forming vesicles and blisters on the mouth, lips-generally above the waist) and Type II (usually sexually-transmitted, with symptoms mostly below the waist). Both types form acute initial outbreaks, go dormant, reactivate, and so forth. For most folks, frequent outbreaks are clear signs of stress or immunosuppression. Both types are equally dangerous for infants.
Jaundice
Yellow discoloration of the skin, whites of the eyes and excreta as a result of an excess of the pigment bilirubin in the bloodstream.
Leukemia
Cancer of the lymph glands and bone marrow resulting in overproduction of white blood cells (related to Hodgkin's disease).
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Lymph Nodes (Axillary Nodes, Inguinal Nodes, Lymph Gland, Lymph Glands, Lymph Node, Lymphatic)
Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit (axillary) and groin (inguinal), but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Childrens' nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's. Also known (incorrectly) as lymph glands.
Lymphocyte
A type of white blood cell found in lymph, blood, and other specialized tissue such as bone marrow and tonsils, constituting between 22 and 28 percent of all white blood cells in the blood of a normal adult human being. B- and T-lymphocytes are crucial components of the immune system. The B-lymphocytes are primarily responsible for antibody production. The T-lymphocytes are involved in the direct attack against living organisms. The helper T-lymphocyte, a subtype, is the main cell infected and destroyed by the AIDS virus.
Mononucleosis
Infectious Mononucleosis: An acute, infectious disease caused by the herpes virus or Epstein-Barr virus, with fever and inflamed swelling of the lymph nodes around the neck, under the arms, and in the groin. The general symptoms are fever,
sore throat, exhaustion, and abnormal white blood cells.
Ounce (Ounces, oz)
Approximately 28 grams.
Over-The-Counter (OTC, Over The Counter)
A drug or medication that can legally be bought without a doctor's prescription being required.
Platelets (Platelet)
Cells that help the blood to clot.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Saliva (Salivary)
The watery mixture of secretions from the salivary and oral mucous glands that lubricates chewed food and moistens the oral walls.
Seizure (Seizures)
While there are over 40 types of seizure, most are classed as either partial seizures which occur when the excessive electrical activity in the brain is limited to one area or generalized seizures which occur when the excessive electrical activity in the brain encompasses the entire organ. Although there is a wide range of signs, they mainly include such things as falling to the ground; muscle stiffening; jerking and twitching; loss of consciousness; an empty stare; rapid chewing/blinking/breathing. Usually lasting from between a couple of seconds and several minutes, recovery may be immediate or take up to several days.
Spleen (Splenectomy)
The largest organ of the lymphatic system in the body, located between the stomach and the diaphragm (the muscle below the lungs which provides the motion for breathing). It destroys old red blood cells, produces lymphocytes and plasma cells, and stores blood. It also has other as yet unknown functions. A splenectomy is the surgical removal of the spleen.
Streptococcus (Strep)
A genus of gram-staining chain-forming cocci bacteria. Some are responsible for common and potentially serious human infections, ranging from scarlet fever and strep throat to bacterial endocarditis and pus pockets. Most of the disease-potential streps are also a normal part of the skin, mouth and upper respiratory flora.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Teaspoon (Teaspoons, tsp)
Equivalent to 5cc (5ml).
Virus (Viri, Viruses)
Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.
White Blood Cell (WBC, White Blood Cells)
A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. White blood cells are composed primarily of neutrophils, monocytes and lymphocytes. Lymphocytes are either T-cells or B-cells. T-cells (CD3 cells) are divided into T-helper (CD4 cells) and T-suppressor/cytotoxic (CD8 cells) cells.
Last updated: Nov 14, 2009
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