Mononucleosis, often called "Mono", is a usually mild self-limiting illness and, in most cases, does not deserve its bad reputation. Caused by the Epstein-Barr virus (EBV), it usually runs its course quickly and rarely produces any serious complications. There are, however, other viruses that may produce a mono-like illness.
Mononucleosis is an illness that affects teenagers and young adults, mainly ages 14 to 30, but can occur in children and older adults. It has been estimated that approximately 50% of students have had mono by the time they enroll in college. Many times the symptoms are so mild that it is not recognized for what it is.
The symptoms of mononucleosis may be the same as many other illnesses, such as "colds" or strep throat. For this reason, it is particularly difficult to diagnose in the early stages of the illness, although the diagnosis is usually based on symptoms and a physical exam. Symptoms usually disappear within 2-4 weeks, with fatigue sometimes lingering longer. Confirmation, if necessary, can be accomplished by either of two blood tests:
1. EBV causes an increase in a specific type of white blood cell, the atypical lymphocyte. A white blood cell count, WBC, will reflect this change commonly seen in people who have mononucleosis.
2. The mono spot test identifies an antibody which is present in mononucleosis. This test may not become positive until one has had symptoms for 5-14 days and may remain positive for months to years. It is important to remember the mono test merely helps to make the diagnosis; it does not indicate the severity of the disease and does not predict how long symptoms will last.
There are no conventional medical treatments to cure mononucleosis, only those that help manage the symptoms. In approximately 20-30% of people with mononucleosis there is a concurrent bacterial throat infection. Any antibiotics prescribed may help with the sore throat, but not the EBV infection.
Acetaminophen is preferable to aspirin for pain and fever relief because of the association of the EBV and Reye's syndrome in children. In most cases of mononucleosis, hospitalization is not indicated. It has been shown that those who remain active to the limit of personal comfort get well more rapidly than those who remain in bed.
EBV is found in moist, exhaled air, and in nose or mouth secretions. It is not as contagious as many other viruses but may be transmitted through direct contact. This explains its nickname of the "kissing disease". Isolation of the patient is not indicated; one can not catch mononucleosis by sitting in the same room with someone who has it, although persons who have had mononucleosis can shed the virus periodically in their saliva for the rest of their lives.