However, in one study there was no difference in EBV seropositive status between exclusively nursed or bottle-fed infants, suggesting that breastfeeding is not an important route of transmission. In addition, EBV has been isolated in breast milk from healthy nursing mothers. Intrafamilial spread among siblings has also been reported. 7 The virus can persistently shed in the oropharynx of patients with IM for up to 18 months following clinical recovery. Although it should be pointed out that once infected with EBV, the virus might be intermittently found in the oropharynx for decades. 6įollowing IM, the virus may be shed in salivary secretions at high levels for as long as 6 months after onset of illness. Thus, genetic factors may influence who develops clinical disease. 5 In addition, IM occurs more frequently in same-sex twins and first-degree siblings, compared with second- and third-degree relatives. The incidence of clinical infection is approximately 30 times higher in whites than in blacks in the U.S. The vast majority of adults are not affected by this infection because of prior exposure. 3 IM is relatively uncommon in adults (less than 2% of pharyngitis cases). The peak incidence of infection is in the 15- to 24-year age range. Many attribute this finding to personal contact and poor personal hygiene among children, which provides opportunities for early acquisition and further spreading of EBV. In the United States, antibodies to EBV have been demonstrated in all population groups with 25% to 50% in lower socioeconomic groups. The virus has not been recovered from environmental sources, suggesting that humans are the major reservoir. BackgroundĮpstein-Barr virus is spread by contact between sensitive people and EBV carriers. The background, pathogenesis, clinical manifestation, diagnosis, and treatment of IM in adults and adolescents will be briefly reviewed in this article. A few other viruses may also cause the disease. The relationship between EBV and IM was established when a laboratory worker was infected with EBV and developed IM. Mononucleosis was first described in the 1920s and is generally known as the kissing disease. In those between ages 16 and 20 years, it is the cause of about 8% of sore throats. In the developing world, people are more often infected in early childhood when the symptoms are less severe. Mono most commonly affects those between the ages of 15 to 24 years in the developed world. Mono is primarily diagnosed based on the symptoms and can be confirmed with blood tests for specific antibodies. Another typical finding is increased blood lymphocytes, of which more than 10% are atypical. There is no vaccine for EBV, and mono generally gets better on its own. Drinking enough fluids, getting sufficient rest, and taking pain medications such as acetaminophen and ibuprofen are the best recommendations. Spreading may occur through objects such as drinking glasses or toothbrushes and can be prevented by not sharing personal items or kissing infected individuals. It is primarily spread through saliva, and those who are infected can spread the disease weeks before symptoms develop. IM is characterized by a triad of symptoms: fever, tonsillar pharyngitis, and lymphadenopathy. This virus was discovered by the renowned Russian pediatrician Nil Filatov in 1885. