Epstein-Barr Virus Infectious Mononucleosis (EBV) is called human herpes virus 4 is a common DNA herpesvirus that causes infectious mononucleosis. 

It is recognized as a clinical syndrome with fever and adenopathy. German physicians in 1889 termed Drusenfieber known as glandular fever. 

It is transmitted through saliva, thus referred to as the “kissing disease”. 

EBV infects oropharynx epithelial cells, spreads to B cells, induces their proliferation. Symptoms of mono caused due to immune response with cytotoxic T cells. 

Globally this virus is extremely common. Approximately 90% of people worldwide are seropositive for EBV, with developed nations having lower rates. 

It is more seen in young adults and adolescents. Lower socioeconomic areas may have earlier onsets of primary infection. 

Direct contact with infected saliva is the area through which the infection is spread. In the US, 66.5% of children and adolescents aged between 6 to 19 years old have EBV, with females and minority groups shows higher rates. 

EBV targets and infects B lymphocytes. It infects epithelial cells. When the virus interacts with cell surface receptors then it enters B cells. 

T-cell dysfunction leads to uncontrolled B-cell growth. EBV infection triggers fever due to B-lymphocyte invasion. 

Lymphocytosis observed in the reticuloendothelial system (RES) is caused by a proliferation of EBV-infected B lymphocytes and similar proliferation in the lymphatic tissue of the oropharynx causes pharyngitis. 

Lymphocytosis in RES due to EBV-infected B cells causes pharyngitis from lymphatic tissue proliferation. 

The causes for EBV as follows: 

Immune Status 

Genetic and Environmental Factors 

Genetic Susceptibility 

Environmental Factors 

Clinical Manifestations 

Fever 

Pharyngitis 

People with weakened immune systems and those with AIDS may have more severe and protracted infectious mononucleosis episodes. The degree of weariness, sore throat and fever experienced during the acute phase are among the symptoms. 

Even though they are infrequent may impact on its the outcome. Depending on how effectively their underlying health is maintained during infectious mononucleosis, individuals with pre-existing medical disorders may have a variable prognosis. 

Infectious mononucleosis affects young adults and adolescents.

Oropharyngeal Examination  

Examination of lymph nodes 

People with infectious mononucleosis are frequently suggested to not participate in contact sports or other activities that put their spleen at danger of injury. 

There are instances where hepatitis or liver inflammation has been developing. Alcohol and several drugs should be avoided throughout recovery. 

Other vulnerable groups include people who suffer from pre-existing illnesses such as immunodeficiency disorders which lowers their immune function to catastrophic levels or even with chronic illnesses leading to the worsening of their symptoms.

Chronic tiredness is increasingly persistent and most problematic symptom of infectious mononucleosis. The recovery course generally starts with the active phase of the illness, during which people may have to alter their level of physical activity and rest enough to improve. 

The onset of symptoms is usually gradual in people those who first reporting as moderate symptoms. Usually malaise, and an overall feeling of being unwell are common symptoms. 

The flu-like symptoms appear as the illness develops.  

e.g., fever, sore throats, and enlarged lymph nodes.  

Monitor patients closely with enlarged tonsils for airway issues, use steroids as required. 

Treatment of immunocompromised patients with EBV lymphoproliferative disease is controversial. Acyclovir drug is not proven beneficial in treatment phase. 

EBV lymphoproliferative disease in immunocompromised patients is controversial while acyclovir is not effective. 

EBV mononucleosis patients with streptococcal colonization may develop rash. 

Positive group A streptococci throat cultures in EBV patients do not need treatment for colonization. 

Infectious Disease

Patients should avoid sports activities and heavy lifting for a minimum of a month. Patients are advised to take rest and avoid any strenuous activities for specific period. 

Patients should follow good hygiene practices to avoid spreading the virus. 

Proper education and awareness about infectious mono should be provided and its related causes, and how to stop it with management strategies. 

Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort. 

Family Medicine

Infectious Disease

No antiviral therapy is available for Epstein-Barr virus (EBV) infectious mononucleosis in immunocompetent persons. 

Corticosteroids:  

The short courses of corticosteroids are indicated with hemolytic anemia and extreme tonsillar enlargement. It should be considered in those with airway obstruction. 

Infectious Disease

In cases of substantial splenomegaly, splenic rupture is an uncommon but potentially dangerous consequence for infectious mononucleosis.  

Surgical care may be required if there is a suspicion of splenic rupture. 

Infectious Disease

In the diagnosis phase, evaluation of symptoms such as fever, sore throat, swollen lymph nodes, and fatigue to confirm diagnosis. 

Pharmacologic therapy is very effective in the treatment phase as it includes use of corticosteroids and surgical intervention. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation. 

The regular follow-up visits with the physician are schedule to check the improvement of patients along with treatment response.