Mononucleosis

Mononucleosis is acute infection with the Epstein Barr virus. This virus has a worldwide geographic distribution. Humans become infected in early childhood or late adolescence. 90% of adults have had contact with the virus.

How is it produced?

The Epstein Barr virus is transmitted through oral secretions, by the transfer of saliva during kissing. For this reason, mononucleosis is also known as the "kissing disease." It can also be transmitted by sharing cutlery and glasses of an affected person. From the mouth, the virus spreads through the body through the bloodstream. The virus penetrates and infects mainly the B lymphocytes of the immune system (they are a type of white blood cells). Mononucleosis results from the body's inflammatory reaction to infection by the virus.

10% of mononucleosis are caused by another virus, cytomegalovirus. The clinical picture is the same. The only difference is that the test for heterophile antibodies is negative.

Symptoms

Young children have few or no symptoms, and the infection may go undetected. Adolescents or young adults present with mononucleosis as a flowery picture. After an incubation period of between 4 and 6 weeks, symptoms of fatigue, weakness, fever (not very high), muscle aches, sore throat due to pharyngitis or inflammation of the tonsils, and lymphadenopathy appear. Swollen lymph nodes or lymph nodes are usually located in the neck, are painful and tender to palpation.

In half of the cases there may be an enlarged spleen (known as splenomegaly).

In 5% of cases, a skin rash or rash appears on the arms and trunk. It is typical for it to appear after taking an antibiotic from the penicillin family, although it is not an allergic reaction.

Fever and pharyngitis usually last the first two weeks. Lymphadenopathy, fatigue, and splenomegaly can last for several more weeks.

Most mononucleosis heals spontaneously. Complications are very rare and consist, among others, of bacterial superinfection of the initial pharyngitis or tonsillitis, hepatitis, ruptured spleen (a very serious or even fatal complication), meningitis and some anemia.

Diagnosis

The diagnosis of Epstein Barr virus infectious mononucleosis is confirmed by blood tests:

• Activated lymphocytes: these are lymphocytes with specific alterations that suggest infection by this virus.
• Determination of heterophile antibodies: if positive, it confirms Epstein Barr virus infection. It can be negative at the beginning of the infection, then it is necessary to consider repeating it a few weeks later.

Treatment

Treatment is symptomatic. Rest is important for the first few weeks. Intense exercise is not recommended during the first three months after infection, especially if there is splenomegaly, as the risk of ruptured spleen increases.

• Drinking plenty of fluids is recommended to maintain good hydration.
• Antipyretics may be given if there is a high fever or pain relievers to relieve a sore throat and pain in the glands in the neck.
• Corticosteroids are not indicated as initial symptomatic treatment.

Specific complications must be treated individually.

Precautionary measures

It is not necessary to isolate patients with mononucleosis. It is better not to kiss or share glasses or cutlery while the person is sick. Point out that there is no vaccine either.