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...

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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