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Understanding Mononucleosis -- the Basics

What Is Mononucleosis?

Mononucleosis, often referred to as "mono," is a very common viral illness. About 90% of people over 35 have been infected with it, probably during early childhood, and have antibodies to the virus in their blood.

When mono strikes young children, the illness is usually so mild that it's not noticed or passes as a common cold. When it occurs during adolescence or adulthood, however, the disease can be much more serious.

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Mono usually comes on over a few days. It begins with flu-like symptoms -- fever, headache, and general malaise and lethargy. After a few days, the lymph glands begin to swell, although this symptom is not noticeable in everyone. Swollen glands of the neck are especially typical of mono. Most people develop a sore throat, which can be very severe, with inflamed tonsils. A fever -- usually no higher than 104 degrees -- also can develop and may last up to three weeks.

Some people, particularly those who take the antibiotic amoxicillin, may develop a red rash all over the body. Others may notice red spots or darkened areas in the mouth that look like bruises. In about half of all cases, the spleen becomes enlarged, which may cause an area in the upper-left abdomen to become tender to the touch.

In most cases, mono mildly affects the liver. Only a few individuals with mono develop jaundice, a yellowing of the skin and eyes caused by an increase of liver protein in the blood. In rare cases of mono, the liver fails.

Other major complications that can develop from mono include rupturing of the spleen, low blood platelet count, swelling of the lining of the brain or spinal cord, or inflammation of the brain itself. These complications are extremely rare.

Most people who come down with mono feel much better within two or three weeks, although fatigue may last for two months or longer. Some people feel the disease lingers for a year or so.

In the past, research suggested that the virus causing mono might be linked to a persistent, debilitating illness known as chronic fatigue syndrome, which can last for years. Most recent research has shown no such link, however, and the cause of chronic fatigue syndrome remains unknown.

What Causes Mononucleosis?

Most cases of mono are caused by the Epstein-Barr virus, named after the two British researchers who first identified it in 1964, although the disease itself had been recognized many years earlier. A common member of the herpes family of viruses, the Epstein-Barr virus is spread primarily through the exchange of saliva, which is why mono is sometimes known as "the kissing disease." Coughing or other contact with infected saliva can also pass the virus from one person to another.

The mono virus can stay active in a person weeks or months after all overt symptoms are gone, so close contact with someone who shows no sign of the disease can still put others at risk. On the other hand, not everyone who lives in close proximity to a person infected with mono comes down with the illness. Scientists believe that a healthy immune system may make it possible to fight off the infection successfully.

WebMD Medical Reference

Reviewed by Daniel Brennan, MD on March 12, 2014

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