Infectious Mononucleosis

Dear DR. Z,

My daughter got the kissing disease. What is that, and where did she get it?

Infectious Mononucleosis is commonly known as “Mono.” Mono has the infamous nickname, “the kissing disease.” The reason for this name is that the virus is transmitted through saliva. Over the years it has appeared that the virus needed saliva exchange in order to be contagious. However, mono can be spread through coughing and sneezing. Although it is less contagious than the common cold and is more liking spread by sharing drinks, toothbrushes, forks and spoons.

Infectious mononucleosis has been a known clinical illness since the 1800’s. In the 1960’s the Epstein Barr Virus (EBV) was identified as the cause for mono. This virus most commonly causes a classic triad of symptoms which includes a sore throat, fever, and lymphadenopathy (enlarged lymph nodes) of the neck and possibly under the arm pits. Other symptoms of mono are fatigue, decreased appetite, myalgias (body aches), rash, headache, swollen tonsils, enlarged spleen, enlarged liver and even night sweats. The virus typically takes 4 to 6 weeks to incubate in the body, meaning an individual can be contagious without having symptoms yet.

One should seek medical advice if experiencing any of the above symptoms for more than a week. The provider will perform a physical exam. A rapid strep test is often done to rule out strep throat due to the similarity in symptoms.

Some clinics have rapid mono tests, which consists of a simple finger stick, providing results within 10 minutes. This test may produce a false negative within the first week of symptoms. A different blood test can be done to look for antibodies associated with EBV; these results may take a week or longer to receive.

Unfortunately, there is not a specific treatment for mono. Since it is a viral illness, antibiotics will not shorten its course, one must wait for their own immune system to fight the virus. The best thing a patient can do is drink lots of fluids, and rest so that the body has the strength to fight the virus. The duration of symptoms of the virus varies with each person with the potential of intense fatigue lasting for several months. Occasionally, strep throat can exist with mono, and in that case antibiotics are necessary for the strep throat infection.

Complications can occur from mono, although the majority of the time mono is not a serious illness. The main concern is the risk of an enlarged spleen rupturing. This is why any patient with a positive mono test should refrain from contact sports until symptoms have resolved. Another complication is liver inflammation which can cause jaundice resulting in yellowing of the eyes or skin; if this occurs go see your provider. Those who are at risk for complications from mono are the elderly and immunocompromised patients.
Infectious mononucleosis occurs commonly in all age groups, but the strongest association is in young adults. Individuals may still have the virus in their saliva for approximately 3 weeks after symptoms have subsided. However, the virus remains in the body for ones lifetime. The individual should have antibodies against the virus and therefore should not get mononucleosis again. By the age of 35, 90-95% of individuals has been exposed to EBV and will have antibodies against it even if they were never symptomatic. If you have any reason for concern please visit your medical home for further evaluation.
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