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Mononucleosis - Causes, Symptoms and Treatment

Definition:

Infectious mononucleosis is an acute infectious disease caused by the Epstein Barr virus (EBV), a member of the herpes group. It primarily affects young adults and children, although in children it's usually so mild that it's often overlooked.

Characteristically, infectious mononucleosis produces fever, sore throat, and cervical lymphadenopathy (the hallmarks of the disease), as well as hepatic dysfunction, increased lymphocytes and monocytes, and development and persistence of heterophil antibodies. The prognosis is excellent, and major complications are uncommon.

Causes of Mononucleosis

Apparently, the EBV reservoir is limited to humans. Infectious mononucleosis probably spreads by the oropharyngeal route because about 80% of patients carry EBV in their throats during the acute infection and for an indefinite period afterward.

It can also be transmitted by blood transfusion and has been reported after cardiac surgery as the "post-pump peclusion" syndrome. Infectious mononucleosis is probably contagious from before symptoms develop until the fever subsides and oropharyngeal lesions disappear.

Infectious mononucleosis is fairly common in the United States, Canada, and Europe, and both sexes are affected equally. Incidence varies seasonally among college students (most common in the early spring and early fall) but not among the general population.

Signs and Symptoms of Mononucleosis

The symptoms of mononucleosis mimic those of many other infectious diseases, including hepatitis, rubella, and toxoplasmosis. Typically, after an incubation period of about 10 days in children and from 30 to 50 days in adults, infectious mononucleosis produces prodromal symptoms, such as headache, malaise, and fatigue.

After 3 to 5 days, patients typically develop a triad of symptoms: sore throat, cervical lymphadenopathy, and temperature fluctuations, with an evening peak of 101 to 102° F (38.3° to 38.9° C). Splenomegaly, hepatomegaly, stomatitis, exudative tonsillitis, or pharyngitis may also develop. Sometimes, early in the illness, a maculopapular rash that resembles rubella develops; also,jaundice occurs in about 5% of patients. Major complications are rare but may include splenic rupture, aseptic meningitis, encephalitis, hemolytic anemia, and Guillain-Barre syndrome. Symptoms usually subside from 6 to 10 days after onset of the disease but may persist for weeks.

Diagnosis for Mononucleosis

Physical examination demonstrating the clinical triad suggests infectious mononucleosis. The following abnormal laboratory results confirm it:

1. White blood cell (WBC) count increases 10,000 to 20,000/ul during the second and third weeks of illness. Lymphocytes and monocytes account for 50% to 70% of the total WBC count; 10% of the lymphocytes are atypical.

2. Heterophil antibodies (agglutinins for sheep red blood cells) ill Serum drawn during the acute illness and at 3-to 4-week intervals rise to four times normal.

3. Indirect immunofluorescence shows antibodies to EBV and cellular antigens. Such testing is usually more definitive than heterophil antibodies.

4. Liver function studies are abnormal.

Differential diagnoses to consider include other acute infections, such as those caused by cytomegalovirus, toxoplasma, human herpesvirus 6, and hepatitis virus.

Treatment for Mononucleosis

Infectious mononucleosis resists prevention and antimicrobial treatment. Thus, therapy is essentially supportive: relief of symptoms, bed rest during the acute febrile period, and aspirin or another salicylate for headache and sore throat. If severe throat inflammation causes airway obstruction, steroids can be used to relieve swelling and avoid tracheotomy.

Special Considerations and Prevention Tips for Mononucleosis

During the acute illness, stress the need for bed rest. If the patient is a student, tell him that he may continue less demanding school assignments and see friends, but should avoid long, difficult projects until after recovery.

To minimize throat discomfort, encourage the patient to drink milk shakes, fruit juices, and broths, and also to eat cool, bland foods.

Advise the use of saline gargles and aspirin as needed.

Because uncomplicated infectious mononucleosis doesn't require hospitalization, patient teaching is essential. Convalescence may take several weeks, usually until the patient's WBC count returns to normal.

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