The Kissing Disease

“The Kissing Disease”:

“The Kissing Disease” Andrew Semaan P8

Background Information:

Background Information Infectious mononucleosis is often called the “kissing disease” because it is transferred primarily through saliva (Mayo Clinic). It can also be transferred through a cough or sneeze, or by sharing a glass or food utensil with someone who has mono (Mayo Clinic). Mononucleosis is most common in young adults (Mayo Clinic).

History of Mononucleosis:

History of Mononucleosis Infectious mononucleosis is caused by the Epstein-Barr virus ( Mono Treatment). This virus was first described in the late 19th century as acute glandular fever ( Mono Treatment) . It struck mostly adolescents and young adults and was characterized by lymphadenopathy, fever, hepatosplenomegaly, malaise, and stomach pains ( Mono Treatment) .

History of Mono cont.:

History of Mono cont. In 1920, Researcher Sprunt and his associates gave the name infectious mononucleosis to cases that showed acute leukemia that seemed to resolve on its own with blastlike cells in the blood ( Mono Treatment) . In 1923, another researcher, Downey, described the lymphocyte morphology ( Mono Treatment) . In 1932, Paul and Bunnell, who are credited with finding mono, discovered that serum from patients with symptoms showed heterophile antibodies ( Mono Treatment) . This allowed doctors and researchers to diagnose mono more accurately and to understand who had infectious mononucleosis and who was actually exhibiting other illnesses ( Mono Treatment).

History of Mono cont.:

History of Mono cont. Researchers continued, for many years, to search for the etiologic agent of mono; however, they were not successful because they didn't realize that many people who get mono are actually asymptomatic ( Mono Treatment) . In addition, they didn't realize that most adults are seropositive ( Mono Treatment) .

History of Mono cont.:

History of Mono cont. In 1964, Epstein found virus particles in a Burkill lymphoma cell line and he described his findings, explaining that this was the first human tumor virus ( Mono Treatment) . In 1968, Henle made the connection between, and reported on, the relationship between acute infectious mono and the Epstein-Barr virus ( Mono Treatment) . As a result of his work, a large study was done at Yale University with students to establish that Epstein-Barr was actually the etiologic agent of infectious mononucleosis ( Mono Treatment) .

CMV:

CMV A virus called cytomegalovirus (CMV) can also result in infectious mononucleosis ( Mono Treatment) . This virus is related to the herpes family, and is commonly picked up by the time you turn 40 ( Mono Treatment) . Like EBV, the cytomegalovirus is contracted by 85% of the population by the age of 35 ( Mono Treatment) . It often causes no symptoms, but it can result in mono, especially in adolescents and teenagers ( Mono Treatment).

Symptoms:

Symptoms Mononucleosis can occur throughout your life, though you are most likely to get it sometime between the ages of 15 and 25 (Mono treatment) . Mono symptoms can be slightly different depending on your age and how severe the infection is (Mono treatment) . It is important to recognize symptoms early because mono that goes undetected can become chronic (Mono treatment) .

Symptoms cont. :

Symptoms cont. Mononucleosis in children under twelve is often hard to detect and the symptoms tend to be mild (Mono treatment) . Symptoms include loss of appetite, light fatigue, listlessness, and mild fever (Mono treatment) . Mono most often occurs in teenagers and young adults and about 50% of students have had mononucleosis by the time they finished high school (Mono treatment) . Symptoms in this age group generally take about four to six weeks to appear, though sometimes they can take as many as twelve. The initial symptoms are a lack of energy, the chills, and a loss of appetite. Sore throat and swelling of lymph nodes is often experienced in the first couple of weeks. Other symptoms include fever, extreme fatigue, tender spleen, and rash (Mono treatment) .

Symptoms cont.:

Symptoms cont. Adult mono symptoms tend to be more severe than those in children and teenagers (Mono treatment) . Adults suffer the same symptoms and teenagers and young adults, but they also tend to suffer from jaundice, stiffness of the neck, rapid heart rate, and shortness of breath (Mono treatment) . Fatigue will probably be the most noticeable symptom and it can take months to get the energy level back up (Mono treatment) .

Diagnosis:

Diagnosis The diagnosis of mono is suspected on the symptoms ( MedicineNet 3) . Mono is confirmed by blood tests that may also include tests to exclude other possible causes of the symptoms ( MedicineNet 3) . Early in the course of the mono, blood tests may show an increase in one type of white blood cell (lymphocyte). Some of these increased lymphocytes have an unusual or "atypical" appearance when viewed under a microscope, which suggests mono ( MedicineNet 3) .

