What is Infectious Mononucleosis?
Q: What exactly is infectious mononucleosis?
A: Infectious mononucleosis (IM), often referred to as “mono,” is a viral syndrome characterized by symptoms like fever, sore throat (pharyngitis), and swollen lymph nodes, particularly in the neck (posterior cervical lymphadenopathy). It’s most commonly caused by the Epstein-Barr virus (EBV).
Q: Who is most at risk for contracting mononucleosis?
A: While anyone can get mono, it most frequently affects adolescents and young adults between the ages of 15 and 24. The primary transmission mode is through close personal contact, especially through an infected person’s saliva.
Diagnosis and Testing
Q: How is mono diagnosed?
A: Initial testing for mono typically includes a complete blood count with differential to check for a high percentage of lymphocytes and atypical lymphocytes. A rapid heterophile antibody test, also known as the monospot test, is commonly used due to its quick results, with a sensitivity of 87% and specificity of 91%.
Q: Are there any limitations to these tests?
A: The heterophile antibody test can yield false-negative results, especially in children under five and adults during the first week of illness. Epstein-Barr viral capsid antigen-antibody testing is recommended for more accurate results, though it is more costly and takes longer to process.
Treatment and Management
Q: What treatments are available for mono?
A: Treatment is primarily supportive. Routine use of antivirals and corticosteroids is not recommended. Management focuses on symptomatic relief such as hydration, rest, and pain relievers for sore throat and fever.
Q: What precautions should people with mono take?
A: Due to the risk of splenic rupture, a rare but serious complication, patients are advised to avoid athletic activity for at least three weeks from the onset of symptoms. Decision-making about the return to activities should involve careful consideration of the patient’s symptoms and recovery status.
Risks and Complications
Q: What are the potential severe complications of mono?
A: In immunosuppressed populations, mono can lead to more severe forms of the disease and significant morbidity. Furthermore, the Epstein-Barr virus has been linked to several types of cancer, including Hodgkin and non-Hodgkin lymphoma and nasopharyngeal carcinoma, as well as some autoimmune diseases. There is a link between mono and the Alice in Wonderland syndrome.
Q: How common is splenic rupture in mono patients, and what should be done if suspected?
A: Splenic rupture is uncommon but can be life-threatening. It typically presents with acute abdominal pain. If a patient with mono experiences such symptoms, immediate medical evaluation, potentially including an abdominal CT scan, is crucial to assess for this complication.
Prognosis and Long-term Effects
Q: Can you fully recover from mono?
A: Yes, most individuals recover completely from mono without long-term effects, although fatigue can linger for several months. It’s important to gradually return to normal activities and follow medical advice to prevent complications.
Q: Are there any long-term health issues associated with having had mono?
A: Most people do not experience long-term health problems. However, since EBV remains in the body for life, it can potentially reactivate, though this is usually without symptoms unless the immune system is significantly compromised.
This Q&A should provide a comprehensive understanding of infectious mononucleosis for the general public, addressing common concerns and highlighting the need for careful management and monitoring of the condition.
References:
Frecentese DF, Cogbill TH. Spontaneous splenic rupture in infectious mononucleosis. Am Surg. 1987 Sep;53(9):521-3. PMID: 3631766.
Womack J, Jimenez M. Common questions about infectious mononucleosis. Am Fam Physician. 2015 Mar 15;91(6):372-6. PMID: 25822555.
Sylvester JE, Buchanan BK, Silva TW. Infectious Mononucleosis: Rapid Evidence Review. Am Fam Physician. 2023 Jan;107(1):71-78. PMID: 36689975.