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This name is associated with the main route of infection: direct contact with the saliva of an infected person.
Infectious mononucleosis is a typical acute viral infectious disease that results from infection Epstein-Barr virus. This virus shows high affinity to lymphoid tissue, which results in excessive stimulation of lymphocytes, which is reflected in the clinical picture and the results of additional tests.
Infectious mononucleosis is most often observed in the age range of 12-24 years, while young children and adults over 40 suffer less frequently.
The source of the virus is mainly sick people and convalescents, who may periodically be excreted with the virus along with their saliva. A sick person can infect even 4 to 18 months after the onset of the disease.
Routes of infection:
- direct, close contact with infectious material (saliva) through a kiss or indirect, e.g. a glass, bottle, eating the same sandwich or fruit together, etc.
- blood and blood products – as a result of transfusion
- bone marrow or organ transplant
Clinical symptoms
Often, infectious mononucleosis is asymptomatic. The incubation period of the disease is approximately 40 days. Often the disease begins suddenly and resembles the flu.
The classic symptoms include:
- high fever up to 400C and lasts for about 1-2 weeks
- severe sore throat – most often a significant enlargement of the palatine tonsils with the presence of raids
- in children, swelling of the eyelids, eyebrows and epiphyses is very common in the course of the disease
- lymphadenopathy – mainly cervical and submandibular; lymph nodes are tender, painful; less often generalized lymphadenopathy
- enlargement of the liver and spleen
- less commonly maculo-papular rash all over the body (especially in children) or a very characteristic appearance of a rash when taking antibiotics (ampicillin or amoxicillin) in the course of infectious mononucleosis
- during recovery: feeling exhausted, general weakness, difficulty concentrating
Complications in the course of mononucleosis:
- risk of rupture of the spleen associated with its enlargement – a life-threatening situation; the greatest risk appears in the 2nd or 3rd week of illness; it is important to avoid injuries to the abdomen during this period
- haematological complications: thrombocytopenia, anemia, deficiency of white blood cells
- neurological complications: encephalitis involving the cerebellum, convulsions, meningitis
- secondary bacterial infections
- in children: shortness of breath associated with restricted airway obstruction by enlarged tonsils, lymph nodes and nasal obstruction
- very rare: myocarditis
Diagnosis of the disease
In addition to clinical symptoms, additional tests show an altered characteristic blood picture: an increased number of white blood cells (leukocytes) with a significant predominance of lymphocytes, and the presence of the so-called atypical lymphocytes.
Additionally, liver enzymes are elevated, especially ALAT (alanine aminotransferase).
The decisive test confirming the diagnosis of mononucleosis is a serological test that detects IgM and IgG antibodies in the blood against virus antigens. Due to the prevalence of infection with a virus with an active disease process, increased values of IgM antibodies are evidence.
Treatment and prevention
In mononucleosis, the therapy is symptomatic, i.e. directed at the symptoms of the disease. Antipyretics, oral disinfectants and an easily digestible diet, as well as bed rest and rest are the most commonly used drugs. In the case of respiratory or hematological complications, additional corticosteroid therapy is used. There are no antiviral drugs for the Epstein-Barr virus.
Prevention comes down to compliance with the basic rules of hygiene. There are no specific vaccines.
In most cases, the disease occurs without sequelae and the prognosis is good. The risk of fetal infection in pregnant women is also very low. However, it should be remembered that symptoms resembling mononucleosis may also be the result of HIV infection, therefore it is very important to diagnose in this direction in adolescents and adults, especially when there were situations favorable for this type of infection.
Text: Mirosław Jawień, MD, PhD
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