infectious mononucleosis

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Infectious Mononucleosis



Infectious mononucleosis is a contagious illness caused by the Epstein-Barr virus that can affect the liver, lymph nodes, and oral cavity. While mononucleosis is not usually a serious disease, its primary symptoms of fatigue and lack of energy can linger for several months.


Infectious mononucleosis, frequently called "mono" or the "kissing disease," is caused by the Epstein-Barr virus (EBV) found in saliva and mucus. The virus affects a type of white blood cell called the B lymphocyte producing characteristic atypical lymphocytes that may be useful in the diagnosis of the disease.
While anyone, even young children, can develop mononucleosis, it occurs most often in young adults between the ages of 15 and 35 and is especially common in teenagers. The mononucleosis infection rate among college students who have not previously been exposed to EBV has been estimated to be about 15%. In younger children, the illness may not be recognized.
The disease typically runs its course in four to six weeks in people with normally functioning immune systems. People with weakened or suppressed immune systems, such as AIDS patients or those who have had organ transplants, are particularly vulnerable to the potentially serious complications of infectious mononucleosis.

Causes and symptoms

The EBV that causes mononucleosis is related to a group of herpes viruses, including those that cause cold sores, chicken pox, and shingles. Most people are exposed to EBV at some point during their lives. Mononucleosis is most commonly spread by contact with virus-infected saliva through coughing, sneezing, kissing, or sharing drinking glasses or eating utensils.
In addition to general weakness and fatigue, symptoms of mononucleosis may include any or all of the following:
  • Sore throat and/or swollen tonsils
  • Fever and chills
  • Nausea and vomiting, or decreased appetite
  • Swollen lymph nodes in the neck and armpits
  • Headaches or joint pain
  • Enlarged spleen
  • Jaundice
  • Skin rash.
Complications that can occur with mononucleosis include a temporarily enlarged spleen or inflamed liver. In rare instances, the spleen may rupture, producing sharp pain on the left side of the abdomen, a symptom that warrants immediate medical attention. Additional symptoms of a ruptured spleen include light headedness, rapidly beating heart, and difficulty breathing. Other rare, but potentially life-threatening, complications may involve the heart or brain. The infection may also cause significant destruction of the body's red blood cells or platelets.
Symptoms do not usually appear until four to seven weeks after exposure to EBV. An infected person can be contagious during this incubation time period and for as many as five months after the disappearance of symptoms. Also, the virus will be excreted in the saliva intermittently for the rest of their lives, although the individual will experience no symptoms. Contrary to popular belief, the EBV is not highly contagious. As a result, individuals living in a household or college dormitory with someone who has mononucleosis have a very small risk of being infected unless they have direct contact with the person's saliva.


If symptoms associated with a cold persist longer than two weeks, mononucleosis is a possibility; however, a variety of other conditions can produce similar symptoms. If mononucleosis is suspected, a physician will typically conduct a physical examination, including a "Monospot" antibody blood test that can indicate the presence of proteins or antibodies produced in response to infection with the EBV. These antibodies may not be detectable, however, until the second or third weeks of the illness. Occasionally, when this test is inconclusive, other blood tests may be conducted.


The most effective treatment for infectious mononucleosis is rest and a gradual return to regular activities. Individuals with mild cases may not require bed rest but should limit their activities. Any strenuous activity, athletic endeavors, or heavy lifting should be avoided until the symptoms completely subside, since excessive activity may cause the spleen to rupture.
The sore throat and dehydration that usually accompany mononucleosis may be relieved by drinking water and fruit juices. Gargling salt water or taking throat lozenges may also relieve discomfort. In addition, taking over-the-counter medications, such as acetaminophen or ibuprofen, may relieve symptoms, but aspirin should be avoided because mononucleosis has been associated with Reye's syndrome, a serious illness aggravated by aspirin.
While antibiotics do not affect EBV, the sore throat accompanying mononucleosis can be complicated by a streptococcal infection, which can be treated with antibiotics. Cortisone anti-inflammatory medications are also occasionally prescribed for the treatment of severely swollen tonsils or throat tissues.


While the severity and length of illness varies, most people diagnosed with mononucleosis will be able to return to their normal daily routines within two to three weeks, particularly if they rest during this time period. It may take two to three months before a person's usual energy levels return. One of the most common problems in treating mononucleosis, particularly in teenagers, is that people return to their usual activities too quickly and then experience a relapse of symptoms. Once the disease has completely run its course, the person cannot be re-infected.

Key terms

Antibody — A specific protein produced by the immune system in response to a specific foreign protein or particle called an antigen.
Herpes viruses — A group of viruses that can cause cold sores, shingles, chicken pox, and congenital abnormalities. The Epstein-Barr virus which causes mononucleosis belongs to this group of viruses.
Reye's syndrome — A very serious, rare disease, most common in children, which involves an upper respiratory tract infection followed by brain and liver damage.


Although there is no way to avoid becoming infected with EBV, paying general attention to good hygiene and avoiding sharing beverage glasses or having close contact with people who have mononucleosis or cold symptoms can help prevent infection.



National Institute of Allergy and Infectious Disease. Building 31, Room 7A-50, 31 Center Drive MSC 2520, Bethesda, MD 20892-2520. (301) 496-5717.


