Symptoms Of Infectious Mononucleosis
In most children younger than 5 years, the infection causes no symptoms. In adolescents and adults, it may or may not cause infectious mononucleosis.
The usual time between infection and the appearance of symptoms is thought to be 30 to 50 days. This interval is called the incubation period.
The four main symptoms of EBV infectious mononucleosis are
Other very rare complications include seizures, nerve damage, behavioral abnormalities, inflammation of the brain or tissues covering the brain and of the fluid-filled space between the meninges when it is caused… read more ), anemia, and blockage of airways by the swollen lymph nodes.
How long symptoms last varies. After about 2 weeks, symptoms subside, and most people can resume their usual activities. However, fatigue may persist for several more weeks and, occasionally, for months. Fewer than 1% of people die, usually because of complications such as encephalitis, rupture of the spleen, or blockage of the airways.
How Do You Treat An Ebv Infection Or Reactivation
EBV infections canât be treated with medicine or a vaccine. Because these are viral infections, they canât be treated with antibiotics either.
You can prevent EBV by not kissing or sharing drinks, personal items, and food with people who might have infectious mononucleosis.
Since EBV infections are generally not life-threatening, most doctors recommend taking care of your symptoms by:
- Going to bed early and sleeping for longer periods
- Taking more frequent breaks
- Taking medication for your sore throat and fever
- Drinking plenty of water
Key Points About Infectious Mononucleosis
Infectious mononucleosis is characterized by swollen lymph glands, fever, sore throat, and extreme fatigue
Mononucleosis usually lasts for 1 to 2 months.
Symptoms may include fever, swollen lymph glands in the neck, armpits, and groin, constant fatigue, sore throat, enlarged spleen, and jaundice, a yellow discoloration of the skin.
Treatment includes rest and plenty of liquids.
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Caebv Definition And Features
Chronic active EpsteinBarr virus disease is usually defined as a chronic illness lasting at least 6 months, an increased EBV level in either the tissue or the blood, and lack of evidence of a known underlying immunodeficiency . Other authors, particularly when defining severe CAEBV disease, require both an elevated level of EBV in the blood as well as infiltration of tissues by EBV-positive lymphocytes . Recently, the duration of illness required for defining the disease has been shortened to 3 months . Former definitions required elevated levels of antibody to EBV viral capsid or early antigen in the blood however, we have found that elevated levels of EBV DNA in the blood are more specific for CAEBV than elevated levels of EBV antibodies. Most laboratories now perform ELISA tests for EBV antibodies, and these are often less helpful than the previously used quantitative immunofluorescent assay using endpoint dilution of serum. It is important that DNA PCR is done using either whole blood or peripheral blood mononuclear cells, rather than plasma or serum which is much less sensitive for diagnosis of CAEBV disease.
Figure 1. Histopathologic features of a 47-year-old female patient with T cell chronic active EpsteinBarr virus disease. Hematoxylin and eosin stain. Small- to medium-sized lymphocytes without significant atypia infiltrate the bone marrow clot. EBV-encoded RNA in situ hybridization. The brown staining lymphocytes are positive for EBV RNA.
Preventing The Spread Of Infection
There is no need to be isolated from others if you have glandular fever as most people will already be immune to the Epstein-Barr virus .
You can return to work, college or school as soon as you feel well enough. There is little risk of spreading the infection to others as long as you follow commonsense precautions while you are ill, such as not kissing other people or sharing utensils.
It is also important to thoroughly clean anything that may have been contaminated by saliva until you have recovered.
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Additional Effects Of Mononucleosis
In about fifty percent of mononucleosis cases, the spleen may become enlarged. The patient may also experience hepatitis and jaundice . Very rarely, the heart, lungs, or nervous system may be affected.
Mononucleosis symptoms develop about four to six weeks after the initial infection by EBV. Acute mononucleosis symptoms last for around two to four weeks, but the fatigue may be experienced for several months. Mononucleosis may sometimes occur in a chronic state that lasts for much longer or that reappears at intervals for years.
