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Infectious Mononucleosis (Glandular Fever)

Infectious mononucleosis is an infection caused by the Epstein-Barr virus known as glandular fever. Common names for infectious mononucleosis includes kissing disease or mono. The infection may occur from childhood to old age although it is more often associated with teens and young adults. The infection is transmitted by person to person through direct contact such as by kissing ,with transfer of virally contaminated saliva. Although it is a common mild infection, severe complications of the liver, spleen and nerves are seen mainly in the elderly. These symptoms and complications are at times confused with other more common diseases that are more frequently seen in the senior years.

Symptoms of Glandular Fever

The prodromal phase of the disease lasts for 3 to 5 days. During this period symptoms are mild such as malaise, muscle pain, headache and fatigue. Photophobia, nausea vomiting and diarrhea may also be present.

Frank clinical symptoms are seen in next seven to twenty-one days. These symptoms commonly include fever, sore throat and bilateral cervical enlargement of lymph nodes. The condition often mimics streptococcal throat infections as the tonsils are most commonly enlarged and inflamed. Bleeding from pharynx, oral and nasal cavity may also be experienced. The less common symptoms include splenomegaly, hepatomegaly and neurological manifestations. The less common symptoms are more prominently seen in the elderly.

The oral cavity shows tiny petechiae on the soft palate and oral mucosa .Acute gingivitis and stomatitis may be present. Transient reddish, flat or slightly elevated eruptions are seen on the trunk and the extremities. One of the complications of infectious mononucleosis is rupture of the spleen due to inflammation of the spleen. The other complications include encephalitis, meningitis and pneumonitis.

Causes of Glandular Fever

Infectious mononucleosis is caused by the Epstein Barr virus (EBV). The virus belongs to the herpes virus family. It infects the B-lymphocytes which are one of the essential cells in body’s defense mechanism. The virus also predisposes the infected individual to develop certain types of lymphomas and nasopharyngeal carcinoma.

The virus is present throughout the world and majority of the people get infected by the virus in childhood or adulthood. The infection generally does not produce any symptoms in childhood. The infected persons often develop immunity against the virus. However, it is more complicated when the first exposure occurs in the senior years.

The exact mechanism of human transmission is not entirely known but one important means is thought to be through deep kissing. Epstein-Barr virus is present in oropharyngeal secretions and mixed saliva during active phases of the disease. The individual remains contagious for at least 6 weeks after being infected.

Treatment for Mono

Infectious mononucleosis is usually a self limiting disease requiring no specific treatment. However, treatment to reduce the symptoms can be given. The patient is advised to take complete rest.

  • Non-steroidal anti-inflammatory drugs like acetaminophen and ibuprofen can be prescribed to reduce pain. Anti-viral drugs such as gancyclovir and alpha interferon reduce Epstein-Barr virus replication.
  • Corticosteroids are indicated only in the presence of complications like airway obstructions, progressive neurological involvement and hemolytic anemia.
  • Topical anesthetic can be used in painful ulcers.
  • Hydrogen peroxide rinses aid in easing gingivitis caused by infectious mononucleosis.

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