Epstein-Barr Virus

 

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Original Editors - Nicole Clark from Bellarmine University's Pathophysiology of Complex Patient Problems project. Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

== Definition/Description == Mononucleosis is a viral infection causing fever, sore throat, and swollen lymph glands, especially in the neck. Mono is

File:Throat.jpg

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001617/figure/A000591.B2936/?report=objectonly

typically referred to as the "kissing disease." The virus that causes mono is transmitted through saliva, so you can get it through kissing, but you can also be exposed through a cough or sneeze, or by sharing a glass or food utensil with someone who has mono. However, mononucleosis isn't as contagious as some infections, such as the common cold. Infectious mononucleosis is known as Acute Cytomegalovirus (CMV) infection is a condition caused by a member of the herpes virus family. Once symptoms have subsided the individual is still caring the virus, it has just become dormant. A few of the viral cells will remain permanently and the person may have an acute flare up years down the road.
== Prevalence == Each year a survey is conducted to study statistics of mononucleosis. Some of its results are given below: *In a research conducted in 2002, it was found that about 95 percent of adults of the age group 35-40 years had been infected by mononucleosis in the United States. *When Epstein-Barr Virus (EBV) infection occurs during teenage or young adulthood, in 35 to 50 percent cases it causes infectious mononucleosis. *In the research conducted in 2005, it was found that Epstein-Barr Virus (EBV) infects more than 98 percent of the world's population. *Epstein-Barr Virus (EBV) causes infectious mononucleosis in 90 percent of the cases.
In the United States 95% of people in their late 30's have been infected with EBV, but may be asymptomatic. Only 35-50% of the time will people who have been contaminated with the virus in their 20's will display symptoms. For those in their 20's that have lived in dorms or other close quarter housing the chance of infection increases.

Mono occurs most commonly between the ages of 15 to 17, however you many develop mono at any age.
==
Characteristics/Clinical Presentation ==   Typical Patient Presentation http://www.healthcentral.com/sleep-disorders/000548.html Common Symptoms - these symptoms usually resolve in a few days  *Drowsiness *Fever *General discomfort *Loss of appetite *Muscle aches/stiffness *Rash *Sore Throat *Swollen lymph nodes *Swollen spleen Fatigue Less Uncommon - may be signs of rare but serious condition. Patient's should be instructed to contact physician immediately. *Chest pain *Cough *Headache *Hives *Jaundice *Neck stiffness *Nosebleed *Rapid heart rate *Sensitivity to light *Shortness of Breath == Associated Co-morbidities == While there are very few co-morbidities associated with mono, a select group of studies as shown a correlation between Chronic Fatigue Syndrome (CFS) and Mononucleosis. According to research the Epstein Barr Virus has many similar clinical features. It has yet to be determined whether or not the conditions are synonymous or just present with similar symptoms due to their viral nature of transmision.
== Medications == Since Mono is not a bacterial infection, anti-biotics are not typically prescribed to help fight off the infection. Viral infections, such as mono are more typically managed with over the counter medications such as Tylenol and Ibuprofen (Advile). In more complex cases patients may be prescribed corticosteriods to help control any systemic effects occuring from the virus.
 

File:Antibody.jpg

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001617/figure/A000591.B9069/?report=objectonly

== Diagnostic Tests/Lab Tests/Lab Values == A combination of clinical examination, lab tests, and positive Monospot test are used to diagnosis Mononucleosis. Antibodies in the serum are elevated during the acute phase of the illness and can last for 3-4 weeks. This must be differentiated from Chronic Fatigue because these same antibody levels were at one time shown to be increased with CFS as well. In the initial clinical evaluation a strep test should also be performed to rule that out as a possible cause for the fever and swollen glands. Elevated white blood cell count will be noted during lab work and may remain this way for up to 4 months.                                                                                                       
== Etiology/Causes == Mono is caused by the Epstein-Barr virus, a form of herpesvirus. EBV is one of the most common virus in the United States and does not disappear once symptoms supposide like some viruses. Some of the EBV cells remain dormant in their host for the rest of the patient's life. The virus is passed through saliva and close contact. It has also been shown that mono can be caused from other viral organisms such as cytomegalovirus. Mononucleosis is spread sharing beverages, utensils, lip balm, and most commonly known is kissing.
== Systemic Involvement == Enlargement of the spleen is the most serious systemic complication that can arise from Mono. In very rare, extreme cases the spleen may rupture if not treated properly. This would be evident by sudden, sharp, stabbing pain in the left side of the upper abdomen. The liver may also become involved in some cases. Hepatitis, or inflammation can occur in some cases or the patient may experience jaundice which is characterized by yellowing of the skin and whites of the eyes. If any abdominal pain or yellowing of the skin occurs medical attention should be sought immediately.

