What You Need to Know about Infectious Mononucleosis and Epstein Barr Virus

March 25, 2020

4 min read

Infectious mononucleosis, often simply referred to as “mono,” frequently rips through high schools and college campuses. Learn the symptoms of mono infection and what you can do to prevent it.

What Is Infectious Mononucleosis?

Infectious mononucleosis is a contagious disease that is spread via saliva, which is why it is sometimes known as the “kissing disease.” Symptoms of mono develop about 4 to 6 weeks after you are exposed to the virus that causes the disease. Initially, it can be difficult to diagnose mononucleosis because the symptoms develop slowly and may not appear at the same time. The most common symptoms of mono include:

· Extreme fatigue

· Sore throat

· Body aches

· Headache

· Fever

· Rash

· Swollen lymph nodes in the armpits or neck

· Enlarged liver or spleen. The spleen, located in the upper left abdomen, becomes enlarged in about half of people with mono.

Extreme fatigue is the most common and longest-lasting mono symptom. In general, people tend to feel better within two to four weeks. For some people, however, the fatigue may last six weeks or longer.

Mono can be caused by a number of different viruses. However, most cases of mono are due to the Epstein-Barr Virus (EBV). EBV is also known as human herpesvirus 4. As a member of the herpesvirus family, EBV is one of the most common human viruses (it’s not the same herpesvirus that causes genital herpes).

EBV commonly spreads through bodily fluids such as saliva. Sharing a drinking glass or toothbrush with somebody who has EBV may cause you to contract the virus. It is also possible to transmit EBV through blood or sexual contact. After contracting EBV, it may take 4 to 6 weeks before you develop symptoms. During that time, you can spread the virus to other people without knowing about it. That is why mono infections often spread quickly through young adults’ social circles, such as college campuses. Approximately 25% of young adults who get the Epstein-Barr Virus will develop mononucleosis.

In less common cases, other viruses can cause mono infections. Cytomegalovirus, toxoplasmosis, HIV, adenovirus, and rubella can all cause mono.

Diagnosis and Treatment of Infectious Mononucleosis

If you think you may have mono, visit your healthcare provider immediately. Your doctor can typically diagnose infectious mononucleosis based on your symptoms alone. Although lab tests usually aren’t needed to make a diagnosis, your doctor may order them to rule out other causes of infection. Blood tests of people with mono typically show more white blood cells than normal, fewer platelets, atypical looking white blood cells, and liver abnormalities.

Unfortunately, there is no vaccine for EBV and no fast-acting cure for mono. The goal is to manage your symptoms while preventing the spread of the disease. To alleviate symptoms, you should:

· Drink lots of fluids to stay hydrated. Juice, sports drinks, and soups are great ways to keep hydrated when sick.

· Get plenty of rest. Sleeping and avoiding strenuous activity is important to give your body the opportunity to fight the infection.

· Try warm salt water gargles if your throat is sore.

· Take over-the-counter medications for pain and fever. Medications such as ibuprofen or acetaminophen can help to reduce pain and lower inflammation.

Penicillin antibiotics such as amoxicillin or ampicillin should be avoided if you have mono. These medications can cause a rash.

Complications of Mononucleosis

The vast majority of cases of infectious mononucleosis clear up on their own. In rare cases, however, mono can lead to complications. One of the biggest risks is a ruptured spleen. Because the spleen becomes enlarged in many people with mono, it can be damaged by strenuous activity. If your spleen ruptures, it will cause a sudden, sharp pain in the upper left side of your abdomen. Seek medical attention immediately, because a ruptured spleen may require surgery. Avoiding strenuous physical activity and weightlifting in the weeks following mono will help to avoid rupturing your spleen.

Other complications are rare. These include:

· Jaundice. Your skin may become yellowed due to abnormal liver functioning.

· Hepatitis, or mild inflammation of the liver.

· Anemia, due to decreased red blood cells.

· Inflammation of the heart (myocarditis)

· Thrombocytopenia, or low levels of blood clotting cells (platelets)

· Guillain-Barre syndrome, an autoimmune condition causing paralysis

· Encephalitis or meningitis (brain infections)

· Swollen tonsils

Chronic Epstein Barr Virus Disease

In some cases, your body cannot effectively fight the Epstein Barr Virus. Patients with chronic EBV have an infection lasting longer than six months. Doctors diagnose chronic EBV by doing blood tests to check for signs of viral DNA and white blood cells affected by the virus. The symptoms of chronic EBV are similar to an acute infection, with fever, swollen lymph nodes, enlarged spleen, and extreme fatigue. Over time, chronic EBV can compromise the immune system and leave you vulnerable to other infections, multiorgan failure, or other serious complications. Stem cell transplants may be effective in treating chronic EBV, but little is known about the best way to manage this rare condition.

The best way to avoid infectious mononucleosis is to practice good hygiene. Avoid sharing meals or beverages with others, wash your hands frequently, and don’t kiss anyone who has recently been sick. If you do get sick, take care of yourself and know that the virus may take a couple of weeks to run its course. Getting a note from your medical provider can be helpful to excuse you from work or school responsibilities.