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Epstein - Barr Virus (EBV)
and
Infectious Mononucleosis

The disease occurs worldwide, and most people become infected sometime during their lives. Infectious mononucleosis is almost never a fatal disease. This disease also called as "mono" or "kissing disease". It is not usually a serious disease

It occurs most often in young adults between the ages of 15 and 35 and is especially common in teenagers.

Etiological agent

Epstein-Barr virus (EBV) is a member of the herpesvirus family
EBV remains dormant or latent in a few cells in the throat and blood for the rest of the life. Periodically, the virus can reactivate and is commonly found in the saliva of infected persons. This reactivation usually occurs without symptoms of illness. Also, the virus will be excreted in the saliva intermittently for the rest of their lives.

The virus affects white blood cell called the B lymphocyte producing characteristic atypical lymphocytes that may be useful in the diagnosis of the disease.

Incubation period

Incubation period ranges from 2 to 7 weeks.
After the incubation period, 20% of circulating B lymphocytes infected with EBV.

Persons with infectious mononucleosis may be able to spread the infection to others for during this period.
In fact, many healthy people can carry and spread the virus intermittently for life. For this reason, transmission of the virus is almost impossible to prevent.

Symptoms

It generally causes weakness and fatigue

Other symptoms

- Flu like illness
- Lethargy
- Fever
- Sore throat
- Nausea and vomiting
- Decreased appetite
- Headaches
- Joint pain
- Skin rash

Signs

- Lymphadenopathy last for 1 to 4 weeks
- Sometimes, spleenomegaly or hepatomegaly occurs.
- Involvement of the heart the central nervous system occurs only rarely.

Infectious mononucleosis is almost never fatal.

In rare instances, the spleen may rupture, producing sharp pain on the left side of the abdomen, a symptom that warrants immediate medical attention.

Clinical diagnosis

The clinical diagnosis is suggested on the basis of the symptoms of fever, sore throat, and swollen lymph nodes. However, a variety of other conditions can produce similar symptoms.

Confirmation of the diagnosis

Laboratory tests are needed for confirmation.
Serologic results

- Elevated white blood cell count
- Increased percentage of certain atypical white blood cells
- Increased total number of lymphocytes
- Greater than 10% atypical lymphocytes
- Positive Paul-Bunnell heterophile antibody test result is diagnostic

(When "mono spot" test results are negative, additional laboratory testing may be needed to differentiate EBV infections from a mononucleosis-like illness induced by cytomegalovirus, adenovirus, or Toxoplasma gondii.)

Treatment

There is no specific treatment, other than treating the symptoms. No antiviral drugs or vaccines are available. 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.

Fever, headache and other body pain can be managed with acetaminophen or ibuprofen but aspirin should be avoided because mononucleosis has been associated with Reye's syndrome specially in children, a serious illness aggravated by aspirin.

Some physicians have prescribed a 5-day course of steroids to control the swelling of the throat and tonsils. The use of steroids has also been reported to decrease the overall length and severity of illness, but these reports have not been published.

Prognosis

Most people with mononucleosis will be able to return to their normal daily routines within two to three week time.

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