Mononucleosis

Mononucleosis is a feverish illness caused by the Epstein-Barr virus (EBV) and belonging to the herpesvirus family. Its name originates from the fact that the illness causes an increase of white blood cells and in particular, of mononuclear cells. It is common above-all among young people and can be contracted in any crowded environment as it is extremely contagious; contagion takes place through saliva (it is also known as the kissing disease) and urine. Incubation period varies between 30 and 50 days.

Mononucleosis Often, contagion is asymptomatic and can be confused with other pathologies as its main symptom is fatigue; only in a small number of cases does it manifest itself with the swelling of the lymph nodes in the neck, back of the neck, armpits and groin, a severe sore throat (at times tonsils are covered with a greenish mucus), high, prolonged fever (even two weeks), asthenia, exanthema (in one out of ten patients) and a slight swelling of the spleen. As its origin is viral, antibiotics are not recommended (on the contrary, pink blotches can often appear all over the body of patients treated with ampicillin) nor are cortisone-based treatments as they reduce the efficiency of the white blood cells, which play an important role in the pathology. Likewise, the use of acetylsalicylic acid (regular aspirin) is also not recommended due to the risk of Reye’s Syndrome, a serious form of acute encephalopathy. The course of the illness varies from ten to more than sixty days. Normally, the infection resolves itself; only for the more serious cases is it possible to use antivirals of the latest generation (aciclovir).

Diagnosing mononucleosis – Definite diagnosis is obtained by verifying the increase of white blood cells and the presence of antibodies to the Epstein-Barr virus. The mononucleosis virus is extremely widespread and approximately 90% of adults has come in contact with it and has been immunised.
The most simple diagnostic test is the monotest; that is the search for heterophilic antibodies (able to agglutinate red blood cells in sheep), which appear in 95% of the cases of infection from the Epstein-Barr virus. The monotest is fast and inexpensive, however it is not 100% specific for mononucleosis. Therefore it is advisable to search for antibodies specifically aimed against some proteins (antigens) of EBV such as EA (early antigens), VCA (viral capsid antigens) and EBNA (Epstein-Barr nuclear antigens).

In sports – As in many cases the illness is asymptomatic, in young people mononucleosis can be responsible for periods of poor performance difficult to explain. As it also involves the spleen, in some sports in the event of trauma to the abdomen, the spleen can rupture.

Consequences – The most unpleasant consequences of mononucleosis have only recently been discovered. In some individuals (especially females), an alteration of the endocrine balances persists, which causes a state of persistent fatigue; Chronic Fatigue Syndrome is a true pathology and often times incapacitating. In order to avoid easy alarmism and the possibility of confusing a period of fatigue following mononucleosis with the beginning of a new pathologic condition, Chronic Fatigue Syndrome (CFS) is now easily recognisable in specialised centres (for example, the subject has a high level of pain in very specific points).