| Mononucleosis is a contagious disease that is most often caused by the Epstein-Barr virus (EBV) but can also be caused by other viruses such as cytomegalovirus. The vast majority of adult Americans have been exposed to EBV and have built up antibodies that last for a lifetime, so mononucleosis is considered contagious primarily among adolescents and young adults.
Kissing, coughing, and sneezing are common ways of spreading infectious mononucleosis. The disease usually develops several weeks to 2 months after exposure to the virus, which spreads primarily through exchanges of saliva. Many individuals are unaware of the infection because symptoms often are nonexistent to very mild. Frequent shedding of the virus in oral secretions by asymptomatic individuals and the long incubation period often obscures the source of infection.
The incubation period of the EB virus is 2 to 8 weeks followed by an acute phase of 2 to 8 weeks. During this time, the virus can shed intermittently.
Although immunity usually results after infection, in rare cases the disease may recur periodically.Risk: Sharing contaminated eating utensils is a common way of transmitting the disease, which is widespread at college campuses, public schools, and military bases. Incidence and Prevalence: An estimated 95% of adults between the ages of 35 and 40 have been infected with EBV. If adolescents or young adults become infected with EBV, the virus usually causes infectious mononucleosis 35% to 50% of the time ("Epstein-Barr Virus"). In less developed countries, mononucleosis is often seen in younger children. |
Source: Medical Disability Advisor
| History: The individual typically reports a general feeling of illness (malaise) or fatigue at onset. Symptoms slowly become more specific and may develop into persistent sore throat, fever, swollen lymph nodes in the neck and armpits, rash, headache, and loss of appetite. White patches may develop at the back of the throat. Less common symptoms include persistent muscle aches, joint pain, chills, and nausea. The individual may also report exposure to a person infected with the disease. Most symptoms usually last from 2 to 8 weeks, but fatigue and malaise can linger for months. An individual with an extreme or advanced case of mononucleosis may also complain of pain in the left upper part of the abdomen, faintness, difficulty breathing, a rapid heart rate, and abnormal bleeding indicating the spleen has ruptured. Physical exam: The exam may show enlarged tonsils, a sore throat (pharyngitis), and enlarged lymph nodes in the neck or elsewhere in the body (lymphadenopathy). An enlarged spleen (splenomegaly) or liver (hepatomegaly) may be detected. The individual may complain of tenderness when pressure is applied over the spleen or liver. Jaundice or a rash are occasionally seen. Fever may be as high as 102° F (38.9° C). A sore throat (palatal petechiae) or swollen eye (periorbital edema) may be detected. Tests: A complete blood count (CBC) may be performed. A white blood cell count (WBC) may show elevated levels peaking between 10,000 and 20,000 during the second or third week after infection. A high percentage of abnormal white blood cells (lymphocytes) also indicates the presence of the disease. Liver function tests (LFTs) may also show abnormal function through increased bile pigment (serum bilirubin) and somewhat elevated levels of certain enzymes (serum transaminases and alkaline phosphatase). A positive Monospot blood test indicating the presence of antibodies to EBV is usually the best way of detecting short-term (acute) infectious mononucleosis. The best indicator of mononucleosis is the presence of IgM antibody to EBV viral capsid antigen, usually apparent when the infection is most active. In ongoing (chronic) or recurring cases of mononucleosis, antibodies needed to confirm the diagnosis may be absent. |
Source: Medical Disability Advisor
| Since no specific treatment exists for mononucleosis, options for medical intervention are usually limited. Individuals may be advised to rest, although there is no evidence that extended rest shortens the duration of mononucleosis. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to reduce fever. Aspirin should be avoided in young children. If an enlarged spleen is suspected, contact sports and strenuous activities may be curtailed because of the possibility of rupture. Other activities are reduced in accordance with the symptoms. Good hygiene also is recommended.
