Infectious mononucleosis is an acute infectious disease characterized by sore throat, fever, and swollen cervical lymph glands. The disease primarily affects adolescents and young adults. It is also called glandular fever.
Infectious mononucleosis is caused by the Epstein-Barr virus (EBV). This virus is shed in the saliva of infected individuals and is usually spread through the oral-pharyngeal route (the reason for another name: the “kissing disease”). Once in the body, EBV infects B lymphocytes, a type of white cell found in the lymph, blood, and connective tissue, that are one important component of the body’s immune system. Infectious mononucleosis is most likely contagious for a period before symptoms develop until the fever subsides and the oral-pharyngeal lesions disappear.
Signs and Symptoms
Initial symptoms are usually vague, mimic those of other diseases, and may include malaise, anorexia, and chills. After 3 to 5 days, sore throat, fever, and swollen lymph glands in the throat and neck occur. Early in the infection, a rash that resembles rubella sometimes develops.
A thorough client history and physical examination are essential to rule out closely related disorders and will reveal the triad of symptoms: (1) sore throat, (2) fever, and (3) swollen lymph glands. A blood test is necessary to confirm the diagnosis. It will show increased numbers of leukocytes, lymphocytes, monocytes, and antibodies to EBV.
FIGURE. Atypical lymphocytes seen in infectious mononucleosis. (From Thomas, CL [ed]: Taber’s Cyclopedic Medical Dictionary, ed 21. FA Davis, Philadelphia, 2009, p 1488, with permission.)
Treatment is supportive because mononucleosis resists prevention and antimicrobial treatment. Bed rest may be indicated during the acute phase, but clients may still need to lessen their activities until the disease completely subsides. Analgesics may be recommended for headache and sore throat. Warm saline gargles are also helpful.
Bed rest is especially important in the acute phase of the infection. It is recommended that clients drink plenty of water, filtered to remove chlorine, heavy metals, benzene, lead, and mercury, and eat organic meats, eggs, milk, and poultry that contain no growth hormones or antibiotics. Vitamin supplements may be recommended.
Stress adequate rest and reduction of activities. Clients may suffer from ongoing fatigue during much of the period of infection and tend to resume normal activity too quickly.
The prognosis is excellent, but recovery may take several weeks or months. Once infected with EBV, the virus remains—usually in a dormant state—for life. If the virus does reactivate, it does not cause illness. Mononucleosis sometimes leads to a serious condition called chronic active EBV infection, which causes illness more than 6 months after the initial diagnosis.
The best prevention is to avoid oral-pharyngeal contact with a known EBV-infected person. Do not share dishes or eating utensils with someone who has mononucleosis. (EBV virus is spread when saliva from an infected person gets into another person’s mouth.)