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Mononucleosis

Infectious Mononucleosis (also known as mono, the kissing disease, and, in British English, Glandular Fever) is a disease characterized by fever, sore throat and tiredness and caused by the Epstein-Barr virus or the cytomegalovirus. The Epstein-Barr virus is typically transmitted through saliva, e.g. through intimate kissing or sharing drinks.

The virus infects B cells, and most commonly affects those between 15 and 40 years old. There is an accompanying lymphocytosis, and there are abnormal T lymphocytes[?] visible on a blood film[?].

Symptoms similar to those of mononucleosis can be caused by adenovirus[?] and the protozoan Toxoplasma gondii.

Symptoms

Typical symptoms of mononucleosis are:

  • a high fever - this varies from mild to severe, but is seen in nearly all cases.
  • enlarged lymph nodes - particularly the cervical lymph nodes, on both sides of the neck.
  • sore throat - about half those with glandular fever will experience tonsillitis.
  • extreme tiredness

Other possible symptoms include:

  • enlarged spleen or liver
  • aching muscles
  • headache
  • soreness
  • loss of appetite
  • jaundice

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. 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. About 6% of people who have had this disease will relapse. The fact that many with EBV are asymptomatic makes epidemiological control of the disease impractical.

Since mononucleosis can cause the spleen to swell, in rare cases, this disease may lead to a ruptured spleen. This rupture is possible without any obvious risk factors, but impact to the spleen, for example from playing sports, may cause a rupture.

It is extremely rare, though not unheard of, to die from this infection. Death is usually from the severe hepatitis or splenic rupture.

Testing for the disease, treatment

The mono spot tests for infectious mononucleosis by testing the patient's blood for antibodies to key viral proteins, but is non-specific. Confirmation of the exact etiology can be obtained through other tests.

An old test once used is the Paul Bunnell test. The patient's serum is mixed with sheep red blood cells. If EBV is present, there will usually be antibodies that cause the sheep's blood cells to agglutinate (stick together). This test has been replaced by more specific EBV and CMV antibody tests.

There is no known treatment for mononucleosis, other than generic treatments to reduce the severity of the symptoms. Aspirin should be avoided, since its use while suffering from mononucleosis can cause Reye's syndrome[?].

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