Other Causes Of Glandular Fever
Beyond the EBV, cytomegalovirus and rubella, sometimes called German measles, can also cause glandular fever. Also, a person may develop similar symptoms if they have toxoplasmosis, a parasitic infection.
Cytomegalovirus, rubella, and toxoplasmosis can affect a fetus. If a pregnant woman develops any of these infections, treatment with antibiotics and antibodies may be necessary.
The doctor will perform a physical examination to detect swollen lymph nodes and assess the tonsils, liver, and spleen.
If they suspect glandular fever, they also may order some tests. An antibody test can detect antibodies developed specifically to combat EBV.
During pregnancy, tests can show whether rubella or toxoplasmosis are present. The EBV does not harm a fetus or an embryo.
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What Else Should I Know
Mono can make the spleen swell for a few weeks or longer. An enlarged spleen can rupture, causing pain and bleeding inside the belly, and needs emergency surgery. So doctors recommend that kids who have mono avoid contact sports for at least a month after symptoms are gone. Your child should stay away from rough play, heavy lifting, and any strenuous activities until the doctor says it’s OK.
In most cases, mono symptoms go away in a matter of weeks with plenty of rest and fluids. If they seem to linger or get worse, or if you have any other questions, call your doctor.
Epidemiology And Risk Factors
EpsteinBarr virus is a human B lymphotropic virus, the causative agent of infectious mononucleosis. The major route of transmission of EBV is through saliva, and EBV infects the epithelial cells of the oropharynx and adjacent structures as well as those of the uterine cervix. Epithelial cells may play a major role in the persistence of EBV by allowing chronic viral replication and release of infectious particles throughout the lifetime of a virusinfected host. Eighty percent to 90% of children in developing countries are seropositive for EBV between 2 and 3 years of age. By the third decade, nearly 100% of adults have EBV serum antibodies.145
Britta Maecker-Kolhoff, … Stephen Gottschalk, in, 2021
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How The Condition Progresses
Most symptoms of glandular fever will usually resolve within two or three weeks. Your throat will normally feel most sore for three to five days after symptoms start before gradually improving, and your fever will usually last 10 to 14 days.
Fatigue is the most persistent symptom and often lasts a few weeks, although some people may feel persistently fatigued for several months after the other symptoms have passed.
Preparing For The First Visit
Working with a medical team to find a diagnosis can be a long process that will require more than one appointment. Make better health decisions by being prepared for the first visit with each member of the medical team.
Make informed decisions about health care:
- Prepare a list of questions and concerns before the appointment
- List the most important questions first, not all questions may be answered in the first visit
- Ask questions about symptoms, possible diagnoses, tests, and treatment options
For future appointments:
- Discuss what was not addressed at the last visit
- Discuss changes in the quality of life for the patient, family, and caregivers
- Discuss health goals and other issues in the patientâs and familyâs life that may affect the health care decisions
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The Connections Between Ebv And Chronic Illness
Scientists are just beginning to explore the link between chronic EBV and other chronic illnesses, but one of the most well-researched is EBVs relationship with multiple sclerosis . Many studies have defined a variety of different mechanisms by which the virus could initiate and perpetuate MS not enough to define EBV as the sole cause of MS, but highly suggestive that it does play a role in the illness.
Similarly, studies have shown high viral loads of active EBV in a high proportion of patients with a variety of autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, Sjögrens syndrome, and autoimmune thyroiditis. Again, a strong link, but not enough to suggest EBV as the absolute cause alone.
Plus, theres a multi-microbe connection to factor in. For example, evidence has suggested that EBV and HHV-6a might together play a role in MS. MS has also been linked to a variety of different microbes, including, but not limited to, Chlamydia pneumoniae, Mycoplasma sp., Spherula insularis, and paramyxovirus.
Autoimmune diseases have also been linked to a variety of microbes, including EBV, but also additional herpesviruses other viruses including parvovirus a protozoan called toxoplasmosis and bacteria, including Mycoplasma, Yersinia, and others commonly associated with chronic Lyme disease.
