Infectious mononucleosis

Content

Introduction

Infectious mononucleosis is a disease caused by the virus Epstein-Barr (EBV), belonging to the herpesvirus family. Infection is quite common and over 90% of the world population comes into contact with the virus in the first years of life, during adolescence or in adulthood (Video).

In industrialized countries, by virtue of the better general hygienic conditions, the infection is more frequent in young people between 15 and 30 years of age and less common in children.

In developing countries, on the other hand, the infection frequently affects children of pediatric age, even if it is often not diagnosed because it is accompanied by mild disorders or which can be confused with other infections common in childhood.

The evolution (course) of the infection is generally slow with non-specific disorders (symptoms) such as sore throat, low-grade fever and widespread swelling of the lymph glands (lymphadenopathy). The disorders (symptoms) may persist from a few weeks to a few months.

Generally, the infection heals without particular consequences but, in some more serious circumstances, however less common, rupture of the spleen can occur, complications affecting the liver or the nervous system can occur.

Symptoms

Infectious mononucleosis generally begins with a sudden sore throat (acute pharyngitis) characterized by the presence, on the tonsillar arch, of a redness and a whitish-gray patina (exudate) which often suggest streptococcal bacterial infections and staphylococcus.

In the following days, a low-grade fever appears accompanied by intense fatigue, pain and widespread swelling of the lymph nodes (lymphadenopathy) of the neck, armpits and groin.

Generally, the disorders last a few weeks, and in some cases even a few months, and then gradually disappear without consequences for the body. Abdominal pain caused by involvement of the spleen or liver may also be present in about one third of cases.

In severe cases of an enlarged spleen, the organ may rupture and cause internal blood loss (bleeding), which may require emergency surgery. Rupture of the spleen can manifest as sharp pain in the left side of the abdomen and with intense weakness caused by a severe anemic state following the loss of blood inside the abdominal cavity.

Involvement of the liver can lead to yellow discoloration of the skin (jaundice).

Causes

The Epstein-Barr virus (EBV) is transmitted primarily through the saliva and secretions from the throat (pharynx) of people with active infection.

The contagion, therefore, can occur through:

  • common use of crockery, cutlery and glasses in the family, in restaurants and canteens
  • common use of toothbrushes or personal hygiene items
  • common use of toys among children
  • deep kisses and exchange of saliva
  • inhalation or ingestion of droplets of saliva or mucus dispersed in the air from infected people who talk or cough at a short distance in very busy environments (public transport, schools)

Diagnosis

In the presence of ailments such as persistent low-grade fever, weakness and swollen lymph glands, it is advisable to consult the general practitioner or infectious disease specialist to verify the possible presence of infectious mononucleosis.

The doctor will ascertain (diagnose) the disease by visiting and prescribing specific laboratory tests including, in particular, the white and red blood cell count (blood count) and the search for IgM antibodies (those that indicate the presence of an "infection in progress) and the search for IgG class antibodies (those that indicate a" infection contracted in the past) against Epstein-Barr virus antigens (early-EA, capsid-VCA, nuclear-EBNA).

The monotest, a sensitive but less specific examination, is prescribed less frequently today.

In case of infection, the values ​​relating to the number of white blood cells in the blood will show an increase in the number of lymphocytes (lymphocytosis) and an abnormal shape (morphology) of lymphocytes and monocytes.

In the case of liver impairment, the blood values ​​of some proteins present in the liver, the transaminases liver disease, and bilirubin, a protein derived from red blood cells, may be increased.

Therapy

There is no specific cure for infectious mononucleosis as antiviral drugs specific for herpes viruses (acyclovir and analogues) are not effective in blocking the reproduction (replication) of the Epstein-Barr virus (EBV).

People who have the symptoms (symptoms) of the infection, must remain at rest, observe a light diet so as not to tire the liver, take, if necessary, anti-inflammatory drugs to lower fever and relieve pain in the lymph glands.

Antibiotics, sometimes incorrectly prescribed in the early stages of the disease, thinking that the sore throat is due to a "bacterial infection, should be avoided because they are not effective against viruses and can cause allergic reactions, mainly affecting the skin.

Complications affecting the spleen or nervous system (meningitis, neuropathies) may require the use of corticosteroid drugs.

The rupture of the spleen requires urgent hospitalization, surgery and any blood transfusions.

Prevention

It is difficult to prevent infectious mononucleosis. However, it is possible to reduce the risk of being infected by avoiding the exchange of dishes and glasses in the family, in restaurants, in canteens.

Similarly, it is necessary to avoid deep kisses and the exchange of dishes and glasses with people who are already ill or who have ailments that could suggest mononucleosis.

If you suspect that you have been infected, it is advisable to undergo tests to ascertain (diagnose) the disease and, if the infection is confirmed by the results of the tests, it is advisable to avoid going to work or school so as not to spread it to other people.

Living with

Infectious mononucleosis generally evolves from a few weeks to a few months but, if neglected, can cause serious complications affecting the spleen and liver.

For this reason it is essential that sick people stay at rest, limit work and physical activity as much as possible, follow a light diet with low fat and calories in order not to overwork the liver.

Equally important is avoiding close contact with other people, kissing, exchanging dishes, glasses and toothbrushes.

Sick children must avoid contact with other children, particularly in the phase in which they are present (sore throat, swollen lymph nodes, fever, fatigue, pains) and do not have to go to school.

Bibliography

Dunmire SK, Hogquist KA, Balfour HH. Infectious Mononucleosis. In: Münz C. (eds) Epstein Barr Virus Volume 1. Current Topics in Microbiology and Immunology, vol 390, 2015

In-depth link

United Against AIDS (ISS). Infectious Mononucleosis

Centers for Disease Control and Prevention (CDC). About Epstein-Barr virus (EBV) (English)

Centers for Disease Control and Prevention (CDC).About infectious mononucleosis (English)

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