It is a viral disease that affects at least half of all American by the age of 5 years and most of the rest of the population by early adulthood. However, most of us think little of infectious mononucleosis beyond the severe sore throat and long-lasting fatigue that it causes. The disease is not given as much attention yet there are instances where this seemingly mild disease, also referred to as kissing disease, can be life-threatening.
What is mono?
Mono as it is commonly called is a disease known as infectious mononucleosis. It is also sometimes referred to as kissing disease but this can be misleading because it is not only spread through kissing. Infectious mononucleosis is a viral infection and the main virus to cause it is the Epstein-Barr virus (EBV). Other viruses may also be responsible. The symptoms like a sore throat, fever, fatigue and headache are intense and last for a few weeks.
Some of the complication can be serious and a few are even life-threatening. However, it is rare for complications to arise in most instances. Therefore mono is not always considered to be serious. In fact treatment is not always necessary for mono and with sufficient rest and good nutrition the infection will resolve spontaneously. Some of the symptoms like fatigue can persist for as long as 3 month but will eventually resolve with little to no treatment.
Signs and Symptoms
The signs and symptoms of infectious mononucleosis are not significantly different from other common viral infections involving the upper respiratory tract. The difference however is that the symptoms tend to persist longer than the average flu or common cold. The signs and symptoms of infectious mononucleosis includes:
- Sore throat
- Lymphadenopathy (enlarged lymph nodes)
- Skin rashes
Less commonly there may be enlargement of the uvula, enlarged spleen (splenomegaly), enlarged liver (hepatomegaly), spots on the palate (roof of the mouth) and jaundice. Sometimes there may be respiratory symptoms when the virus spreads to the lungs. Rupture of the spleen is a rare but serious complication of infectious mononucleosis which can become life-threatening without prompt medical attention.
Causes of Mono
Infectious mononucleosis is mainly caused by the Epstein Barr virus (EBV). Thw virus is widely present across the globe and most people have antibodies against it by the late teens to early adulthood. Antibodies indicates that a person has already come into contact with the virus and the immune system developed some protection towards it. In fact about 50% of American children show these antibodies by the age of 5 years.
How is mono spread?
Mono is spread from one person to another by contact with the mouth and throat secretions. Naturally this occurs with kissing, hence the term kissing disease. However, it can also be spread through coughing and sneezing when the infected droplets are propelled through the air. Similarly saliva on eating utensils can also transmit the virus from one person to another.
When the virus enters the body, usually through the mouth, it infects the B-cells (a type of white blood cells that has important immune functions) in the mouth and throat lining. B-cells can then move through the body thereby spreading the infection at other sites, usually other organs that play a role in defending the body such as the spleen, liver and lymph nodes. Other immune cells like T-cells ensure that the infection is kept under control.
Is mono contagious?
Yes, infectious mononucleosis is contagious but not as contagious as other more common viral infections such as the flu or common cold. By not sharing utensils, food and drinks or kissing a person with mono it is unlikely to be spread. Therefore people who have mono do not have to be isolated but it is important to be cautious during interaction.
Can mono be transmitted by blood and during childbirth?
It is rare for mono to be spread through a blood transfusion. Similarly it is not very common for mono to be spread from mother to unborn child. However, the virus can be shed from the cervix and this may be transmitted to a newborn baby during childbirth. Transmission from mother to child is much more likely to occur after birth when the baby comes in contact with the mother’s saliva.
Recurring and Chronic Mononucleosis
The Epstein-Barr virus remains dormant in the body and does not cause ongoing infection due to the action of the immune system. It may therefore never recur in life. However, in some people with weakened immune systems the virus may become reactivated. Sometimes there are no symptoms during this reactivation although tests will show positive results while with others the mono symptoms may recur.
Another rare occurrence is chronic mononucleosis where the infection persists for 6 months or more. This is more correctly referred to as chronic active EBV infection because the virus does not become dormant as it should. Symptoms of mono may therefore be ongoing. While recurring mono and chronic mono can be seen in any person with a weakened immune system, it is more commonly associated these days with HIV infection and AIDS.
Treatment of Mono
There are no specific drugs indicated for infectious mononucleosis. A combination of bed rest, good nutrition and plenty of fluid intake is advised to help the body overcome the infection. However, when complications arise then drugs may be needed. Sometimes corticosteroids are prescribed to reduce the blockage in the throat due to inflammation. Antibiotics may also be prescribed if secondary bacterial infections arise but antbiotics cannot treat the viral infection itself. Chronic or recurring mono needs to be treated and managed by a medical professional.
Prevention and Vaccine
There is currently no vaccine available for infectious mononucleosis. However, there are vaccines that are being tested for possible use in the prevention of mono. Since infectious mononucleosis is usually such a mild infection and that half of all 5 year olds already have been exposed to the virus, this vaccine may not become a mandatory shot in childhood immunization programs in the future. The only effective way to prevent mono is to avoid contact with the secretions of an infected person, especially with saliva.