Diagnosis cont. :

Diagnosis cont. More specific blood tests, such as the monospot and heterophile antibody tests, can confirm the diagnosis of mono (MedicineNet 3) . These tests rely on the body's immune system to make measurable antibodies against the EBV (MedicineNet 3) . The antibodies may not become detectable until the second or third weeks of the illness. A blood chemistry test may reveal abnormalities in liver function (MedicineNet 3) .

Pathology:

Pathology Humans are the only known reservoir of Epstein-Barr virus ( Bennett and Domachowske 1) . After initial inoculation, the virus replicates in nasopharyngeal epithelial cells. Cell lysis is associated with a release of virions, with viral spread to contiguous structures, including salivary glands and oropharyngeal lymphoid tissues ( Bennett and Domachowske 1) . Further viral replication results in viremia, with subsequent infection of the lymphoreticular system, including the liver, spleen, and B lymphocytes in peripheral blood ( Bennett and Domachowske 1) . Host immune response to the viral infection includes CD8+ T lymphocytes with suppressor and cytotoxic functions, the characteristic atypical lymphocytes found in the peripheral blood ( Bennett and Domachowske 1) .

Pathology cont. :

Pathology cont. The T lymphocytes are cytotoxic to the Epstein-Barr virus–infected B cells and eventually reduce the number of Epstein-Barr virus–infected B lymphocytes to less than 1 per 10^6 circulating B cells ( Bennett and Domachowske 1) . Primary infection with Epstein-Barr virus is followed by latent infection, a characteristic of herpes viruses. After acute Epstein-Barr virus infection, latently infected lymphocytes and epithelial cells persist and are immortalized. In vivo, this allows perpetuation of infection, while, in vitro, immortalized cell lines are established ( Bennett and Domachowske 1) . During latent infection, the virus is present in the lymphocytes and oropharyngeal epithelial cells as episomes in the nucleus. These episomes rarely integrate into the cell genome but do replicate with cell division and are passed to subsequent generations of cells ( Bennett and Domachowske 1) .

Pathology cont.:

Pathology cont. The rate of viral reactivation within the population of latently infected cells is low. Epithelial cells are the primary source of new virus in latently infected individuals, infecting B cells as they circulate through the oropharynx ( Bennett and Domachowske 1) .

Treatments:

Treatments The treatment for mononucleosis can generally be accomplished at home with plenty of rest, fluids, and over-the-counter medications (eMedicineHealth 4) . Acetaminophen (Tylenol) or ibuprofen (Advil) can be taken for fever and pain control (eMedicineHealth 4) . Throat lozenges or gargling may soothe a sore throat and there should be plenty of fluid intake to avoid dehydration (eMedicineHealth 4) . Plenty of bed rest is needed and everyday activities should be limited according to the degree of illness. Strenuous activities and contact sports should be avoided for at least one month because the spleen may be enlarged and vigorous activity may cause it to rupture (eMedicineHealth 4) .

Complications:

Complications The most feared complication arises most often during the first three weeks of infectious mononucleosis when a massively enlarged spleen either spontaneously ruptures or rupture is provoked by trauma that would otherwise be insignificant (Auwaerter, Infectious Mononucleosis) . Affecting at most 0.1-0.5% of patients, onset of severe abdominal pain or severe left shoulder pain (referred pain from blood irritating the diaphragmatic nerves) should demand urgent medical attention. Death may occur from bleeding (Auwaerter, Infectious Mononucleosis) . Although emergency surgery to remove the spleen has been routinely advocated, some ruptures have been managed without surgery (Auwaerter, Infectious Mononucleosis) .

Complications cont.:

Complications cont. Another major complication is airway obstruction. Tonsillar enlargement from EBV may be so significant as to close off the airway resulting in death from asphyxiation (Auwaerter, Infectious Mononucleosis) . Corticosteroids are used in this severe form of infectious mononucleosis in an effort to quickly shrink tonsillar tissue. Physicians may elect to place an airway tube or even perform a tracheotomy to mechanically ventilate such patients until it is again safe for them to breathe on their own (Auwaerter, Infectious Mononucleosis) . Chronic fatigue is another serious complication that can arise from infectious mononucleosis (Auwaerter, Infectious Mononucleosis) .

