Infectious mononucleosis, or "mono," is a contagious viral illness that initially attacks the lymph nodes in the neck and the throat. When these tissues become less effective in fighting infection, sore throat, swelling of the lymph nodes, and fever result.
Cause

Mono is caused by the Epstein-Barr virus, which is named after the scientists who first identified it in the mid-1960s. The virus enters the lymph nodes and attacks the lymphocytes (the white blood cells manufactured there). As the white blood cells come into contact with the virus, they change shape and multiply. At first there are no symptoms, because it takes several weeks before enough of the altered cells can accumulate to generate a reaction. Gradually, however, symptoms appear. First, there is a mild sore throat, sluggishness, and fever. The symptoms worsen as the body tries to fight the infection by creating more white blood cells. The symptoms usually disappear about six to eight weeks later.

Mono spreads by contact with moisture from the mouth and throat of an infected person. Kissing, sharing drinking glasses, or touching anything that has been near the mouth of an infected person may result in transmission of the disease.
Those at Risk

Teenagers and young adults seem to be most susceptible to mono. However, even children less than one year old can contract the disease. Mono is uncommon in people older than 35.
Symptoms

In all cases, the infection develops so slowly and with such mild symptoms that it may be initially indistinguishable from a cold or the flu. However, a sore throat that lasts two weeks or more; swollen lymph nodes in the neck, throat, armpits, and groin; a persistent fever (usually about 102 degrees Fahrenheit); and tiredness and malaise (a vague feeling of discomfort) may indicate that the illness is mononucleosis. Mono symptoms can be so severe that throat pain makes swallowing difficult and fever reaches 105 degrees Fahrenheit. Some people also experience a rash, eye pain, and eye discomfort when exposed to bright light.
Complications

Most cases of mono run an uncomplicated course. Occasionally, however, the infection spreads to other parts of the body besides the throat and lymph nodes. For example, mono may lead to monohepatitis (an inflammation of the liver that is not the same as hepatitis A, B, or non-A, non-B). Jaundice, a symptom of this complication, appears as a yellow discoloration of the skin and whites of the eyes. A much more serious problem is pain or tenderness in the abdomen. This discomfort may mean a swollen spleen (an organ in the lymph system), which could burst. Any of these symptoms should be reported to a physician for immediate medical attention.
Diagnosis

To diagnose infectious mononucleosis, blood samples are analyzed to detect the presence of antibodies to the Epstein-Barr virus and to determine overall blood cell count. Inflammation of the liver can also be detected and followed up with blood tests.
Treatment

As long as there are no complications, the best treatment for mononucleosis is to rest, drink plenty of liquids until the temperature returns to normal, and then gradually resume normal activities as strength returns. If the patient feels well enough, complete bed rest is probably not necessary.

Antibiotics are ineffective against mono, since it is a viral infection and viruses do not respond to antibiotics. In severe cases, corticosteroid drugs that reduce swelling of the throat are prescribed. If the spleen is swollen, the doctor may recommend avoiding strenuous activities, such as lifting and pushing, that can cause sudden rupture of the spleen. Hospitalization is necessary if a serious complication, such as rupture of the spleen, occurs.

Most people recover in six to eight weeks, but some cases take as long as six months for complete recovery. A tired feeling, which may include depression, is the last symptom to disappear. Mono may return in a milder form within a few months. Fortunately, mononucleosis almost never reappears in its full-blown form after a year.



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