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Infectious mononucleosis, or mono, is a very common syndrome characterized by the triad of fever, swollen lymph nodes (lymphadenopathy) – most frequently in the neck, and sore throat with inflamed tonsils (tonsillar pharyngitis). Patients may also present with headache, fatigue, and enlarged spleen upon physical examination. The syndrome can be caused by several different agents, but the most common is Epstein-Barr virus, EBV; and the term “mononucleosis” usually refers to the disease caused by EBV.
EBV is ubiquitous in human. About 95% of all adults have antibodies against EBV, likely from an infection during childhood. Symptomatic infections are most prevalent in older teens and young adults, especially among college students. Infected young children are often asymptomatic or have mild symptoms. Older adults are either immune to the disease thanks to an earlier infection, or have atypical presentations that are misdiagnosed.
EBV is transmitted mainly via infected saliva. The virus is not very contagious, it takes several exposures to high viral loads to acquire EBV. Hence, kissing is the major route of transmission and mono is colloquially known as “the kissing disease”.
The incubation period is typically 3 to 5 weeks. The disease is self-limited and patients usually recover after 2 to 6 weeks, but the virus may remain in the saliva for months. Recovered patients may also shed virus periodically for life without developing symptoms. This is why most people get infected by an asymptomatic person and often cannot recall being exposed to EBV.
After infecting the oral epithelial cells, EBV attacks lymphocytes, in particular B-cells, in the tonsils. Infection then spreads throughout the lymphatic system, causing a massive immune response that is responsible for most of the symptoms. The immune response produces antibodies against EBV, providing lifelong immunity to EBV. At the same time, infection by EBV causes B-cells to proliferate and become antibody-producing plasma cells. Because B-cells are the source of antibodies of all kinds, NON-specific antibodies that do not react to EBV antigens are also produced. These so-called heterophile antibodies may be responsible for the mild thrombocytopenia, generalized rash, and antibiotic-related rash that are occasionally associated with mononucleosis.
As part of the immune defense, cytotoxic T-cells are increased in numbers and activated to kill EBV-infected B-cells. These T-cells have atypical morphology; they are known as Downey cells and are part of the diagnostic workup.
There are 2 antibody tests for mono: monospot test for heterophile antibodies, and EBV-specific antibody test. The monospot test is highly specific, but may give false-negative results in the first week of illness, and has low sensitivity, especially in children. EBV antibody test is performed when monospot test is negative but mono is still suspected.
Mononucleosis is often misdiagnosed as strep throat, and antibiotics may be given inappropriately. Antibiotic treatment can cause a rash to develop and this is often mistaken for antibiotic allergy.
Mononucleosis is self-limited, most patients fully recover after a few weeks, although fatigue may persist for months. Complications are rare but can be severe, sometimes life-threatening.
Treatment is supportive and includes bed rest, hydration, and fever and inflammation reducer. Heavy lifting and active sports must be avoided for a month to prevent splenic rupture. Corticosteroids can be helpful in certain complications, such as impending airway obstruction, but are not usually recommended for uncomplicated disease.

Diagnosing EBV can be done via the heterophile antibody test (“monospot” test), the anti-VCA antibody test, and the anti-EBNA antibody test. The monospot test is neither sensitive nor specific. For more videos and questions, visit – https://www.macrophage.co. Subscribe – https://goo.gl/EMRlRa. Support us on Patreon – https://goo.gl/bhmrgJ.

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Infectious Mononucleosis (Mono) | Epstein-Barr Virus, Transmission, Symptoms, Diagnosis, Treatment

Infectious Mononucleosis (also known simply as Mono or Mononucleosis) is a condition whereby immune cells (known as monocytes) increase in levels due to an infection (most commonly by Epstein-barr virus, or EBV). In this lesson, we discuss how this virus is transmitted, along with the signs and symptoms of mono, how it is diagnosed and how it is treated.

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**MEDICAL DISCLAIMER**: JJ Medicine does not provide medical advice, and the information available on this channel does not offer a diagnosis or advice regarding treatment. Information presented in these lessons is for EDUCATIONAL PURPOSES ONLY, and information presented here is NOT TO BE USED as an alternative to a healthcare professional’s diagnosis and treatment of any person/animal.

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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 tiredness.[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 Epstein–Barr virus, also known as human herpesvirus 4, which is a member of the herpesvirus family,[3] a few other viruses may also cause the disease.[3] 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][7] 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][8] The monospot test is not recommended for general use due to poor accuracy.[9]

We’ve all heard of mono. It’s the kissing disease! But this term is a little minimizing and outdated. The disease is caused by the Epstein-Barr virus, and there are lot more details regarding transmission and disease than can be described simply by kissing, so let’s get into the finer points now.

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Created by world-class clinical faculty, Learning in 10 (LIT) Reviews covers topics in the United States Medical Licensing Exam (USMLE) Step 2CK examination.

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“EBV causes typically an asymptomatic infection or can cause acute tonsillitis as a part of bigger infection called infectious mononucleosis also known as glandular fever. EBV typically occurs in adolescents and young adults and is transmitted orally via saliva. This is the reason EBV infections are also known as the kissing disease. Nearly everyone will become infected with EBV at some point, the good thing is for most of us it is asymptomatic. In this videos we will talk about a primary EBV infection which is asymptomatic and how the infection can evolve to be become infectious mononucleosis which is a symptomatic condition.

The pathophysiology of EBV infection begin with saliva transmission and the EBV virus targeting the tonsils which is a lymphoid tissue made up of T cells and B cells. In the tonsil the EBV target B cells and tonsillar epithelial cells. This is called the EBV primary infection and is usually asymptomatic. Once EBV infects the B cells the EBV has an Incubation period of about 2-6 weeks. During the incubation period a number of things happen:

EBV replicates in B-cell and the virus is shed intermittently into pharyngeal secretions, particularly saliva. Saliva is therefore how EBV is transmitted between people.

The cycle can continue and the person can be completely asymptomatic of course during this incubation and reactivation time the immune system will respond.

EBV Induces an immune response where by b cells capture an antigen of EBV and processes it, The b-cells can mount an immune response locally in the tonsils and the B cells enter circulation and mount an immune response in the lymph node, spleen and liver. Here the B cells stimulate CD8 T cell activity. CD8 t cells also known as cytotoxic t cells are important in the suppression of primary EBV infection. On a side note the CD8+ are thought to be the important players in preventing EBV reactivation and EBV associated lymphoproliferative disease. The B cells also activate CD4+ T cells through costimulation, which means the B cells also become activated. Activated B cells become plasma cells. The plasma cells are the antibody producing cells. The plasma cells will produce EBV specific antibodies which mean antibodies against components of the EBV – firstly the viral capsid antigen with IgM followed by the viral capsid antigen with igG. Plasma cells then eventually produce epstein Barr nuclear antigen igG once infection is resolved. The activation of other immune cells in the lymph nodes, spleen and liver is part of the immune response against EBV.

During the incubation period the EBV can also enter circulation. Here the immune cells in the blood will try to destroy them and also mount an immune response releasing cytokines. This interaction is one of the reasons why people in EBV infection become febrile and feel miserable.

During the incubation period the abnormal infiltrated B cells produce heterophile antibodies which is an important and quick marker for diagnosing EBV”

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