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Infectious Mononucleosis

Disease Details

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Description: Infectious mononucleosis, often called "mono" or the "kissing disease," is a contagious illness typically caused by the Epstein-Barr virus (EBV) that manifests with symptoms like fever, sore throat, swollen lymph nodes, and fatigue.
Type: Infectious mononucleosis, also known as mono or the "kissing disease," is an infectious disease caused primarily by the Epstein-Barr virus (EBV). It is not genetically transmitted; instead, it is spread through saliva, often by kissing, but also by sharing drinks, food, or utensils, and through other forms of close personal contact.
Signs And Symptoms: The signs and symptoms of infectious mononucleosis vary with age.
Prognosis: Serious complications are uncommon, occurring in less than 5% of cases:
CNS complications include meningitis, encephalitis, hemiplegia, Guillain–Barré syndrome, and transverse myelitis. Prior infectious mononucleosis has been linked to the development of multiple sclerosis.
Hematologic: Hemolytic anemia (direct Coombs test is positive) and various cytopenias, and bleeding (caused by thrombocytopenia) can occur.
Mild jaundice
Hepatitis with the Epstein–Barr virus is rare.
Upper airway obstruction from tonsillar hypertrophy is rare.
Fulminant disease course of immunocompromised people are rare.
Splenic rupture is rare.
Myocarditis and pericarditis are rare.
Postural orthostatic tachycardia syndrome
Myalgic encephalomyelitis/chronic fatigue syndrome
Cancers associated with the Epstein–Barr virus include Burkitt's lymphoma, Hodgkin's lymphoma and lymphomas in general as well as nasopharyngeal and gastric carcinoma.
Hemophagocytic lymphohistiocytosisOnce the acute symptoms of an initial infection disappear, they often do not return. But once infected, the person carries the virus for the rest of their life. The virus typically lives dormant in B lymphocytes. Independent infections of mononucleosis may be contracted multiple times, regardless of whether the person is already carrying the virus dormant. Periodically, the virus can reactivate, during which time the person is again infectious, but usually without any symptoms of illness. Usually, a person with IM has few, if any, further symptoms or problems from the latent B lymphocyte infection. However, in susceptible hosts under the appropriate environmental stressors, the virus can reactivate and cause vague physical symptoms (or may be subclinical), and during this phase, the virus can spread to others.
Onset: Infectious mononucleosis, often caused by the Epstein-Barr virus, typically has an incubation period of 4 to 6 weeks after initial exposure. Symptoms usually begin gradually and can include fatigue, sore throat, fever, and swollen lymph nodes.
Prevalence: The prevalence of infectious mononucleosis, commonly known as "mono," varies widely depending on the population studied. In the United States, it predominantly affects adolescents and young adults, with an estimated 25% to 50% of college students likely having been infected by the Epstein-Barr virus, which causes mono. Most people are exposed to the virus at some point in their lives, often during childhood, but only a subset develops the characteristic symptoms of mono.
Epidemiology: Infectious mononucleosis, often caused by the Epstein-Barr virus (EBV), predominantly affects adolescents and young adults. The virus spreads through saliva, leading to its nickname, the "kissing disease." Epidemiologically, EBV infects about 90-95% of the global adult population. In developed countries, the peak incidence occurs in individuals aged 15-24 years. Transmission is facilitated by intimate contact, but it can also occur through blood and organ transplants. The disease incidence is lower in early childhood due to more asymptomatic or mild infections in this age group.
Intractability: Infectious mononucleosis (commonly known as mono) is not generally considered intractable. It is caused by the Epstein-Barr virus (EBV) and typically resolves on its own within a few weeks to months. Most individuals recover fully with rest, hydration, and symptomatic treatment. However, some people may experience prolonged fatigue or other symptoms for a longer period, but this is relatively uncommon.
Disease Severity: Infectious mononucleosis, commonly known as "mono," generally has a range of severity from mild to moderate. Most individuals experience symptoms such as fever, sore throat, swollen lymph nodes, and fatigue. While the majority recover without complications within a few weeks to months, some may experience prolonged fatigue. Severe complications, though rare, can include spleen enlargement or rupture, liver issues, and low blood cell counts.
Healthcare Professionals: Disease Ontology ID - DOID:8568
Pathophysiology: The virus replicates first within epithelial cells in the pharynx (which causes pharyngitis, or sore throat), and later primarily within B cells (which are invaded via their CD21). The host immune response involves cytotoxic (CD8-positive) T cells against infected B lymphocytes, resulting in enlarged, atypical lymphocytes (Downey cells).When the infection is acute (recent onset, instead of chronic), heterophile antibodies are produced.Cytomegalovirus, adenovirus and Toxoplasma gondii (toxoplasmosis) infections can cause symptoms similar to infectious mononucleosis, but a heterophile antibody test will test negative and differentiate those infections from infectious mononucleosis.Mononucleosis is sometimes accompanied by secondary cold agglutinin disease, an autoimmune disease in which abnormal circulating antibodies directed against red blood cells can lead to a form of autoimmune hemolytic anemia. The cold agglutinin detected is of anti-i specificity.
Carrier Status: Carrier status for infectious mononucleosis, caused by the Epstein-Barr virus (EBV), can vary. Many people become carriers after infection, with the virus remaining dormant in their bodies for life. These carriers can intermittently shed the virus in their saliva, potentially infecting others, even if they are asymptomatic.
Mechanism: Infectious mononucleosis, commonly caused by the Epstein-Barr virus (EBV), primarily targets B lymphocytes. The mechanism involves the following stages:

