Infectious mononucleosis What we need to know

06.06.2023

The term infectious mononucleosis was first used in 1920 to describe a group of students with similar pharyngeal (throat) complaints and laboratory findings. Epstein-Barr virus was later identified as the main cause of mononucleosis.

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Epstein-Barr virus belongs to herpesviruses and spreads with saliva. Clinical manifestations of the disease begin 4-6 weeks after infection with the Epstein-Barr virus. In addition to Epstein-Barr virus, mononucleosis can be caused by:

Cytomegalovirus
Adenoviruses
Hepatitis A virus
Human immunodeficiency virus
Toxoplasma
rubella virus

When the Epstein-Barr virus enters the oropharyngeal (larynx) area, it begins to multiply. The disease spreads through the lymphatic system. The body reacts to the viral process by producing antibodies. The Epstein-Barr virus remains in the body throughout life, with periodic reactivation. In conditions of a weak immune response, there is a possibility of developing Hodgkin's lymphoma.

Symptoms

The disease is characterized by a clinical triad:

Fever
Tonsillo-pharyngitis
Lymphadenopathy (enlarged lymph nodes)

In addition to these symptoms, there are:

Strong general weakness
Enlargement of the liver and/or spleen
Rash
muscle pain

Sometimes the general weakness lasts for months after the transfer of the disease. Lymphadenopathy is mainly expressed in the back of the neck. Pharyngitis often occurs with exudate of the tonsils. There are petechiae (dotted bruises) on the palate and navel. Enlargement of the spleen occurs in almost half of the patients during the active period of the disease. A non-specific, generalized maculo-papular rash is also quite common in the active phase of the disease.

Diagnosis

Diagnosis is based on clinical and laboratory data. The disease is characterized by lymphocytosis - a sharp increase in the number of lymphocytes. Heterophilic and specific antibodies appear in the blood a little later, thus confirming the diagnostics of mononucleosis. Neutropenia and thrombocytopenia combined with leukocytosis are also frequent events.

The active phase of the disease lasts on average 2-4 weeks, however, the symptoms of infection may last up to 6 months.

Differential diagnostics

Disease caused by Epstein-Barr virus is very similar to conditions caused by other viruses and some rickettsiae. Differential diagnostics is made with cytomegalovirus, human immunodeficiency virus, herpesvirus type 6, hepatitis B virus, and Lyme disease (borreliosis).

Treatment

Treatment is symptomatic - with fever and anti-inflammatory drugs. Resting, adequate fluid and food intake are important factors. In case of otolaryngological complications, steroid therapy is indicated. Antibiotic therapy is not recommended because it can cause a generalized maculo-papular rash. Early physical activity is also not recommended due to possible complications of spleen enlargement.

The disease cannot be prevented because there is no mononucleosis vaccination.

forecast

Most people infected with Epstein-Barr virus recover without complications and develop robust immunity that controls the "dormant" pathogen. In rare cases, the connection of malignant processes with Epstein-Barr virus has not been definitively confirmed.