Mononucleosis Diagnosis

  • Diagnosis

    Mononucleosis, also known as the "kissing disease," or simply "mono," is a group of symptoms that occur in some individuals who become infected with Epstein-Barr virus (EBV). The Epstein-Barr virus (EBV) is so widespread that 90% to 95% of all adults everywhere have signs of it in their blood. Infants become susceptible to EBV when they are no longer protected by their mother's immune system, usually after the first year of life. Fortunately, young children don't show symptoms when they are infected. Additionally, getting EBV infection at an early age confers lifetime immunity against future infections.

    Teens and young adults ages 15 to 25 who escaped EBV infection during early childhood are at high risk of developing symptoms if they become infected with EBV. Mono is rare, but not totally unheard of in middle age.

    Almost all cases of mono resolve within a month. Most teens and young adults get well within two to three weeks with treatment no more complicated than drinking plenty of fluids and getting adequate bed rest. The older the infected person, the more severe the symptoms tend to be.

    Consult a health practitioner such as a family practitioner, pediatrician, or internist if symptoms become severe, or if they persist for more than four weeks.

    Infectious mono is spread through the exchange of saliva. That can occur when people share eating utensils or enjoy a passionate kiss (hence the name, "the kissing disease"). Viruses other than EBV can cause similar, mono-like illnesses. These illnesses have many of the same symptoms, but appear less frequently than mono caused by EBV. For simplicity, most authorities lump both the EBV and non-EBV mono illnesses under the term, "infectious mononucleosis." Regardless of the infecting virus, most cases are mild and resolve uneventfully.

    Newly exposed older children and young adults are likely to experience fatigue, sore throat, swollen glands, and fever. The throat becomes painfully sore, and white patches resembling those seen in strep throat may appear on the tonsils. Sore throats are usually most painful during the first three to five days of the infection.

    Fever can come and go for up to 14 days, and usually peaks in the afternoon or early evening. Fever temperatures can climb as high as 103°C-105°F (39.5°C 40.5°C).

    Up to half of the people who exhibit symptoms of mono also experience a temporary, sometime painful enlargement of the spleen. The spleen, which is located in the upper left part of the abdomen, is an important organ because it filters blood, and is a major part of the immune system.

    When a person develops mono, he or she usually first complains of extreme fatigue. Then, fever, sore throat, and swollen glands of the neck, underarms, or groin develop.

    Headaches and sore muscles are less common symptoms, but also occur. Some individuals experience loss of appetite.

    Infants in undeveloped countries are at high risk for EBV infection at an early age, but that infection is normally without symptoms.

    In more developed countries and among affluent populations, many individuals between the ages of 15 and 25 have escaped EBV infection, and are at risk for developing mono when they become infected.

    High school and college students, interns, nurses and other caregivers, and other people who come into close contact with many people are most likely to get mono.

    Exchanging saliva through kissing someone who has experienced EBV infection, or sharing utensils or a toothbrush with that person puts you at risk for getting the infection yourself.

    Uninfected individuals who take drugs designed to suppress the immune system are also at increased risk for having complications during EBV infection.

    Other viral infections such as cytomegalovirus, hepatitis A, or infrequently, the AIDS virus and cancer, can cause symptoms similar to those caused by mono. That's why if symptoms become severe or don't resolve on their own after a month, the patient should see a doctor. The doctor will most likely do a medical history, a physical examination, and order some lab tests.If you are the patient, you will be asked how long you have had symptoms, and whether you live with, or have come into contact with anyone known to have mono. Your doctor will also take your temperature, examine your neck, arm pits, and groin to see if your glands are swollen, check the upper left part of your abdomen to see if your spleen or liver is enlarged, and note whether you have a rash with raised patches or bumps (a symptom that sometimes appears when a person with mono is mistakenly treated with antibiotics).

    Several different laboratory tests can provide useful information to your doctor in diagnosing mononucleosis. However, the only way to determine for sure whether someone has mono is through a blood test known as the Monospot test. In some cases, however, the monospot test may be negative, and a more expensive test for antibodies to EBV is used (EBV-specific antibody test). The Monospot test is more likely to detect an active mono infection if it is done at least two (but preferably three or four) weeks after symptoms are first noticed. That's because it detects substances in the blood known as antibodies that react to the presence of infection. Those antibodies need time to build up in reaction to the infection.

    Your doctor may also order a lab test known as the Complete Blood Count (CBC). The CBC provides important information about the severity of the infection.

    Sometimes upper respiratory infections such as the flu or those caused by streptococcal infections are confused with mono. Indeed, individuals can have mono and strep at the same time. That's why your doctor may order a throat culture, or a test known as the rapid strep test. Either can confirm or rule out a strep infection.

    If your physician suspects mono, he or she may also order liver tests to determine if the liver is damaged or inflamed.

    Since mono is so widespread and resolves on its own, there is no reason to test for this disease in people with no symptoms.

    To avoid spreading the disease during the course of the illness, patients should avoid kissing or other contact where saliva could be exchanged.

  • Prevention and Screening

    Since mono is so widespread and resolves on its own, there is no reason to test for this disease in people with no symptoms.

    To avoid spreading the disease during the course of the illness, patients should avoid kissing or other contact where saliva could be exchanged.

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