1. **Viral Entry:** EBV infects B lymphocytes through the CD21 receptor and the major histocompatibility complex (MHC) class II molecules.

2. **Viral Replication:** Once inside the cell, the virus uses the host cell's machinery to replicate its DNA and produce viral proteins.

3. **Latent Infection:** EBV can establish a latent infection, where it persists within B cells in a dormant state. During latency, only a few viral proteins are expressed, helping the virus evade the immune system.

4. **Lytic Cycle:** Periodically, the virus can reactivate from latency to enter the lytic cycle, producing new virions and leading to cell lysis, which helps spread the infection.

**Molecular Mechanisms:**

1. **Latency-associated gene expression:** EBV expresses a limited set of genes during latency, including EBNA (Epstein-Barr nuclear antigen) and LMP (latent membrane protein), which help maintain the viral genome and modulate the host immune response.

2. **Immune Evasion:** EBV produces proteins like BCRF1 (an IL-10 homolog) that modulate the immune response, reducing the effectiveness of the host's attempts to clear the virus.

3. **Transformation and Proliferation of B cells:** EBV can induce the transformation and proliferation of infected B cells through the signal transduction pathways activated by LMP1 and LMP2 proteins, mimicking cellular signals for growth and survival.

4. **Epigenetic modifications:** EBV influences host epigenetic mechanisms, such as DNA methylation and histone modification, to regulate both viral and host gene expression, aiding in the persistence and pathogenic potential of the virus.

Understanding these mechanisms provides insights into how EBV establishes lifelong infections and contributes to its associated diseases.
Treatment: Infectious mononucleosis is generally self-limiting, so only symptomatic or supportive treatments are used. The need for rest and return to usual activities after the acute phase of the infection may reasonably be based on the person's general energy levels. Nevertheless, in an effort to decrease the risk of splenic rupture, experts advise avoidance of contact sports and other heavy physical activity, especially when involving increased abdominal pressure or the Valsalva maneuver (as in rowing or weight training), for at least the first 3–4 weeks of illness or until enlargement of the spleen has resolved, as determined by a treating physician.
Compassionate Use Treatment: There are currently no specific medications approved for the treatment of infectious mononucleosis (IM), also known as mono, caused by the Epstein-Barr virus (EBV). However, some off-label or experimental treatments have been explored:

1. **Antiviral Agents**: Although antivirals like acyclovir and valacyclovir have been tested, they are generally not effective in altering the course of the illness and are not routinely recommended.

2. **Corticosteroids**: In severe cases involving complications such as significant airway obstruction, corticosteroids (e.g., prednisone) may be used off-label to reduce inflammation and swelling.

3. **Immunomodulatory Treatments**: Experimental therapies involving immunomodulators or immune response modifiers are being researched but are not widely available or proven effective.

4. **Supportive Care**: While not off-label drugs, supportive measures such as hydration, rest, and pain relievers (acetaminophen or ibuprofen) are standard practice to manage symptoms.

