What Is Mononucleosis (Mono)?
Infectious mononucleosis is also known as glandular fever and is commonly caused by the Epstein-Barr virus (EBV). Other conditions associated with EBV are gastric cancer, nasopharyngeal carcinoma, diseases related to HIV/AIDS virus, and Hodgkin’s lymphoma. The virus usually tampers with B-cells and epithelial cells in the body. Once the Epstein-Barr virus has been eradicated from a person's system, their probability of contracting the disease again is very minimal.
Infectious mononucleosis (mono) is also known as the kissing disease, because the virus that causes mono can spread through saliva, so a person can get this disease by kissing someone infected with it. But one can also get mono through coughing or sneezing and by sharing cups or vessels with someone who has the disease. But mononucleosis is not as contagious as many other infections, like a cold or the flu.
In most cases, a patient suffering from mononucleosis will experience all the signs and symptoms associated with the illness, especially if the patient is a teenager or young adult. But small children tend to have lesser symptoms, and many times, the infection goes unnoticed.
Usual symptoms of mononucleosis include fatigue, sore throat, strep throat (in some cases) that does not get better with medicine, fever and high temperature, swollen lymph nodes in the neck and armpits, swollen tonsils, headache, skin rashes, and a soft, swollen spleen. Most of the symptoms get better within a couple of weeks, but fatigue, enlarged lymph nodes, and a swollen spleen may last for a few weeks or more after recovery from fever and a sore throat.
If a person is suffering from mononucleosis, it is essential to be alert and careful about certain complications linked to this infection, like an enlarged spleen. One must take sufficient rest and consume lots of fluids for faster recovery.
Who Gets Mononucleosis?
Most people who acquire mono are children or teenagers. In young people, it is commonly identified by flu-like symptoms, but it can also be asymptomatic. For adults and older adolescents, mono manifests as rising body temperatures, fever, sore throat, exhaustion, or fatigue. Sometimes, the symptoms of mononucleosis go unnoticed by the person who is infected or they can temporarily subside and return at a later time.
Epstein-Barr virus is in the same family as some varieties of herpes. It generally occurs in patients who are less than 40 years of age. Mono is usually identified by its telltale flu-like symptoms, but patients could require diagnostic testing if their symptoms are not noticeable. Blood tests typically have a very high number of lymphocytes (up to 10% more than normal).
However, mono is a temporary condition that usually does not require serious medical action. There are few treatment methods available to those with mononucleosis or EBV, but they are mostly simple and focus on resolving symptoms.
The disease usually targets teens and young adults aged 16 to 20 years old. The most common symptom of mononucleosis in this age group is a persistent sore throat. The EBV virus is most common in developing countries where children and adolescents are most susceptible. Since mono is rarely serious, it can be left undiagnosed and run rampant in such countries.
Symptoms of mono tend to disappear up to a month or two for some patients or may last up to four months in some. But a majority of people with mono usually recover within a period of two to four weeks, and most of them can even return to regular activities in just two. Chronic EBV infection can occur if your mono symptoms last more than six months.
EBV remains dormant in the blood cells for the rest of your life and can sometimes reactivate without any symptoms. During this time, it is possible to spread the virus to others through your saliva.
What Are the Symptoms of Mononucleosis?
Some of the common signs and symptoms of mononucleosis are:
- Sore throat
- Inflamed lymph glands in the neck and armpits
- Swollen tonsils
- Skin rash
- Swelling of the spleen
- Muscle weakness
- Night sweats
Signs are usually visible around four to six weeks after the virus has affected the patient. In smaller children, the incubation period is shorter. Some of the symptoms, like fever and sore throat, tend to reduce in a few weeks post-infection. But some symptoms, like tiredness and swelling of lymph glands and the spleen, tend to last for a longer period of time.
When Should One Consult the Doctor?
If a person is experiencing the signs and symptoms mentioned above, there is a strong possibility the person is suffering from mononucleosis. If adequate rest and healthy diet does not show any reduction in the symptoms within a week or two, it is best to consult the doctor.
How Does Mononucleosis Spread?
In mononucleosis patients, the EBV virus is carried by saliva, mucus, and, sometimes, tears. The Epstein-Barr virus is unable to spread through the air, so it is possible to live with someone that has mono and not contract it. However, people with compromised immune systems can catch the disease easily. The virus usually stays in a person's nose and throat, where it grows and multiplies.
The fluids located in these areas, like saliva and mucus, then become EBV carriers and transmit the virus if they come into contact with a healthy individual.
In certain cases, blood can also carry EBV. Mononucleosis and the Epstein-Barr virus can be unknowingly transmitted to those who are asymptomatic, so it is important to contact a doctor if you suspect mono.
What Are the Complications Associated With Mononucleosis?