Often referred to as stealth pathogens, the microbes mentioned and many others share similar stealthy characteristics:
Ebv Reactivation And Covid
EBV and are caused by different viruses.
However, a research study from suggest that inflammation caused by COVID-19 may cause EBV reactivation in some people.
Some people hospitalized with COVID-19 were also found to have reactivated EBV as well.
, also known as post-COVID 19 condition, and EBV reactivation have many symptoms in common. The above studies suggest that EBV reactivation may cause some of the symptoms of long COVID.
Its important to note that EBV is not the only associated with long COVID. Having type 2 diabetes or certain antibodies associated with autoimmune diseases such as lupus and rheumatoid arthritis may also be linked to developing long COVID. A high viral load, or the amount of the virus in your blood early in the infection, is also considered a risk factor.
Additional studies are still needed to better understand the link between EBV and long COVID.
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What Are The Symptoms Of Infectious Mononucleosis
Mononucleosis usually lasts for 1 to 2 months. The following are the most common symptoms of mononucleosis. However, each person may experience symptoms differently. Symptoms may include:
Swollen lymph glands in the neck, armpits, and groin
Head and body aches
Liver involvement, such as mild liver damage that can cause temporary jaundice, a yellow discoloration of the skin and whites of the eyes due to abnormally high levels of bilirubin in the bloodstream
Once a person has had mononucleosis, the virus remains dormant in the throat and blood cells for the rest of that person’s life. Once a person has been exposed to the Epstein-Barr virus, a person is usually not at risk for developing mononucleosis again.
The symptoms of mononucleosis may resemble other medical conditions. Always talk with your healthcare provider for a diagnosis.
Taxonomy And Genome Structure
EpsteinBarr virus is a member of the genus Lymphocryptovirus, which belongs to the lymphotropic subfamily Gammaherpesvirinae of the family Herpesviridae. EBV is closely related to the lymphocryptoviruses present in Old World nonhuman primates, including EBV-like viruses of chimpanzees and rhesus monkeys. These viruses share homologous sequences and genetic organization, and infect the B lymphocytes of their host species, resulting in the establishment of latent infection in vivo and transformation in vitro. A transforming, EBV-related virus has also been isolated from spontaneous B-cell lymphomas of common marmosets and is thus the first EBV-like virus to be identified in New World primates. The genome of this marmoset LCV revealed considerable divergence from the genomes of EBV and Old World primate EBV-related viruses, suggesting that this virus represents a more primitive predecessor of the LCVs infecting higher-order primates.
Charles T. Leach, Ciro V. Sumaya, in, 2009
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Possible Treatments For An Epstein
Rest and plenty of fluids are usually prescribed for an active Epstein-Barr infection that is producing mononucleosis or flu-like symptoms. Pain and fever reducers like aspirin, ibuprofen, and acetaminophen may help, but their use must be recommended by a doctor. Some popular pain relievers can cause problems in certain situations. Children and teenagers shouldnt be given aspirin since they may develop Reyes syndrome, a very dangerous condition involving swelling of the brain.
Antibiotics dont affect viruses but may be prescribed if the persons weakened body has developed a bacterial infection as well as an EBV infection. Corticosteroids may be prescribed if the tonsils are very swollen.
If the spleen is swollen, there is a possibility that it could rupture if it isn’t treated gently. A ruptured spleen is a medical emergency. It’s important to follow a doctor’s instructions in order to avoid damaging the organ. Exercise and contact sports must be avoided for as long as recommended by the doctor.
Infectious Mononucleosis Or Glandular Fever
When teenagers and young adults are infected by the Epstein-Barr virus, they have about a fifty percent chance of developing mononucleosis. The disease is also called infectious mononucleosis, mono, glandular fever, or the kissing disease. Mononucleosis may sometimes develop in people of other ages as well. The term glandular fever refers to the fact that the lymph glands under the arms, in the groin, and sometimes in the neck may become swollen and to the fact that the person may develop a high temperature.
Someone suffering from mononucleosis may also experience one or more of the following symptoms. The symptoms could be caused by a different condition, however. A doctor must be consulted for a diagnosis.
