What is Mononucleosis (Epstein-Barr Virus?)

Mononucleosis (Mono) has long been known as the kissing disease. The virus is spread by contact with saliva. Two primary ways of contracting mono is by kissing and sharing drinks with another. The incubation period for mono is anywhere from thirty to fifty days. Symptoms need to be evident for at least seven to ten days before a positive blood test can be done. Early negative tests should be repeated if the patient is still symptomatic. The severity of mono is on a continuum. Some individuals have minimal symptoms, similar to a cold and sore throat while others many have a full blown exacerbation needing to be hospitalized. As per the Merck Manual, approximately fifty percent of children before age five have had mononucleosis. Many of these go undetected.

What are the symptoms of Mononucleosis?

A typical presentation of mono is a young adult who presents with a sore throat, white exudate’s on tonsils, swollen lymph nodes of the neck (common in the back of the neck but can be front and back), fever, loss of appetite and fatigue. Patients who have a severe presentation may have a yellowish color of the whites of their eye (icteric) with a tender, swollen spleen. Some or many of these symptoms can be present. In the absence of a negative strep test this diagnosis should be considered. This author has seen some individual with strep and mono at the same time. As a clinician, once one has a positive strep test one should be alert to other symptoms that can be a tip off for both diagnoses going on at the same time. Fatigue is present in the first few weeks with a want to sleep and rest. It is very unusual for this symptom of fatigue to last longer than two months. Although there are reported cases of fatigue lasting for longer periods of time there is no evidence to why this occurs with the presence of normal lab values. An enlarged spleen occurs in the first three to four weeks but may be present for longer. Athletes need clearance before returning to sports, as a splenic rupture is a medical emergency. The spleen should return to normal after two months post diagnosis, however to be sure some cases may require an ultrasound.

What is the treatment for Mononucleosis?

Treatment is supportive. Rest, fluids, and at times pain relievers can be helpful due to the sore throat. Liquids, milk shakes, pop-sickles all provide relief, all be it transient. In severe cases Prednisone has helped reduce swelling of the throat, and should be used sparingly. Prednisone gets a bad rap from the general public. It is safe in short bursts and patients get relief in a couple of days. No exertion such as lifting and NO contact sports. There have been rare reports of straining from being constipated which has been known to rupture enlarged spleens. The prognosis is excellent with a mortality being less than one percent and is primarily due to a splenic rupture. The acute or early phase of the diagnosis lasts only about two weeks,and according to the Merck manual around twenty percent of cases can return to school after the first week and fifty percent can return in two weeks. In only two percent of cases fatigue last for a few months, however this fatigue is not usually debilitating and the individual can still function with daily tasks.

Can an individual get Mononucleosis more than once ?

The reason this question comes up so often is there is not a direct, straight, black and white answer. The vast majority of cases, approximately ninety-eight percent of the time, a patient will only get mono once. Your antibodies will stay positive for life. In an immune-compromised patient they may have an exacerbation. Be advised there are other viruses that present very similar to mono with similar symptoms. For the most part I tell patients you will only get mono once, there are rare exceptions in medicine with many diagnoses.

Ref: Merck Manual

Ref: Lange: Family Medicine