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| |    Mono (Infectious Mononucleosis): Overview by Lynn Cates, M.D., F.A.A.P. reviewed by Laura Jana, M.D., F.A.A.P. Almost everyone has heard of mononucleosis--usually just called mono--but most people don't realize how common this infection is. It is typically thought of as a disease of teens--the so-called kissing disease that you or some of your friends had in high school or college. Mono also is commonly remembered as an illness that causes prolonged fatigue and that limits regular activities for many weeks. Certainly, the virus that causes infectious mononucleosis affects teens, but it often infects young children as well. The good news is that most cases of mono are mild and don't cause prolonged absences from school or work. Mono is capable of causing serious complications, but these usually are limited to individuals who have underlying medical conditions. Who gets mono? The answer is almost everyone! Mono is caused by the Epstein-Barr virus (EBV), one of the most common human viruses in the world. In developing countries, it infects most people in early childhood. In developed countries, it may infect many young children, although the peak of EBV infections occurs at a somewhat older age, particularly in adolescence and young adulthood. Studies of adults in the United States have shown that about 95 percent have had an EBV infection by the age of 40. Some people appear to get mono more than once, although it's extremely rare. In most of these cases, one of the episodes is due to another of the many organisms that can produce a mono-like syndrome. Examples include enteroviruses (e.g., coxsackie virus), cytomegalovirus (CMV), and toxoplasmosis (toxo). Even strep infections can cause symptoms similar to those of mono. How is it diagnosed? The range of symptoms seen with mono can vary dramatically from none at all to very severe, and they can be seen anywhere in the body, because the Epstein-Barr virus is capable of affecting any organ. Classic symptoms, which are more likely to appear in adolescents and adults, include high fever, sore throat, and swollen lymph nodes. Mono also can cause a swollen liver and/or spleen, rash, or fatigue. Younger children generally have fewer, milder symptoms. No matter what the age, though, a diagnosis of mono can be confirmed only with laboratory tests. How is it spread? Mono is spread through the exchange of saliva (hence the term "kissing disease") and other close personal contact, although it is not transmitted through the air or blood. It isn't surprising, then, that mono spreads readily among family members as well as in any other setting that involves close contact, such as in daycare and college dormitories (for example, any place where people may share a drinking glass). Once a person gets mono, he can continue to spread the virus for months after his symptoms have disappeared. In fact, anyone who has ever been infected with EBV can transmit the virus intermittently for the rest of his life. For this reason, it is impossible to prevent its spread and so no special precautions are recommended. The incubation period--the period between exposure to the infection and the appearance of the first symptoms--is about 30 to 50 days. Mono can occur any time of the year; there is no particular seasonal pattern. What to expect with mono Most EBV infections resolve completely within a period of several days to a few weeks without any specific treatment. Mono usually does not result in serious problems or complications, and the disease is rarely fatal in previously healthy individuals. The presence of a mono infection during pregnancy is not associated with miscarriages or birth defects, but it does warrant close medical attention to fever, decreased appetite, and potential dehydration.
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