- a sore throat
- a general feeling of illness and discomfort, which is known as malaise.
The blood of someone with mononucleosis may contain more white blood cells than normal, and the cells may have an unusual appearance. The lymphocytes are often enlarged. In this condition, they are said to be reactive.
A stained blood smear from someone with infectious mononucleosis the blue cells are reactive lymphocytes while the pink cells are red blood cells
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Chronic Active Epsteinbarr Virus Disease
- 1Department of Virology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- 2Medical Virology Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Chronic active EpsteinBarr virus disease is a rare disorder in which persons are unable to control infection with the virus. The disease is progressive with markedly elevated levels of EBV DNA in the blood and infiltration of organs by EBV-positive lymphocytes. Patients often present with fever, lymphadenopathy, splenomegaly, EBV hepatitis, or pancytopenia. Over time, these patients develop progressive immunodeficiency and if not treated, succumb to opportunistic infections, hemophagocytosis, multiorgan failure, or EBV-positive lymphomas. Patients with CAEBV in the United States most often present with disease involving B or T cells, while in Asia, the disease usually involves T or NK cells. The only proven effective treatment for the disease is hematopoietic stem cell transplantation. Current studies to find a cause of this disease focus on immune defects and genetic abnormalities associated with the disease.
Strengthening The Immune System
Scientists are continuing to study the Epstein-Barr virus and are learning more about it. Recent research had discovered that the virus can infect more areas of the body than was previously thought.
Since most of us have already been infected by the Epstein-Barr virus, we need to do what we can to help our immune systems control it. In general, when the virus is reactivated after the initial infection, no symptoms are produced. This isn’t always the case, though.
Studies related to strengthening the immune system are continuing. The evidence obtained so far suggests that eating a healthy and nutritious diet helps the system to function efficiently. The evidence also suggests that we should limit the amount of alcohol that we drink and avoid smoking. We should also try to maintain a healthy weight, since being very overweight has been shown to lower immunity to disease.
Regular exercise appears to boost the activity of the immune system and often reduces emotional stress. Exercise has many benefits. Very intense exercise or exercising for too long or too often may contribute to physical stress within the body and should probably be avoided, however. Getting an adequate amount of sleep and avoiding other infections should help to reduce physical stress. Steps to avoid infections, such as washing hands frequently, are important.
Regular walking in the countryside or in a city can boost the immune system and protect the body from viral infections.
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What You Can Do At Home
Although no medicine can cure an EBV infection, you can take these steps at home to ease your symptoms:
- Get plenty of rest.
- Drink a lot of water and other liquids to stay hydrated.
- Suck on lozenges or ice pops, or gargle with warm salt water, to make your sore throat feel better.
- Take painkillers like acetaminophen or ibuprofen to bring down fever and relieve body aches.
Ease back into work or school, taking things slowly until you feel better. For a month or so, avoid sports, heavy lifting, or other vigorous activities in which you could injure your spleen.
What Tests Diagnose Epstein
The diagnosis of mononucleosis starts with a detailed history and physical examination. The doctor will look for fever, an inflamed or sore throat, swollen lymph nodes in the neck, and an enlarged spleen. Red dots may be seen on the palate. Up to half of infected people will have an enlarged spleen, and 10% will have an enlarged liver on abdominal examination. People with suspected mononucleosis will have a blood sample drawn for blood counts and a “mono spot” test. If the mono spot is positive, the diagnosis is confirmed. Mono spots may be falsely negative in children under 4 years of age or in the elderly. Repeating the test at a later date may be helpful in these cases. Other viruses and pathogens may cause an illness that is similar to mononucleosis , so additional blood may be drawn to test for other pathogens.
In infected people, the number of normal lymphocytes in the blood is usually increased and the cells may look unusual or “atypical” under the microscope. Approximately 1%-3% of people develop anemia, which is caused by destruction of the red blood cells . Platelet counts may be low in up to half of patients, although this does not usually result in bleeding. In some cases, blood cells may be destroyed by other blood cells . Mild elevations in liver enzymes in the blood are common.
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