If the infection is not treated with medication and rest, complications may develop. These can at times become more serious than the mononucleosis infection itself.
Some of the complications include:
- Spleen enlargement: In severe cases, the spleen may rupture, and this can cause sudden, sharp pain on the upper left side of the abdomen. In such cases, it is important to seek medical care at the earliest, as there may be need for a surgery.
- Liver problems
- Less common complications, like:
- Hepatitis: Mild inflammation of the liver
- Jaundice: Yellowing of skin and the white area of the eyes in certain scenarios
- Anemia: A reduction in red blood cells and hemoglobin, which is an iron-rich protein present in red blood cells
- Thrombocytopenia: Low platelet count, which are the blood cells that cause clotting
- Heart issues: Development of a condition known as myocarditis, which is inflammation of the heart muscles
- Problems with the nervous system: There can be certain issues like meningitis, Guillain-Barre syndrome, etc.
- Inflamed tonsils: This condition can cause breathing problems
Mononucleosis can cause more complications in people who have a weak immune system, for instance, patients suffering from HIV/AIDS or those who take certain medications that weaken the immune system (mostly after surgery).
How to Prepare for the Doctor’s Appointment
If a person suspects they are suffering from mononucleosis, it is very important to consult a doctor at the earliest. It is a good idea to be prepared before the doctor’s appointment. Below are some details that will help ready you for the appointment:
- Make a note of all symptoms: It is very important to mention to your doctor all the signs and symptoms you are experiencing. Also, include symptoms that may not seem to be linked to the infection. This will help the doctor diagnose the cause of the problem.
- Note all personal information: This should include information on major stresses, any recent changes personally or professionally, daily activities, sleeping habits, personal and family medical history, and contact with anyone with mononucleosis or any other infection in recent past.
- Make a note of all medications: This should include all prescribed and over-the-counter medications, herbal medicines, vitamins, supplements, etc.
- Also make a note of questions to ask the doctor
Some of the questions a patient can ask the doctor are:
- What can cause these symptoms?
- What tests do I have to undergo for diagnosis?
- Do I need to make any preparations before going for the test?
- How can I best manage the other health problems along with this condition?
- What are the treatment options available for mononucleosis?
- Are there any restrictions or precautions I need to take?
- Do I need to stay home, and if so, for how long?
- When can I get back to doing activities that require exertion and contact sports?
- Do I need to avoid any medications?
- Is there any written material, brochure, or online site from which I can get information about mononucleosis?
What to Expect From the Doctor
The doctor will ask the patient many questions, including:
- When did you first notice these symptoms?
- Have you been in contact with anyone suffering from mononucleosis?
- Do you experience these symptoms regularly or just occasionally?
- Are the symptoms mild or severe?
- Does anything improve the symptoms?
- Does anything worsen the symptoms?
How Is Mononucleosis Diagnosed?
Your doctor will be able to determine if you are suffering from mono based on the presence of a few common symptoms, such as fever, sore throat, or swollen lymph glands, tonsils, liver, or spleen. The doctor will conduct a physical examination and ask how long the patient has been suffering from their symptoms.
The doctor may also ask your age during the diagnosis, as age is considered a good disease indicator; mono usually tends to occur in teenagers, but it can manifest at any age.
The doctor will request the patient undergo certain blood tests, which include:
- Antibody tests: To be completely sure mononucleosis is the culprit, the patient will be asked to take a mono spot test. This test checks the patient’s blood for antibodies versus Epstein-Barr virus. The results can be known the next day, but the test will not be able to diagnose the infection in its first week. There is another antibody test where the results take longer, but it is able to diagnose the infection in the first week itself.
- White blood cell count: The doctor will ask the patient to undergo other blood tests to check if there is an increase in white blood cell count or the presence of unusual-looking lymphocytes. These tests do not confirm the cause as mononucleosis, but they can serve as indicators. A high white blood cell count could suggest a strong possibility of an infection with EBV. EBV antibodies, or a mono spot test, is also recommended by the doctor for diagnosis. A positive mono spot test is a good indicator of infectious mononucleosis.
What Is the Treatment for Mononucleosis?
There is no specific treatment method for mononucleosis. However, the doctor may prescribe a corticosteroid medication to reduce the swelling in the throat and tonsils. Most symptoms of mono usually resolve by themselves in a month or two. Treatment for patients will be aimed at easing symptoms and making them feel better. Doctors will prescribe over-the-counter medicines to help bring down fever as well. You can also use home remedies such as gargling salt water to relieve a sore throat.
Other remedies include getting plenty of rest, being hydrated with lots of water and fluids, drinking warm soups, and using pain medications such as Tylenol. You should call your doctor immediately if symptoms persist and you found no relief from any of the treatment methods.