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Epstein barr virus mononucleosis

Infectious mononucleosis (also known as mono, the kissing disease, Pfeiffer's disease, and glandular fever) is a disease seen most commonly in adolescents and young adults, characterized by fever, sore throat and fatigue. It is caused by the Epstein-Barr virus (EBV) or the cytomegalovirus (CMV). It is typically transmitted through saliva or blood, often through kissing, or by sharing a drinking glass, eating utensil or needle. Contrary to common belief, the disease is relatively non-contagious. The causative virus is also found in the mucus of the infected person, so it is also easily spread through coughing or sneezing. more...

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It is estimated that 95% of adults in the world have EBV-antibodies, having been infected with the Epstein-Barr virus at some point in their lives. The virus infects B cells (B-lymphocytes), producing a reactive lymphocytosis and the atypical T cells (T-lymphocytes) which give the disease its name.

Symptoms and physical signs

A person can be infected with the virus for weeks or months before any symptoms begin to appear. Symptoms usually begin to appear 4-7 weeks after infection and may resemble strep throat or other bacterial or viral respiratory infections. These first signs of the disease are commonly confused with cold and flu symptoms. The typical symptoms and signs of mononucleosis are:

  • Fever - this varies from mild to severe, but is seen in nearly all cases.
  • Enlarged and tender lymph nodes - particularly the posterior cervical lymph nodes, on both sides of the neck.
  • Sore throat (throat infection) - nearly all patients with EBV-mononucleosis have symptoms similar to tonsillitis.
  • Fatigue (sometimes extreme fatigue)

Some patients may also display:

  • Enlarged spleen (splenomegaly) or liver (hepatomegaly), which may later rupture
  • Abdominal pain
  • Aching muscles
  • Headache
  • Loss of appetite
  • Jaundice
  • Sinus infection
  • Depression
  • Weakness
  • Skin rash

The symptoms of infectious mononucleosis usually last 1-2 months, but the virus can remain dormant in the B cells indefinitely after symptoms have disappeared, and resurface at a later date. Many people exposed to the Epstein-Barr virus do not show symptoms of the disease, but carry the virus and can transmit it to others. This is especially true in children, in whom infection seldom causes more than a very mild illness which often goes undiagnosed. This feature, along with mono's long incubation period, makes epidemiological control of the disease impractical. About 6% of people who have had mono will relapse.

Since mononucleosis can cause the spleen to swell, it may in rare cases lead to a ruptured spleen. Rupture may occur without trauma, but impact to the spleen is usually a factor. Other complications include hepatitis (inflammation of the liver) causing jaundice, and anaemia (a deficiency of red blood cells). In rare cases, death may result from severe hepatitis or splenic rupture.

Usually, the longer the infected person experiences the symptoms the more the infection weakens the person's immune system and the longer he/she will need to recover. Cyclical reactivation of the virus, although rare in healthy people, is often a sign of immunological abnormalities in the small subset of organic disease patients in which the virus is active or reactivated.


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Infectious mononucleosis
From Gale Encyclopedia of Medicine, 4/6/01 by Susan J. Montgomery


Infectious mononucleosis is a contagious illness caused by the Epstein-Barr virus that can affect the liver, lymph nodes, and oral cavity. While mononucleosis is not usually a serious disease, its primary symptoms of fatigue and lack of energy can linger for several months.


Infectious mononucleosis, frequently called "mono" or the "kissing disease," is caused by the Epstein-Barr virus (EBV) found in saliva and mucus. The virus affects a type of white blood cell called the B lymphocyte producing characteristic atypical lymphocytes that may be useful in the diagnosis of the disease.

While anyone, even young children, can develop mononucleosis, it occurs most often in young adults between the ages of 15 and 35 and is especially common in teenagers. The mononucleosis infection rate among college students who have not previously been exposed to EBV has been estimated to be about 15%. In younger children, the illness may not be recognized.

The disease typically runs its course in four to six weeks in people with normally functioning immune systems. People with weakened or suppressed immune systems, such as AIDS patients or those who have had organ transplants, are particularly vulnerable to the potentially serious complications of infectious mononucleosis.

Causes and symptoms

The EBV that causes mononucleosis is related to a group of herpes viruses, including those that cause cold sores, chicken pox, and shingles. Most people are exposed to EBV at some point during their lives. Mononucleosis is most commonly spread by contact with virus-infected saliva through coughing, sneezing, kissing, or sharing drinking glasses or eating utensils.

