How is the virus spreaded and how long is the incubation period?

The virus is transmissible through direct contact with saliva (sneeze, cough, talk, kiss) or contaminated objects. It lives for several hours outside the human body. For example, the virus can survive on a toy that has been put in the mouth by an infected child. If that toy is put in the mouth by another healthy child a few hours later, the virus can be transmitted that way. Likewise, when an uninfected child drinks or eats after an infected adult from the same glass or eats with the same fork. The virus can also be transmitted through a blood transfusion or transplant. After infection, it remains in the body for the rest of its life and will be excreted in the saliva intermittently by the person who has been infected. The period between the exposure of a healthy child to the virus and the appearance of the first symptom is 30-50 days.

Symptoms

Infectious mononucleosis can manifest differently from child to child. It can be asymptomatic (it can go unnoticed), or it can typically manifest itself through the symptoms below:

  • Fever
  • Sore throat with or without small red spots or with „pus in the throat” (the presence of exudate in the throat)
  • Localized or generalized inflammation of the ganglia
  • Enlargement of the liver and spleen (hepatosplenomegaly)

Symptoms are more severe when the child has an immune deficiency. When the child is treated with antibiotics (like ampicillin or amoxicillin) a rash may appear secondary on the body.

The immediate complications of this disease involve the central nervous system (such as meningitis, encephalitis, myelitis, Guillain-Barre syndrome, etc.), hematological complications (including splenic rupture, hemolytic anemia, thrombocytopenia, agranulocytosis, etc.). Pneumonia, inflammation of the testicles (orchitis) or inflammation of the heart muscle (myocarditis) may occasionally be seen.

EBV infection has been associated with diseases such as: Hodgkin’s disease, non-Hodgkin’s lymphoma, nasopharyngeal carcinoma.

What blood tests and investigations can be done?

  • The doctor can diagnose the infection without further investigations when the symptoms are typically. Blood tests such as the following might be necessary:
  • Blood count that typically shows an increase in lymphocytes and monocytes
  • In the blood, Ig M antibodies directed against the membrane that surrounds the nucleus of the EBV virus (viral capsid) – VCA Ig M EBV antibodies, can be detected immediately after the onset of the disease. This is due to the long incubation period. They reach a maximum after about 2 weeks of illness and persist for up to 3 months. This analysis is especially useful for children under 4 years of age or when infectious mononucleosis manifests atypically.
  • Antibodies of type Ig G- VCA Ig G EBV persist for the rest of life and they are a way of checking if the child has been infected.
  • Because the symptoms sometimes resemble to Streptococcal Pharyngitis , the doctor might do a rapid test for Group A beta-hemolytic Streptococcus. A sample is collected from the throat, using a sterile cotton swab. The result is ready in 5 minutes.

What is the treatment for infectious mononucleosis?

First of all, physical rest, good hydration and symptomatic treatment including fever reduction or pain reduction are extremely necessary. Antibiotics do not treat the infection. Antibiotics such as ampicillin or amoxicillin are not recommended, as they may lead to a non-allergic rash. When inflammation of the tonsils is significant and obstructs breathing, the doctor may consider the use of corticosteroids as an anti-inflammatory treatment.

Intense physical activity or contact sports should be avoided during the illness and during the recovery period. This is necessary because the spleen can grow in size and can be traumatized during intense physical activity. In this case, light physical activity can be initiated after 21 days.

The resumption of intense physical activity in children or contact sports can be done after 4-7 weeks, only if the child no longer shows symptoms and the spleen has returned to normal dimensions. It can take up to 3-6 months for an athlete to return to his previous endurance.

How do we prevent EBV infection?

Avoid eating or drinking after another person. Avoid kissing an infected person. Infectious mononucleosis is also called the „kissing disease”. There is no vaccine available for preventing EBV infection.