Recent discoveries:

Recent discoveries Recent data show that by mimicking B-cell antigen-activation pathways the virus enters the long-lived memory B lymphocyte pool where it evades immune elimination by severely restricting its own gene expression (Auwaerter, Recent Advances). By influencing B-cell survival mechanisms Epstein–Barr virus may induce tumors such as B lymphoproliferative disease and Hodgkin's disease (Auwaerter, Recent Advances). Vaccines are being developed to prevent and/or treat these conditions, but an animal model is required to study pathogenesis before a rational vaccine strategy can be formulated (Auwaerter, Recent Advances).

Mono and Multiple Sclerosis:

Mono and Multiple Sclerosis Different lines of evidence have implicated infection with the Epstein-Barr virus in the development of multiple sclerosis (Neilsen 1). Investigations have shown that levels of certain EBV antibodies correlate with multiple sclerosis disease activity and are predictive in multiple sclerosis risk in apparently healthy individuals (Neilsen 1). Age at primary infection and the host’s immunological response may be modifiers of the EBV-associated risk of multiple sclerosis. However, the association between mononucleosis and the risk of multiple sclerosis remains poorly characterized with respect to sex and age at and time since mononucleosis (Neilsen 1).

Mono and Multiple Sclerosis:

Mono and Multiple Sclerosis Results of a recent experiment saw a more than two-fold increased risk of multiple sclerosis after mononucleosis apparent for up to thirty years of observation and uniformly distributed across strata of age and sex (Neilsen 1). This absence of variation in multiple sclerosis risk may reflect a permanent change in immunological statures, which confers an excess in multiple sclerosis risk, a hypothesis that needs to be explored further (Neilsen 1).

Bibliography:

Bibliography " An Inside Look at Infectious Mononucleosis." Nursing . 40.11 (2010): 66. Auwaerter, Paul. "Infectious Mononucleosis - a Knol by Paul Auwaerter." Knol - a Unit of Knowledge: Share What You Know, Publish Your Expertise. 19 July 2008. Web. 01 Dec. 2010 Auwaerter PG. "Recent Advances in the Understanding of Infectious Mononucleosis: Are Prospects Improved for Treatment or Control? " Expert Review of Anti-Infective Therapy . 4.6 (2006): 1039-49. Bennett, Nicholas J., and Joseph Domachowske. "Mononucleosis and Epstein-Barr Virus Infection: EMedicine Pediatrics: General Medicine." EMedicine - Medical Reference . 12 Oct. 2010. Web. 01 Dec. 2010. "Dealing with the Signs and Symptoms of Mono." Your One Stop Information Source About Mono: The C . Web. 30 Nov. 2010. Ebell MH. "Epstein-Barr Virus Infectious Mononucleosis." American Family Physician . 70.7 (2004): 1279-87 "Infectious Mononucleosis: Recovery Time & Complications." Steady Health . 9 Aug. 2010. Web. 28 Oct. 2010. "Infectious Mononucleosis (Mono) Symptoms, Treatment, Causes and Prevention by EMedicineHealth.com." EMedicineHealth: Experts for Everyday Emergencies . 2010. Web. 01 Dec. 2010. "Infectious Mononucleosis Symptoms, Causes, Treatment - How Is Mono Diagnosed on MedicineNet." MedicineNet . Web. 01 Dec. 2010.

Bibliography:

Bibliography "Mono and EBV: What Is the Epstein-Barr Virus?" Your One Stop Information Source About Mono: The C . Web. 30 Nov. 2010. "Mononucleosis." Mayo Clinic . 26 June 2010. Web. 28 Oct. 2010. Nielsen TR, et al. "Multiple Sclerosis After Infectious Mononucleosis." Archives of Neurology . 64.1 (2007): 72-5. Porto, Isabel. "Infectious Mononucleosis." U.S. Pharmacist . 20 May 2008. Web. 28 Oct. 2010. Stöppler, Melissa C. "Infectious Mononucleosis (Mono)." MedicineNet . Ed. William C. Shiel Jr. Web. 28 Oct. 2010. "The History of Mono." Your One Stop Information Source About Mono: The C . Web. 30 Nov. 2010. "What Is Mono?: Mononucleosis Causes and Mono Sympt." Your One Stop Information Source About Mono: The C . Web. 30 Nov. 2010. Wingate PJ, et al. "Regulatory T Cell Activity in Primary and Persistent Epstein-Barr Virus Infection." Journal of Medical Virology . 81.5 (2009): 870-7.