Drugs that suppress immune responses (corticosteroids) are sometimes used for treating complications such as preventing the throat from swelling and blocking the airway. However, some experts advise against use of steroids because of potential side effects such as an association with development of encephalitis or myocarditis. Other researchers recommend use of steroids for severe central nervous system involvement (e.g., Guillain-Barré syndrome), serious anemia, or low blood platelets. Antiviral agents may inhibit replication of EBV but have not been shown to directly affect duration of the disease. Antibiotics may be used to treat a secondary bacterial infection such as tonsillitis or streptococcal infection. Although no specific treatment may be indicated for liver inflammation, the individual should be advised to avoid alcohol to prevent a worsening of symptoms. |
Source: Medical Disability Advisor
| The prognosis for uncomplicated mononucleosis is very good. Symptoms usually last no longer than a month, and most individuals will recover completely within 6 months. The incidence and duration of complications depend upon the severity of the initial EBV infection and how quickly it is diagnosed. Individuals with immune disorders may have greater difficulty recovering from the disease and any accompanying complications. Chronic or recurrent mononucleosis is rare. In other rare cases, fatalities occur when the spleen ruptures or liver failure is involved. Death is very rare. |
Source: Medical Disability Advisor
| Spleen enlargement and rupture is the most serious complication, occurring in approximately 0.5% of individuals, 90% of whom are men; autoimmune hemolytic anemia affects an estimated 1% to 3% of individuals, and a decrease in blood platelets (thrombocytopenia) may occur in up to 50% of cases (Doerr). Neurological disorders may manifest as seizures, psychosis, cranial nerve palsies, encephalitis, Guillain-Barré syndrome, and central nervous system inflammation. Spatial distortion (metamorphopsia) may also occur. Airway obstruction occurs in an estimated 1 out of every 100 to 1,000 cases. Interstitial pneumonia may develop. When the virus invades the blood, inflammation may occur in other organs such as the heart, spleen, liver, parotid glands, kidneys, and pancreas.
In rare instances, mononucleosis can recur in an individual. Usually, the latent virus is reactivated when the body's immunity is suppressed. This can occur as a result of other infectious illnesses, steroid therapy, leukemia, radiation therapy, or generalized malignancy. In rare cases, symptoms may continue beyond 6 months, leading to a condition called chronic mononucleosis. Other serious complications related to EBV include nasopharyngeal carcinoma and Burkitt's lymphoma. Individuals with AIDS may develop tongue lesions (oral hairy leukoplakia) associated with EBV. In rare cases, a ruptured spleen may develop and become fatal. Another rare but sometimes fatal consequence of mononucleosis is liver disease and failure (fulminant hepatitis).
There is some evidence to suggest that mononucleosis may be linked to an increased risk of multiple sclerosis. |
Source: Medical Disability Advisor
| Depending on the severity of symptoms, work activities may need to be curtailed or restricted until the individual, who usually suffers fatigue, is completely recovered. If the liver, spleen, or kidneys are involved, care should be exercised in lifting heavy objects or bending to grasp and carry objects. Strenuous activity such as contact sports should be strictly avoided because of the possibility of rupturing the spleen. Most people can resume normal activities within 3 to 4 weeks. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has individual had exposure to someone with mononucleosis?
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Did individual report malaise?
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Did individual develop fever, sore throat, loss of appetite, and jaundice?
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Were the lymph nodes swollen in the neck and under the armpits?
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Does individual complain of left-sided abdominal pain? Faintness? Difficulty breathing? Rapid heart rate? Abnormal bleeding?
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On physical exam, were the tonsils enlarged? Was pharyngitis or lymphadenopathy present?
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Were splenomegaly or hepatomegaly detected? Was spleen or liver tender to palpation?
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Was jaundice or a rash seen? Fever?
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Has individual had a CBC and liver function tests? Monospot test? Throat culture?
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Have conditions with similar symptoms been ruled out?
Regarding treatment:
- Was individual advised to rest?
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Were NSAIDs used to reduce fever?
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Were corticosteroids used to treat complications?
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Were antiviral agents used?
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Were there any secondary bacterial infections? Were they treated with antibiotics?
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Was individual advised to avoid alcohol?
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Did splenectomy become necessary?
Regarding prognosis:
- Is individual's employer able to accommodate any necessary restrictions?
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Is individual also following these restrictions at home and play?
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Does individual have any conditions that may affect the ability to recover?
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Has individual had recurrent mononucleosis?
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Has individual had complications such as nasopharyngeal carcinoma? Burkitt's lymphoma? Fulminant hepatitis? Ruptured spleen?
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Source: Medical Disability Advisor
| Doerr, Steven. "Mononucleosis." eMedicine Consumer Health. Ed. Scott H. Plantz. 4 Nov. 2004. Medscape. 20 Oct. 2004 <http://www.emedicinehealth.com/articles/16277-7.asp>. "Epstein-Barr Virus and Infectious Mononucleosis ." Centers for Disease Control and Prevention. U.S. Department of Health and Human Services. 20 Oct. 2004 <http://www.cdc.gov/ncidod/diseases/ebv.htm>. |
Source: Medical Disability Advisor
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