"Communicable Disease Fact Sheet." New York State Department of Health.
"Mononucleosis: A Tiresome Disease." Mayo Clinic Online. 〈〉.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.


excess of monocytes in the blood; frequently used alone to refer to infectious mononucleosis.
cytomegalovirus mononucleosis a syndrome similar to infectious mononucleosis but caused by infection with cytomegalovirus.
infectious mononucleosis an acute infectious disease that causes changes in the leukocytes; it is caused by the Epstein-Barr virus and is usually transmitted by direct oral contact (which is why it is sometimes called the “kissing disease”). It occurs more frequently in the spring and affects primarily children and young adults. Although epidemics have been reported, some authorities doubt that the disorder has been the same in all instances. Called also glandular fever.
Symptoms. Generally, after an incubation period of one week to several weeks, headache, sore throat, fatigue, severe weakness, and influenzalike symptoms occur. Skin rashes may also occur. Diagnosis can be confirmed by the finding of a marked increase in the number of monocytes in the patient's blood. Besides these normal cells of the lymphocyte class, there is often an increase in atypical lymphocytes. Another diagnostic test that indicates mononucleosis is the paul-bunnell test, which demonstrates the presence of certain antibodies capable of causing clumping of cells in a sample of sheep's blood.

In about 8 to 10 per cent of all cases, the liver is involved and jaundice occurs, resulting in a condition that resembles infectious hepatitis. In rare cases, the heart, lungs, and central nervous system may also be affected. The spleen may become enlarged; one of the complications, serious but rare, is rupture of the spleen. The lymph nodes and spleen may both remain enlarged for sometime after other symptoms have disappeared.
Treatment. Treatment is chiefly symptomatic. Rest is especially important in the early stages of the disease, or later if the liver is involved. There is as yet no specific treatment for mononucleosis, and no immunization is available. Headache and sore throat may be relieved by aspirin and gargles. Although the more obvious symptoms may disappear after a period of rest, sufficient rest and curtailed activities must be maintained in order to improve the patient's severely weakened condition and prevent recurrence. There is often mental as well as physical fatigue, especially among students, and in these cases some mental depression may accompany convalescence.

Chronic, lingering infectious mononucleosis occurs in some patients. They experience profound fatigue, low-grade fever, swollen lymph glands, a sore throat, and aching muscles and joints. These symptoms can persist for months or years, and often cause the patient to be labeled neurotic because of a lack of objective evidence of disease. The condition can be definitively diagnosed by blood testing for antibodies to the Epstein-Barr virus. Unfortunately, diagnosis can provide psychological relief only, as there is no effective treatment or cure for the disorder.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

in·fec·tious mon·o·nu·cle·o·sis

an acute febrile illness of young adults, caused by the Epstein-Barr virus, a member of the Herpesviridae family; frequently spread by saliva transfer; characterized by fever, sore throat, enlargement of lymph nodes and spleen, and leukopenia that changes to lymphocytosis during the second week; the circulating blood usually contains abnormal, large T lymphocytes that resemble monocytes even though B cells are infected, and there is heterophil antibody that may be completely adsorbed on beef erythrocytes, but not on guinea pig kidney antigen. Collections of the characteristic abnormal lymphocytes may be present not only in the lymph nodes and spleen, but in various other sites, such as the meninges, brain, and myocardium.
Farlex Partner Medical Dictionary © Farlex 2012

infectious mononucleosis

A common, acute, infectious disease, usually affecting young people, caused by Epstein-Barr virus and characterized by fever, swollen lymph nodes, sore throat, and lymphocyte abnormalities. Also called glandular fever.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

infectious mononucleosis

Glandular fever, kissing disease An acute EBV infection, most common in adolescents Epidemiology Spread by kissing; 4 to 8 wk incubation Clinical Fever, sore throat, malaise, fatigue, weakness, lymphadenopathy, hepatosplenomegaly Lab Monocytosis, atypical lymphocytes, high titers of sheep RBC agglutinins Management Vigorous contact sports should be avoided to prevent splenic rupture
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

in·fec·tious mon·o·nu·cle·o·sis

(in-fek'shŭs mon'ō-nū-klē-ō'sis)
An acute febrile illness caused by the Epstein-Barr virus; frequently spread by saliva transfer; characterized by fever, sore throat, enlargement of lymph nodes and spleen, lymphocytosis with abnormal lymphocytes similar to monocytes, and heterophil antibody in serum.
Medical Dictionary for the Health Professions and Nursing © Farlex 2012

infectious mononucleosis

Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005

in·fec·tious mon·o·nu·cle·o·sis

(in-fek'shŭs mon'ō-nū-klē-ō'sis)
Acute febrile illness of young adults, caused by the Epstein-Barr virus; frequently spread by saliva transfer; characterized by fever, sore throat, enlargement of lymph nodes and spleen, and leukopenia that changes to lymphocytosis during the second week.
Medical Dictionary for the Dental Professions © Farlex 2012

Patient discussion about infectious mononucleosis

Q. What is the connection between fibromyalgia and glandular fever? How can you protect yourself from this viral infection?

A. There is a notion that some of the autoimmune conditions are caused by a trigger in the shape of a virus. Like the papiloma virus and cervical cancer. So there might be a connection between fibromyalgia and a virus.

Q. can mono kill you if it gets to the liver? otherwise known as the kissing desiaes.

A. It can be fatal, not necessarily through infecting the liver but through rupture of enlarged spleen or obstruction of the throat, or through the development of cancer (e.g. lymphoma) later in life.

However, these complications are very rare, and most people recover from the disease without major complications.

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More discussions about infectious mononucleosis
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