Infectious mononucleosis or “kissing disease” is a frequently encountered acute contagious disease, produced by the Epstein-Barr virus (a herpes virus).
What is infectious mononucleosis
Mononucleosis is a disease that occurs more frequently among young adults (who have not had previous exposure to the virus), being characterized by a limited evolution, after which antibodies appear with a protective role throughout life. Patients with a competent immune system who come into contact with the virus no longer develop symptoms, the infection remaining subclinical.
In the case of immunocompromised patients, the infection develops with the appearance of lymphomas (tumors) due to the lack of regulation on the part of the immune system through lymphocytes.
How the Epstein Barr virus is transmitted
The virus is located at the level of the oropharyngeal epithelium and in the saliva so possible contamination occurs through direct contact with the patient’s secretions from here and the name “kissing disease”, through coughing or sneezing, but also through contact with shared dishes, incorrectly sanitized (cutlery, mugs, glasses).
Less frequent are the cases of transmission of the infection through blood transfusions, plasma or platelet mass, organ transplantation or through seminal fluid during intimate contact.
What are the most common symptoms of the disease?
The mononucleosis syndrome is represented by:
- Fever
- State of accentuated weakness
- Pharyngitis (painful inflammation of the pharynx)
- Laterocervical adenopathy (inflammation of the lymph nodes)
- Eczema or rashes (red spots on the body)
- Hepatosplenomegaly (increase in size of the liver and spleen)
Rare complications that can appear during the disease and that especially affect people with immunodeficiency syndromes are:
- Anemia (low hemoglobin)
- Thrombocytopenia (low platelets, there is a risk of spontaneous bleeding)
- Myocarditis (inflammation at the heart level)
- Meningitis (inflammation of the meningeal sheets)
- Rupture of the spleen (caused by the sudden increase in the volume of the organ) – surgical emergency
- The appearance of jaundice due to liver viral damage
- The listed symptoms are not specific to Epstein Barr infection, they are common to other pathogens such as Toxoplasma gondii, liver viruses or Cytomegalovirus
How to establish the diagnosis of Epstein Barr infection
Clinical signs (fever, pharyngitis, lymphadenopathy) associated with hematological data indicating lymphocytosis (increased number of lymphocytes in the blood count) are usually sufficient to establish viral infection, but they do not have high specificity.
The definitive diagnosis of Epstein Barr infection is given by the presence of antibodies in the blood:
- heterophile and/or
- specific to viral proteins
- The viral capsid antigen VCA (protein from the viral envelope) induces the synthesis of Ig G and Ig M antibodies
- The diffuse early antigen EBNA induces the synthesis of Ig G-type antibodies
- Optimal treatment in mononucleosis
The treatment in infectious mononucleosis is strictly symptomatic and requires rest and the consumption of liquids in large quantities, if necessary, anti-algesics (reduce the pain in the throat) and antipyretics (reduce the fever) can be administered. The use of antibiotics is not necessary.
Find out more:
- Characteristics of Hodgkin’s Lymphoma after Infectious Mononucleosis – https://www.nejm.org/doi/full/10.1056/nejmoa023141
- Infectious mononucleosis and risk for multiple sclerosis: A meta‐analysis – https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.20820
- The Transmission of Infectious Mononucleosis. – https://www.cabdirect.org/cabdirect/abstract/19552702370
