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Signs and
Symptoms:
When people think of infectious
mononucleosis, or "mono," they often think of extreme tiredness
as one of the major symptoms associated with this
illness.
Other typical symptoms of infectious mononucleosis in
children are:
Loss of appetite and generalized weakness also may be
present, especially in adolescents. Nausea, hepatitis, jaundice, severe headache, stiffness,
chest pain, and difficulty breathing can occur in some cases.
A pink rash can occur all over the body in children who
have been treated with ampicillin or amoxicillin.
Younger children may have few or none of these symptoms; instead they
may have nonspecific symptoms like fever, slight malaise, and loss of
appetite. Adolescents are more likely to exhibit the classic symptoms
described above. Some may experience extreme fatigue, staying in bed
for more than a week because they feel too weak even to
walk around the house.
Infectious mononucleosis is generally a self-limiting
disease, which means it goes away on its own in most
cases. Occasionally mono can cause complications (which are
decribed below).
Description:
Mononucleosis is an illness
caused by the Epstein-Barr virus (EBV), a member of the herpesvirus
family. Similar symptoms and illness are sometimes caused by cytomegalovirus, which is also a member of this
family of viruses.
EBV is transmitted through the saliva. Young children can be
infected from the saliva of playmates or family members. Adolescents with
the virus can spread EBV through kissing (hence its once popular
name, "the kissing disease"). Epidemic outbreaks in hospitals and
workplaces have occurred.
Most people who have infectious mononucleosis recover
completely with no problem, but sometimes complications from EBV
infection can occur. These can include blood disorders leading to lowered numbers of red
and white blood cells because of decreased production of these cells
by the bone marrow, or destruction of red blood cells (hemolytic anemia).
Bell's palsy, a usually temporary condition where there is inflammation
of one of the facial nerves resulting in weakened or paralyzed facial
muscles on one side of the face, can also result from EBV infection.
Other rare complications of EBV infection include rupture of the
spleen, inflammation of the heart muscle (myocarditis), involvement of the
central nervous system (aseptic meningitis and encephalitis), and a nervous system disorder known
as Guillain-Barré syndrome that can paralyze muscles.
Epstein-Barr virus is usually diagnosed with blood
tests. Heterophile antibody levels (antibodies react to infectious
organisms in the blood and create immunity) indicate a current
infection with EBV. Antibody levels (called "titers") against the EBV
virus reveal if there is a current or prior infection from the
virus.
Blood tests usually shows an increase in the overall number of white
blood cells. Blood can also be examined under a
microscope to determine whether there is an increased number of white
blood cells called lympocytes. These white blood cells help fight viral
infections, and an increased number of "atypical" lymphocytes usually
indicates current infection with mononucleosis.
Studies show that most people have been infected with EBV at some point
in their lives, and most have few or no symptoms of viral
infection.
Prevention:
There is no vaccine
for EBV, but prior infection with the virus usually provides long-lasting
immunity. Avoiding contact with the saliva or respiratory secretions
of people known to have EBV is advisable.
Incubation:
The incubation
period is 10 to 60 days; 7 to 14 days is common for children and
adolescents.
Duration:
Mono is a
self-limiting disease; symptoms usually go away on their own within 2 to 4
weeks. The fever and sore throat usually subside after 2 weeks, but
the enlarged lymph nodes and spleen can persist for a few more weeks. In
some children, especially teens, fatigue and weakness may last for weeks,
and occasionally months.
Contagiousness:
EBV is contagious -
it is transmitted through the saliva of an infected person by
coughing, sneezing, and kissing. Susceptible people should avoid contact
with those known to have active mononucleosis; the virus can continue to
be excreted in saliva and repsiratory secretions for months. In general,
strict isolation procedures or special precautions are not needed. People
with recent EBV infection should not donate blood.
Professional Treatment:
If
there is enlargement of the tonsils or lymph nodes in the neck and throat
that interferes with breathing, steroids may occasionally be prescribed to
alleviate the situation.
Because mono is caused by a virus, antibiotics such as penicillin won't
help unless the child has a secondary infection like strep bacteria.
Home Treatment:
The best
treatment for infectious mono is plenty of rest,
especially earlier in the course of the illness when symptoms are the
worst. Acetaminophen (such as Tylenol) or ibuprofen (such
as Motrin) can help to relieve the fever and aching muscles.
Never give aspirin to a child who has a viral
illness because the use of aspirin in such cases has been
associated with the development of Reye syndrome, which can lead to liver failure and
death.
After recovery, adolescents frequently are advised not to play sports for at least 1 month. Children with
enlarged spleens should avoid contact sports (even wrestling with friends
or siblings at home). Sometimes fatigue from mono may persist for a few
months, and in this case, any kind of vigorous activity or exercise should
be avoided. Any child with an enlarged spleen from infectious mono
should be examined by the child's doctor for medical approval before
returning to contact sports.
When to Call Your Child's
Doctor:
As discussed, EBV infection may affect a wide
range of organ systems, and occasional complications can
occur. If your child has symptoms of infectious mononucleosis,
call your child's doctor so your child can be
evaluated.
It's important to remember that any child with an enlarged spleen
should not engage in vigorous activities or play contact sports. Sudden
sharp pains in the left upper abdomen in the context of an infection may
indicate that the spleen has become involved - if this occurs,
call your child's doctor immediately.
Reviewed by: Joel Klein, MD, and Kim Rutherford, MD
Date reviewed:
October 2001 |