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Nasty Infectious Diseases You Want To Avoid - Mononucleosis

Updated on December 31, 2008

This is an acute herpesvirus infection caused by the Epstein-Barr virus and characterized by sore throat, fever, swollen lymph glands, and bruising. Known as the "kissing disease" because it is transmitted in saliva, young people are most often infected. The illness is also commonly known as mono in North America and usually referred to as glandular fever in other English-speaking countries. In childhood the disease is most often mild. The older the patient, however, the more severe the symptoms are likely to be. Infection confers permanent immunity.

Cause - The disease is usually transmitted by droplet EBV virus but is not highly contagious. Cytomegalovirus (CMV) infection can cause a similar infection; both EBV and CMV are members of the Herpes family of viruses.

Symptoms - Between four to six weeks after infection, classic mono begins gradually with symptoms of sore throat, fatigue, swollen lymph glands, and occasional bruising. Although the symptoms usually disappear in four to six weeks, the virus remains dormant in the throat and blood for the rest of the patient's life. Periodically the virus can reactivate and be found in the patient's saliva, although it doesn't usually cause symptoms. Mono may also start abruptly with high fever and severe, swollen sore throat similar to strep throat. Rarely, about 10 percent of patients have a third type, with a low persistent fever, nausea and vomiting, and stomach problems. About half of all patients have an enlarged spleen and a few have an enlarged liver or mild jaundice.

Diagnosis - Symptoms of fever, sore throat, and swollen glands, are used to diagnose the disease. Blood tests and blood counts are needed for confirmation. The mono spot is a rapid antibody test that looks for a specific reaction in the blood of infected patients. Liver function tests will reveal abnormal liver function, the so-called mono-hepatitis that may occur.

Treatment - There is no specific treatment for the disease other than symptom management. No antiviral or antibiotic drugs are available. Some doctors prescribe steroids to reduce the tonsil inflammation because the patient can't swallow. Enforced bed rest may prevent injury to the swollen spleen. Painkillers such as acetaminophen, paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce fever and pain. Saline gargles may help ease the sore throat which the disease brings.

Complications - There may be a swollen spleen or liver inflammation; heart problems or involvement of the central nervous system may rarely occur (mono-meningitis), but this disease is almost never fatal. If the spleen ruptures, immediate surgery and blood transfusions will be necessary. About half the time, the patient will also have a strep throat, which does require antibiotic treatment. Occasionally, patients will have such intense swelling of the lymphatic system of their throat, they require hospitalization for IV fluids to prevent dehydration.

Prevention - Most people exposed to patients with mono have already been infected with EBV and aren't at risk for developing disease themselves, since 95 percent of adults over age 35 have antibodies to the virus. Transmission routes are not fully understood, although doctors suspect it is transmitted via saliva.

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