Mononucleosis

Background Info
Mono is often called the kissing disease
Transmitted through saliva (direct or indirect)
Kissing; sharing drinks, foods, utensils, or
toothbrushes; coughs or sneezes
Agent is the Epstein-Barr (EBV) Virus in most cases
Could also by Cytomegalovirus (CMV) in some cases
EBV infects B lymphocytes, which may compromise
immune function
Mayo Clinic
Background Continued
Most common among 15-35
year olds who have not yet
been exposed to the virus
Peak incidence in those 15 to
17 years old. Only 50 people
out of 100,000 in the general
population get mono, but it
strikes as many as 2 out of
1,000 teens and
twenty-somethings, especially
those in high school, college,
and the military 4collegewomen
Descriptive Epidemiology
Host characteristics:
Naturally acquired active immunity: infected individuals produce antibodies to attack EBV
virus
Slow to respond
Results in long lasting immunity, no risk of re-infectivity
Environmental attributes: lower number of cases in underdeveloped
countries because more likely to be exposed as young child
Temporal variation: more severe cases are said to occur during colder
months (more saliva and mucus secreted to protect)
No gender predispositions, seasonal or yearly cycle differences

AAFP
Common Symptoms
Fever
Sore throat
Severe fatigue
Swollen lymph nodes
especially those that
are located near the
back of the neck
Rash
Severe symptoms:
Enlarged spleen or liver
Risk Factors
Age (15-24)
Difficult to get if younger
Immunological memory for Adults
Constant and close contact with people
Nurses, Students, Military, etc.
Intimate contact with an individual who
has active Mono or EBV
Spread through Saliva, a quick kiss is
unlikely to spread the virus
Shared drinking glasses, eating utensils,
toothbrush, etc.
Causal Mechanism of EBV Virus
Typically occurs in Oropharynx
Receptor mediated B-cells and direct
cell-to-cell contact with epithelial cells
EBV invades B-cells through CD21 co-receptor,
and inserts DNA into nucleus
EBV causes proliferation of memory B-cells
without the help of the T-cell
Can cause B-cells to proliferate and not
recognize EBV antigens, may ultimately
produce antibodies that interact with other
animals RBCs
NK cells and Cytotoxic CD8 T-cells ultimately kill
infected cells via apoptosis
Diagnosis
Diagnosis based off of symptoms, and
confirmed via blood test
Monospot and Heterophile antibody test
Looking for antibodies against
EBV/CMV virus, or abnormal
lymphocytes. Can take a while for
adaptive immunity to develop
these antibodies
May also include tests to rule out other
causes and symptoms, such as strep
throat
Blood chemistry test to evaluate liver
function
Treatment
No Specific Treatment
Viral infection, so antibiotics wont work
Mostly rest, and nutrients
Treatment for secondary infections
Often Strep Throat co-occurs with this
disease, and can be treated with
antibiotics such as Penicillin
Penicillin can cause a secondary rash,
which could lead to misinterpretation of
an allergic reaction to antibitocis
Severe infections may be treated with
steroid medications like Prednisone

Virus stays in the body forever

Potential Complications
Acute interstitial nephritis
Hemolytic anemia
Myocarditis and cardiac conduction abnormalities
Neurologic abnormalities
Cranial nerve palsies
Encephalitis (swelling of brain)
Meningitis (swelling of tissues covering brain)
Mononeuropathies
Retrobulbar neuritis
Thrombocytopenia
Splenomegaly and/or hepatomegaly

AAFP
Disease Statistics
Morbidity: 95% of population has EBV in their systems, but only small
percentage of population actually shows symptoms and gets sick
Mortality: very low due to infection itself. Odds increase rapidly with
complications such as splenic rupture, upper airway obstruction, or
neurologic complications
Infectivity: 10-20% annually get infected
30%-50% develop symptoms
Those 15-24 years old have highest incidence rate of 5%
Prevalence: Virus stays in the body forever, so this is hard to determine

Incubation period: 4-7 weeks

Prevention Methods
Primary
Wash your hands
Dont share drinks, food, utensils, toothbrushes, or dishes/glasses
Try not to kiss a bunch of random people
No vaccine exists for mononucleosis
Be one of the 95% that have developed immunity
Secondary
No screening tests exist (per se)
Tertiary
Drink plenty of water and fruit juices
Take ibuprofen
Stay in bed and rest (bolsters immune system)
Gargle with salt water
Do not return to sports or physical activities until a doctor has cleared you
Risk of splenic rupture
Mayo Clinic
Resources
http://www.4collegewomen.org/fact-sheets/mononucleosis.html

http://www.mayoclinic.org/diseases-conditions/mononucleosis/more-about/expert-answers/ssc-201
65937

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244317/

http://www.aafp.org/afp/2004/1001/p1279.html

https://bacterialandviraldiseases.wikispaces.com/Mononucleosis

http://www.cdc.gov/epstein-barr/about-ebv.html

http://www.medicaldaily.com/mono-mono-how-kissing-disease-knocked-me-my-feet-and-taught-me-
personal-health-283140