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Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Infectious mononucleosis, "mono," "kissing disease," and glandular fever are all terms popularly used for the very common infection caused by the Epstein-Barr virus (EBV). EBV is a member of the herpesvirus family. The characteristic symptoms of infection with EBV include fever, fatigue, malaise, and sore throat. The designation "mononucleosis" refers to an increase in a particular type of white blood cells (lymphocytes) in the bloodstream relative to the other white blood cells as a result of the EBV infection.
The disease was first described in 1889 and was referred to as "Drüsenfieber," or glandular fever. The term infectious mononucleosis was first used in 1920 when an increased number of lymphocytes were found in the blood of a group of college students who had fever and symptoms of the condition.
The EBV that causes mono is found throughout the world. By the time most people reach adulthood, an antibody against EBV can be detected in their blood. In the U.S., up to 95% of adults 35-40 years of age have antibodies directed against EBV. This means that most people, sometime in their lives, have been infected with EBV. The body's immune system produces antibodies to attack and help destroy invading viruses and bacteria. These specific antibodies can be detected in the blood of people who have been infected.
When infection occurs in childhood, the virus most often produces no symptoms. It is estimated that only about 10% of children who become infected with EBV develop the illness. Likewise, probably because of immunity from prior infection, adults typically do not develop the illness. Most cases of infectious mononucleosis occur in the 15-24 age group.
While there are other illnesses falling under the broad classification of mononucleosis that can cause similar symptoms (cytomegalovirus [CMV] infection is one example) and an increase in blood lymphocytes, the form caused by the EBV is by far the most common.
The EBV can infect any person. As previously discussed, the majority of people have become infected with the virus by the time that they reach adulthood, and the majority of these infections produce no symptoms or are not recognized as mono. Mono is most often diagnosed in adolescents and young adults, with a peak incidence at 15-17 years of age. However, it can also be seen in children. Generally, the illness is less severe in young children and may mimic the symptoms of other common childhood illnesses, which may explain why it is less commonly diagnosed or recognized in this younger age group.
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| Infectious mononucleosis symptoms and signs |
Mono is spread by person-to-person contact. Saliva is the primary method of transmitting mono, which leads to the infection of B lymphocytes in the mouth and throat. Infectious mononucleosis developed its common name of "kissing disease" from this prevalent form of transmission among teenagers. It typically takes between four to eight weeks for symptoms of mono to appear after the initial infection with EBV. A person with mono can also pass the disease by coughing or sneezing, causing small droplets of infected saliva and/or mucus to be suspended in the air which can be inhaled by others. Sharing food or beverages from the same container or utensil can also transfer the virus from one person to another since contact with infected saliva may result.
Most people have been exposed to the virus as children, and as a result of the exposure, they have developed immunity to the virus. It is of note that most people who are exposed to the EBV don't ever develop mononucleosis. The incubation period for mono, meaning the time from the initial viral infection until the appearance of symptoms, is between four and eight weeks. During an infection, a person is likely able to transmit the virus to others for at least a few weeks and possibly longer, even after symptoms have disappeared (see below).
Research has shown that, depending on the method used to detect the virus, anywhere from 20%-80% of people who have had mononucleosis and have recovered will continue to secrete the EBV in their saliva for years due to periodic "reactivations" of the viral infection. Since healthy people without symptoms also secrete the virus during reactivation episodes throughout their lifetime, isolation of people infected with EBV is not necessary. It is currently believed that these healthy people, who nevertheless secrete EBV particles, are the primary reservoir for transmission of EBV among humans.
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