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Infectious mononucleosis

"Mononucleosis" redirects here. For excessive monocyte counts more generally, see Monocytosis.
Not to be confused with Pfeiffer syndrome (a genetic disorder).
Infectious mononucleosis
Other namesGlandular fever, Pfeiffer's disease, Filatov's disease,[1] kissing disease
Swollen lymph nodes in the neck of a person with infectious mononucleosis
SpecialtyInfectious disease
SymptomsFever, sore throat, enlarged lymph nodes in the neck, fatigue[2]
ComplicationsSwelling of the liver or spleen[3]
Duration2–4 weeks[2]
CausesEpstein–Barr virus (EBV) usually spread via saliva[2]
Diagnostic methodBased on symptoms and blood tests[3]
TreatmentDrinking enough fluids, getting sufficient rest, pain medications such as paracetamol (acetaminophen) and ibuprofen[2][4]
Frequency45 per 100,000 per year (U.S.)[5]

Infectious mononucleosis (IM, mono), also known as glandular fever, is an infection usually caused by the Epstein–Barr virus (EBV).[2][3] Most people are infected by the virus as children, when the disease produces few or no symptoms.[2] In young adults, the disease often results in fever, sore throat, enlarged lymph nodes in the neck, and fatigue.[2] Most people recover in two to four weeks; however, feeling tired may last for months.[2] The liver or spleen may also become swollen,[3] and in less than one percent of cases splenic rupture may occur.[6]

While usually caused by the Epstein–Barr virus, also known as human herpesvirus 4, which is a member of the herpesvirus family,[3] a few other viruses[3] and the protozoon Toxoplasma gondii[7] may also cause the disease. It is primarily spread through saliva but can rarely be spread through semen or blood.[2] Spread may occur by objects such as drinking glasses or toothbrushes or through a cough or sneeze.[2][8] Those who are infected can spread the disease weeks before symptoms develop.[2] Mono is primarily diagnosed based on the symptoms and can be confirmed with blood tests for specific antibodies.[3] Another typical finding is increased blood lymphocytes of which more than 10% are atypical.[3][9] The monospot test is not recommended for general use due to poor accuracy.[10]

There is no vaccine for EBV; however, there is ongoing research.[11][12] Infection can be prevented by not sharing personal items or saliva with an infected person.[2] Mono generally improves without any specific treatment.[2] Symptoms may be reduced by drinking enough fluids, getting sufficient rest, and taking pain medications such as paracetamol (acetaminophen) and ibuprofen.[2][4]

Mononucleosis most commonly affects those between the ages of 15 and 24 years in the developed world.[9] In the developing world, people are more often infected in early childhood when there are fewer symptoms.[13] In those between 16 and 20 it is the cause of about 8% of sore throats.[9] About 45 out of 100,000 people develop infectious mono each year in the United States.[5] Nearly 95% of people have had an EBV infection by the time they are adults.[5] The disease occurs equally at all times of the year.[9] Mononucleosis was first described in the 1920s and is colloquially known as "the kissing disease".[14]

  1. ^ Filatov's disease at Who Named It?
  2. ^ a b c d e f g h i j k l m n "About Epstein-Barr Virus (EBV)". CDC. January 7, 2014. Archived from the original on August 8, 2016. Retrieved Aug 10, 2016.
  3. ^ a b c d e f g h "About Infectious Mononucleosis". CDC. January 7, 2014. Archived from the original on 8 August 2016. Retrieved 10 August 2016.
  4. ^ a b Ebell MH (12 April 2016). "JAMA PATIENT PAGE. Infectious Mononucleosis". JAMA. 315 (14): 1532. doi:10.1001/jama.2016.2474. PMID 27115282.
  5. ^ a b c Tyring S, Moore AY, Lupi O (2016). Mucocutaneous Manifestations of Viral Diseases: An Illustrated Guide to Diagnosis and Management (2 ed.). CRC Press. p. 123. ISBN 978-1-4200-7313-3. Archived from the original on 2017-09-11.
  6. ^ Handin RI, Lux SE, Stossel TP (2003). Blood: Principles and Practice of Hematology. Lippincott Williams & Wilkins. p. 641. ISBN 978-0-7817-1993-3. Archived from the original on 2017-09-11.
  7. ^ Cite error: The named reference jms1978 was invoked but never defined (see the help page).
  8. ^ "Mononucleosis - Symptoms and causes". Mayo Clinic. Retrieved 5 February 2020.
  9. ^ a b c d Ebell MH, Call M, Shinholser J, Gardner J (12 April 2016). "Does This Patient Have Infectious Mononucleosis?: The Rational Clinical Examination Systematic Review". JAMA. 315 (14): 1502–9. doi:10.1001/jama.2016.2111. PMID 27115266.
  10. ^ "Epstein-Barr Virus and Infectious Mononucleosis Laboratory Testing". CDC. January 7, 2014. Archived from the original on 7 August 2016. Retrieved 10 August 2016.
  11. ^ "A Study of an Epstein-Barr Virus (EBV) Candidate Vaccine, mRNA-1189, in 12- to 30-Year-Old Healthy Adolescents and Adults". clinicaltrials.gov. 19 November 2023.
  12. ^ "New Epstein-Barr virus vaccine trial hailed a success so far". MS-UK. 15 August 2023.
  13. ^ Marx J, Walls R, Hockberger R (2013). Rosen's Emergency Medicine - Concepts and Clinical Practice (8 ed.). Elsevier Health Sciences. p. 1731. ISBN 978-1-4557-4987-4. Archived from the original on 2017-09-11.
  14. ^ Smart P (1998). Everything You Need to Know about Mononucleosis. The Rosen Publishing Group. p. 11. ISBN 978-0-8239-2550-6.

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