Infectious Mononucleosis – The Kissing Disease
Mononucleosis also known as Mono or “Kissing disease” is a viral infection causing fevers, sore throat, and swollen lymph glands. It is typically caused by the Epstein-Barr virus (EBV), but can also be caused by other organisms. Mononucleosis is often transmitted by saliva. While it is known as “the kissing disease,” occurring often in 15- to 17-year-olds, the infection may occur at any age. We have seen many children get exposed to and contract Mono by the fourth year of life. Mono may begin slowly with fatigue, malaise, headache, and sore throat. The sore throat becomes progressively worse, often with enlarged tonsils covered with a whitish-yellow covering. The lymph nodes in the neck are frequently enlarged and painful. A pink, measles-like rash can occur and is more likely if the patient is given an antibiotic for a throat infection (Antibiotics will NOT be given without a positive Strep test). The symptoms of Mono gradually subside on their own over a period of weeks to months.
Symptoms
- Fever
- Sore throat
- Enlarged lymph nodes, especially in the neck and armpit
- General discomfort, uneasiness, or ill feeling
- Drowsiness and fatigue
- Loss of appetite
- Muscle aches or neck stiffness
- Enlarged spleen
- Jaundice (yellow cast to skin) or a red measles like rash
- Headache and sensitivity to light
- Chest pain
Signs and Tests: During a physical examination, the doctor may find enlarged lymph nodes in the front and back of the neck, as well as swollen tonsils with the whitish covering. The doctor might also find an enlarged liver or spleen when pushing on your child’s abdomen. There also may also be a skin rash present.
Laboratory findings often include an elevated white blood cell count, and the characteristic finding of atypical lymphocytes — unusual-appearing white blood cells that are seen when blood is examined under a microscope. Abnormal liver function tests are also characteristic.
Common tests for EBV include:
- A Monospot (positive for infectious mononucleosis). It is not a very sensitive test.
- Epstein-Barr Virus Antigen (for EBV)
- Epstein-Barr Virus Antibody Titers can help distinguish acute infection from past infection with EBV
Treatment:
Most patients recover within 2-4 weeks without medication. Younger children often don’t have symptoms, while some older patients may have fatigue for up to 6 weeks. There is no specific treatment available. Antiviral medications do not help. Steroid medication may be considered for patients with severe symptoms.
To relieve typical symptoms:
- Take acetaminophen or ibuprofen for pain and fever.
- Gargle with warm salt water for sore throat.
- Get plenty of rest. Drink plenty of fluids.
- Avoid contact sports while the spleen is enlarged (to prevent it from rupturing).
Expectations (prognosis):
The fever usually drops in 10 days, and swollen lymph glands and spleen heal in 4 weeks. Fatigue usually resolves within a few weeks, but may linger for 2 to 3 months.
Calling the Office:
The initial symptoms of Mono feel very much like a typical viral illness. It is not necessary to contact us unless symptoms last longer than 10 days or your child develops the following:
- Severe sore throat or swollen tonsils
- Difficulty breathing
- Abdominal pain
- Severe headache
- Persistent high fevers (more than 101.5°F)
- Yellow discoloration of your eyes or skin
- Weakness in the arm or legs
Call 911 or go to an emergency room if your child develops:
- Sharp, sudden, severe abdominal pain
- Significant difficulty swallowing or breathing
- A stiff neck or severe weakness
Prevention
Saliva and close contact probably spread the infection. Children may be contagious while they have symptoms and for up to a few months afterwards. The virus can live for several hours outside the body. Avoid kissing or sharing utensils if you or someone close to you has Mono. The exact period that people are contagious varies.