In addition to general weakness and fatigue, symptoms of mononucleosis may include any or all of the following:

  • Sore throat and/or swollen tonsils
  • Fever and chills
  • Nausea and vomiting, or decreased appetite
  • Swollen lymph nodes in the neck and armpits
  • Headaches or joint pain
  • Enlarged spleen
  • Jaundice
  • Skin rash.

Complications that can occur with mononucleosis include a temporarily enlarged spleen or inflamed liver. In rare instances, the spleen may rupture, producing sharp pain on the left side of the abdomen, a symptom that warrants immediate medical attention. Additional symptoms of a ruptured spleen include light headedness, rapidly beating heart, and difficulty breathing. Other rare, but potentially life-threatening, complications may involve the heart or brain. The infection may also cause significant destruction of the body's red blood cells or platelets.

Symptoms do not usually appear until four to seven weeks after exposure to EBV. An infected person can be contagious during this incubation time period and for as many as five months after the disappearance of symptoms. Also, the virus will be excreted in the saliva intermittently for the rest of their lives, although the individual will experience no symptoms. Contrary to popular belief, the EBV is not highly contagious. As a result, individuals living in a household or college dormitory with someone who has mononucleosis have a very small risk of being infected unless they have direct contact with the person's saliva.


If symptoms associated with a cold persist longer than two weeks, mononucleosis is a possibility; however, a variety of other conditions can produce similar symptoms. If mononucleosis is suspected, a physician will typically conduct a physical examination, including a "Monospot" antibody blood test that can indicate the presence of proteins or antibodies produced in response to infection with the EBV. These antibodies may not be detectable, however, until the second or third weeks of the illness. Occasionally, when this test is inconclusive, other blood tests may be conducted.


The most effective treatment for infectious mononucleosis is rest and a gradual return to regular activities. Individuals with mild cases may not require bed rest but should limit their activities. Any strenuous activity, athletic endeavors, or heavy lifting should be avoided until the symptoms completely subside, since excessive activity may cause the spleen to rupture.

The sore throat and dehydration that usually accompany mononucleosis may be relieved by drinking water and fruit juices. Gargling salt water or taking throat lozenges may also relieve discomfort. In addition, taking over-the-counter medications, such as acetaminophen or ibuprofen, may relieve symptoms, but aspirin should be avoided because mononucleosis has been associated with Reye's syndrome, a serious illness aggravated by aspirin.

While antibiotics do not affect EBV, the sore throat accompanying mononucleosis can be complicated by a streptococcal infection, which can be treated with antibiotics. Cortisone anti-inflammatory medications are also occasionally prescribed for the treatment of severely swollen tonsils or throat tissues.


While the severity and length of illness varies, most people diagnosed with mononucleosis will be able to return to their normal daily routines within two to three weeks, particularly if they rest during this time period. It may take two to three months before a person's usual energy levels return. One of the most common problems in treating mononucleosis, particularly in teenagers, is that people return to their usual activities too quickly and then experience a relapse of symptoms. Once the disease has completely run its course, the person cannot be re-infected.


Although there is no way to avoid becoming infected with EBV, paying general attention to good hygiene and avoiding sharing beverage glasses or having close contact with people who have mononucleosis or cold symptoms can help prevent infection.

Key Terms

A specific protein produced by the immune system in response to a specific foreign protein or particle called an antigen.
Herpes viruses
A group of viruses that can cause cold sores, shingles, chicken pox, and congenital abnormalities. The Epstein-Barr virus which causes mononucleosis belongs to this group of viruses.

Reye's syndrome
A very serious, rare disease, most common in children, which involves an upper respiratory tract infection followed by brain and liver damage.

Further Reading

For Your Information


  • The Merck Manual, 16th edition. Whitehouse Station, NJ: Merck & Co., 1992.


  • Baily, Eugene R. "Diagnosis and Treatment of Infectious Mononucleosis." American Family Physician (March 1994): 879-887.


  • National Institute of Allergy and Infectious Diseases, National Institutes of Health Bethesda, MD 20892.


  • Mayo Health Oasis. "Mononucleosis: A Tiresome Disease."
  • New York State Department of Health, Communicable Disease Fact Sheet. Revised December 1996.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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