File:2011-infectious-mononucleosis.jpg

http://www.medicinenet.com/infectious_mononucleosis/article.htm

 
== Medical Management (current best evidence) == Usually the treatment for mononucleosis is self-treatment. Normally, all symptoms have resolved within a month. Your doctor will advise you to get plenty of rest, gargle with salt water to sooth sore throat, take Tylenol or Ibuprofen for any present fever or headache, and avoid sports or heavy lifting in the event of an enlarged spleen. In more severe cases corticosteroids maybe prescribed to reduce swelling of throat, tonsils, or spleen. Patients with mono should avoid contact with other individuals if running a fever to reduce the risk of contamination. If in contact with others while the virus is active, avoid sharing utensils or drinking after others to minimize the risk of spreading the virus.
== Physical Therapy Management (current best evidence) == {| border="1" cellspacing="1" summary="Published with Permission from Elsevier. “This article was published in Publication title, Vol number, Author(s), Title of article, Page Nos, Copyright Elsevier (or appropriate Society name) (Year).”" cellpadding="1" width="600" align="center" |+ Infectious Mononucleosis: Preferred Practice Pattern 6B |- | width="300" |                 Impaired Aerobic Capacity/Endurance Associated with Deconditioning |- | Infectious mononucleosis is probably contagious before symptoms develop until the fever subsides and the oral and pharyngeal lesions disappear. Although infectious mononucleosis appears to be only mildly contagious, adherence to standard precautions, especially good handwashing and avoidance of shared dishware or food items with other people, is essential in preventing the HCW from contracting this condition. |- | The person with infectious mononucleosis should be cautioned against engaging in excessive activity, especially contact sports, which could result in splenic rupture or lowered resistance to infection. Usually this guideline is appropriate for a period of at least 1 month. |- | Any sign of splenic rupture (e.g., abdominal or upper quadrant pain, Kehr's sign, sudden left shoulder pain, or shock) requires immediate medical evaluation. Any soft tissue mobilization or myofascial techniques necessary in the left upper quadrant, especially up and under the rib cage, must take into consideration the enlarged liver and/or spleen; indirect techniques away from the spleen are indicated. |}
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== Alternative/Holistic Management (current best evidence) == While medical management for Mono is limited to rest, over the counter pain/fever reducers, and avoidance of aggrevating activities, unless an extreme case presents, there are some sources that advocate the use of specific diets and natural cures if the virus is to arise. == Differential Diagnosis == Since Mono is caused by a strand of herpevirus there are other conditions that may present with similar symptoms. It is always important for patient to consult with M.D. to rule out possibilty of any of the following: *Diphtheria *Herpes Simplex *HIV Infection and AIDS *Mumps *Pediatrics, Roseola Infantum *Pediatrics, Rubella *Peritonsillar Abscess *Pharyngitis *Retropharyngeal Abscess *Scarlet Fever
Also, there are several complications that can occur if patient's are not taking care of themselves once sypmtoms are present. Many of these condition are rare but dangerous:  *Hemolytic anemia *Hepatitis with jaundice (more common in patients older than 35) *Inflammation of the testicles (orchitis) *Guillain-Barre syndrome *Meningitis *Seizures *Bell's Palsy *Uncoordinated movements *Strep Throat *Spleen rupture (rare; avoid pressure on the spleen) == Case Reports/ Case Studies == *Cosmopoulos K, Pegtel M, Hawkins J, Moffett H, Novina C, Middledorp J, Thorly-Lawson DA. Comprehensive profiling of Epstein-Barr virus microRNAs in nasopharyngeal carcinoma.  J Virol. 2009 Mar;83(5):2357-67. Epub 2008 Dec 17. *Candy B, Chalder T, Cleare AJ, Wessely S, White PD, Hotopf M. Recovery from infectious mononucleosis: a case for more than symptomatic therapy? A systematic review. Department of Psychological Medicine, Guy's, King's and St. Thomas' School of Medicine, London. Br J Gen Pract. 2002 October; 52(483): 844–851 *Candy B, Chalder T, Cleare AJ, Peakman A, Skowera A, Wessely S, Weinman J, Zuckerman M, Hotopf M. Predictors of fatigue following the onset of infectious mononucleosis. Department of Psychological Medicine, Public Health Laboratory and Medical Microbiology, Guy's, King's and St Thomas' School of Medicine and Institute of Psychiatry, London. Psychol Med. 2003 Jul;33(5):847-55. *Katz BZ, Shiraishi Y, Mears CJ, Binns HJ, Taylor R. Chronic fatigue syndrome after infectious mononucleosis in adolescents. Department of Pediatrics, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine and Children's Memorial Hospital, Chicago, Illinois 60614, USA. [email protected] Pediatrics. 2009 Jul;124(1):189-93. *Buchwald DS, Rea TD, Katon WJ, Russo JE, Ashley RL. Acute infectious mononucleosis: characteristics of patients who report failure to recover. Department of Medicine, University of Washington, Seattle, Washington, USA. Am J Med. 2000 Nov;109(7):531-7. == Resources
== Center for Disease Control WebMD MayoClinic Merck Manual == Recent Related Research (from Pubmed) ==  

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== References == see adding references tutorial.