Infectious Mononucleosis

The infectious mononucleosis (MNI) is a generally benign Infection, caused by the Virus of Epstein-Barr (EBV), which belongs to the same viral family as those of the Herpès.

This affection attends is characterized by a Leucocytose lympho-plasmo-monocytaire and a serologic reaction of Paul and Bunnell positive.

The various synonyms for this disease are: adénolymphoïdite acute benign, acute angina monocytaire, lymphoblastose benign, monocytose, disease of the kiss and disease of in love one.

Transmission

It is transmitted by the Salive, from where its name of disease of the kiss or in love . 20% of the adults are carrying the virus in their saliva. It can be also transmitted, exceptionally, by blood Transfusion. In general, the contamination occurs in the childhood or at the time of adolescence. It is estimated that 80 % of the adults are carrying the virus EBV and 20 with 30 % are excréteurs asymptomatic of the virus.

In the young children, but also in the adults, mononucleosis can be transmitted by “exchanges of kisses”, by the postilions and the toys which pass from mouth in mouth. Studies showed that one can find Anticorps against the Virus of Epstein-Barr, at approximately half of the children of 4 with 5 years. These children were thus indeed infected but without remarkable symptoms and are immunized.

However, with the general development of the Hygiene in the developed countries, the rate of infected and immunized young children tends to decrease, on the other hand the rate of Primo-infection is increasing in the teenagers and the young adults (10-25 years), with different consequences.

In fact, once entered the organization, the virus is placed in the Ganglion S where it remains all the life in quiet form, without giving Récidive. The people infected by the virus can nevertheless contaminate, because they can produce virus in their saliva (asymptomatic excréteurs). The risks of contamination are generally only of short duration.

Symptoms

The disease is characterized by the great variability of its symptomatology and its gravity. It is in general rather benign. The beginning is often insidious: the first days the subject complains about faintnesses, anorexia, light cephalgias, shivers with fébricules a little as in an infection grippale. In the teenagers and the young adults, the infection by the Epstein-Barr virus is accompanied by an important deterioration of the general state: Fever which has anything characteristic, neither from the point of view of its rise (38 - 40°C), nor of its evolution during the day (remittent or continues, it ends up going down in lysis), great tiredness, loss of appetite, Ganglion S inflated with the neck especially, the armpits and the groin but painless, Angine red, bilateral, symmetrical, not-ulcerous and not-hemorrhagic, difficulties of keeping the sleep more 2-3 H, pains muscular, headaches, respiratory disorders related to the hypertrophy of ganglia, and even enlargement of spleen and jaundice, of the méningées attacks, nervous or cardiac or of the autoimmune reactions….

There exists also often a eruption which is located with the trunk and the root of the legs and the arms. This eruption sometimes spontaneous but is generally started by the catch of Ampicilline (antibiotic often prescribed in the event of angina). It is not a question of real a Allergie to this antibiotic but of a reaction specific in the case of the infection to EBV.

Diagnosis

The diagnosis is based on clinical signs and modifications of the blood picture (increase in the lymphocytes and especially presence of cells characteristic known as of MNI), it is thus necessary to carry out a blood assessment and to seek the specific antibodies against the virus with tests serologic.

The first test carried out is the MNItest which is sensitive and which makes it possible to detect in a broad way the recently contaminated people (it is positive in 80 % of the cases in the event of recent infection). This test produces in 3 % of the cases of the false-positives (positive test whereas there is no infection). This first test must be supplemented by a test of confirmation:

standard search for antibody IgM anti VCA in the event of recent infection;
search for antibody IgG EBV-VCA and IgG EBNA in the event of older infection.

These tests are primarily indicated for the monitoring of reactivation of the virus at subjects to weakened immunizing defenses.

Complications

The principal bodies which can be touched by the Epstein-Barr virus are: the brain (Encéphalite, Meningitis), heart (Myocarditis), lung (Pneumonia), kidney (Nephritis)… When they are dealt with correctly, these complications are good forecasts and regress in a few days. In certain cases extremely rare and associated with other factors (Genetic S, Environment with) this virus can be Cancérogène.

In acute phase of the infection, the rupture of Rate is also a rare but very traditional complication of this disease. Infectious mononucleosis is sometimes responsible for blood complications: Anemia (rare) by accelerated destruction of the red globules (one speaks about haemolytic Anémie), Purpura thrombocytopenic (reduction in the number of plates responsible for an anomaly for coagulation for blood and small spots red or purplished on the body), Cryoglobulinémie.

Very seldom, the virus of Epstein-Barr can be responsible for a syndrome of activation of the Macrophage S: certain cells (macrophages) destroy partly the cells of the osseous Moelle and are responsible for the fall of all the blood lines of cells (red, white globules and plates).

Infectious mononucleosis can also evolve/move in a chronic way (chronic syndrome of tiredness). In addition to this tiredness constantly presents, one can note pains (headaches, pains of throat, pains muscular or articular), psychological central nervous system disorders and (eye trouble, disorders of the memory, excessive, turbid irritability of concentration, depression), a prolonged fever with 37,5 - 38,5°C, a moderated slimming, painful ganglia.

Virus EBV is also associated at the higher risk of appearance of some Cancer S: cancers of the Nasopharynx and Lymphoma S (lymphomas of Burkitt or with cells B). These cancers are very rare in the population, but are more often found at the people carrying virus EBV than at the others.

In the event of complications of the additional examinations are essential: test blood (Test of Coombs to seek a destruction of the red globules, tests hepatic to appreciate the function of the Liver), Myélogramme for the study of the cells of the osseous Marrow, Biopsy of a ganglion in case of doubt about the diagnosis.

Treatment and convalescence

infectious mononucleosis is a minor illness, but it is followed of a long convalescence. It is not necessary to isolate the patient. No antibiotic influences the course of the disease . If symptomatology is aggressive, one can make regress the demonstrations (high temperature, haemolytic hepatitis, ictère or nervous complications) by a short treatment the Prednisone (5 to 10 days).

To control the fever, which can exceed the 39°, and to relieve the pains, the rest is essential, but if there is a risk of complications (persistent fever, hepatic attack) a hospitalization can be considered.

In the event of superinfection of the Angina by a Streptocoque, the recourse to the Antibiotique S will be necessary, but by avoiding the derivatives of penicillin (ampicilline), because those can cause an cutaneous eruption and increase the symptoms of the disease.

At the time of complicated forms with Hepatitis or important Anemia, a Corticothérapie can be proposed during 10 days.

The hard disease, in general, from two to four weeks, but general tiredness (Asthenia), the Adénopathie S can persist sometimes during months. Tonics could be taken.

During convalescence, the physical efforts are to be avoided, because there is a risk of rupture of the Rate but a stay prolonged with the sea or the mountain is advised.

Some councils to prevent the contagion

not to exchange the kitchen utensils, glasses and the dishes (and to clean them well).
not to share food.
to wash the hands Well.
To protect the others from its sneezes.
To avoid the kisses on the mouth.
To wait at least six months after the appearance of the symptoms before making a blood donation.

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