It's important for patients to consult healthcare providers for tailored medical advice and potential experimental treatments.
Lifestyle Recommendations: For infectious mononucleosis, commonly known as mono, consider the following lifestyle recommendations:

1. **Rest**: Ensure adequate rest to help your immune system fight the infection and recover.
2. **Hydration**: Drink plenty of fluids, such as water and clear broths, to stay hydrated.
3. **Nutrition**: Eat a balanced diet rich in fruits, vegetables, and lean proteins to support your immune system.
4. **Avoid strenuous activities**: Refrain from heavy lifting and vigorous exercise, especially if your spleen is swollen, to prevent potential rupture.
5. **Personal hygiene**: Practice good hygiene to avoid spreading the virus to others, such as frequent hand washing and not sharing utensils or drinks.
6. **Pain relief**: Use over-the-counter pain relievers like acetaminophen or ibuprofen to alleviate symptoms such as sore throat and fever (consult a healthcare provider for proper dosage).

These lifestyle adjustments can help manage symptoms and promote recovery.
Medication: Paracetamol (acetaminophen) and NSAIDs, such as ibuprofen, may be used to reduce fever and pain. Prednisone, a corticosteroid, while used to try to reduce throat pain or enlarged tonsils, remains controversial due to the lack of evidence that it is effective and the potential for side effects. Intravenous corticosteroids, usually hydrocortisone or dexamethasone, are not recommended for routine use but may be useful if there is a risk of airway obstruction, a very low platelet count, or hemolytic anemia.Antiviral agents act by inhibiting viral DNA replication. There is little evidence to support the use of antivirals such as aciclovir and valacyclovir although they may reduce initial viral shedding. Antivirals are expensive, risk causing resistance to antiviral agents, and (in 1% to 10% of cases) can cause unpleasant side effects. Although antivirals are not recommended for people with simple infectious mononucleosis, they may be useful (in conjunction with steroids) in the management of severe EBV manifestations, such as EBV meningitis, peripheral neuritis, hepatitis, or hematologic complications.Although antibiotics exert no antiviral action they may be indicated to treat bacterial secondary infections of the throat, such as with streptococcus (strep throat). However, ampicillin and amoxicillin are not recommended during acute Epstein–Barr virus infection as a diffuse rash may develop.
Repurposable Drugs: The term "nan" is not typically associated with referencing repurposable drugs. If you are asking about repurposable drugs for infectious mononucleosis (IM), there is limited evidence for specific repurposable drugs in treating IM. Infectious mononucleosis, primarily caused by the Epstein-Barr virus (EBV), typically focuses on supportive care, such as rest, hydration, and pain relievers like acetaminophen or ibuprofen.

However, some antiviral drugs (e.g., acyclovir and valacyclovir) have been studied for reducing EBV replication but are not routinely recommended due to limited clinical benefits in acute IM cases. It is best to consult with a healthcare provider for appropriate management and treatments.
Metabolites: Infectious mononucleosis, commonly known as "mono" or the "kissing disease," is primarily caused by the Epstein-Barr virus (EBV). Some key metabolites associated with the disease include elevated levels of atypical lymphocytes and liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Testing for heterophile antibodies (Monospot test) and specific EBV antibodies (VCA-IgM, VCA-IgG, and EBNA) are also commonly used diagnostic markers.
Nutraceuticals: In the context of infectious mononucleosis, there is limited scientific evidence to support the effectiveness of specific nutraceuticals in treating or alleviating the condition. Infectious mononucleosis, often caused by the Epstein-Barr virus (EBV), primarily requires rest, hydration, and symptomatic treatments. Nutraceuticals, such as vitamins, minerals, and herbal supplements, may support overall health and immune function but should not replace conventional treatments. Always consult with a healthcare professional before starting any nutraceutical regimen.
Peptides: In the context of infectious mononucleosis (commonly caused by the Epstein-Barr virus), peptides are not typically a primary focus in diagnosis or treatment. However, certain peptide sequences are recognized by the immune system, which can potentially be of interest in research for vaccines or immunotherapy. Peptide-based diagnostics or treatments are not standard for this infection.

"Nan" does not appear to be directly relevant to infectious mononucleosis. If you meant "nanoscale" or "nanotechnology," while it is an emerging field in medicine, its application in the treatment or diagnosis of infectious mononucleosis is still largely experimental and not part of conventional practice.