Almost anyone at any age can get mononucleosis.  About 70-80 percent of the documented cases involve persons between the ages of 15 and 30.  The disease occurs slightly more in men than in women and the college students are diagnosed as having the disease during the fall and early springtime.  Epidemics do not occur, meaning if you have the disease you will not be at risk of spreading it to an entire population with whom you live or are in contact.

Transmission:
Adolescents and young adults transmit the virus to each other through prolonged kissing.  Hence the name "kissing disease".  This is because the virus reproduces in the cells of the saliva as well as the white blood cells of your body.  The virus can be found in your saliva for at least 6 months after the acute infection.  About 15 percent of people continue to have the virus in their saliva thereafter.  The virus can also be transmitted through sharing of drinking glasses or beverage cans because the non-infected person comes in contact with infected saliva left on the glass or beverage can.  Despite this possibility, Mono is a disease that is hard to catch and only transmitted through direct contact with the virus-infected saliva.

The time frame in which someone with Mono is contagious to another is unknown.  People who have been infected with the virus are potentially contagious at various times throughout their lives.  However, the period of communicability seems to begin sometime before symptoms appear and then decrease when the symptoms appear.  It may take between 2 weeks to almost 2 months after exposure for a susceptible person to develop the disease if infected.

The mono virus, EBV, remains in your body for life.  Patients with mono or with a history of having had mono do not need to be isolated from household members.  College roommates are only at a slight risk of being infected during the period of communicability.

Symptoms:
The symptoms of mononucleosis can last a few days to as long as several months, but in most cases disappear in 1 to 3 weeks.

Early symptoms:  "not feeling well", headache, fatigue, chilliness, puffy eyelids, and loss of appetite.

Later symptoms:  fever (101' to 105') which may last between 5 days and a few weeks, sore throat with painful swallowing, swollen lymph glands especially in the side and back of the neck.  Abdominal complaints may be related to an enlarged spleen (50%) or liver (20%).  Bleeding gums, a body rash and yellowing of the skin are also possible symptoms.

Diagnosis:
A blood test is the key method to confirm the diagnosis of mononucleosis.  The test can be positive for the antibodies (or body defenses indicating that the virus is present) as early as 4 days into the disease and persists for months.  In some cases however, the appearance of the antibodies is delayed and the repeat test may be necessary to establish the diagnosis.

Treatment and Recovery:
There is no specific treatment for mononucleosis.  Medication is recommended to relieve some of the symptoms of mono but does not "cure" or get rid of the virus.

There are necessary recommendations concerning physical activity when one has mono.  These recommendations are directed at avoiding damage to the spleen, which is enlarged and is fragile during this disease.  Therefore, lifting, straining, and competitive sports should be avoided until complete recovery.  Other types of activity, namely, going to class or work should be limited based upon how the patient feels.

Other recommendations include rest, plenty of fluids to guard against dehydration from the fever, and eating foods as tolerated.  Acetaminophen (Tylenol) is recommended for headache or muscle aches as is warm salt gargles to soothe a sore throat.  In certain circumstances the use of steroid in pill form is used to lessen the symptoms from the very painful and debilitating sore throat. 

Fatigue and weakness may linger for several months after the acute illness.  It is therefore important to realize that one's activity level may not be back to normal for a long period of time. 

Although EBV, the virus of mono, remains in the body indefinitely following a bout of mononucleosis, the disease rarely recurs.  Individuals with mono-like illnesses require evaluation for other viral illnesses that present similarly.

If you have any other questions regarding this disease, please call the University Health Service at 832-1925.

We would like to acknowledge the National Institute of Allergy and Infectious Disease for information in this handout.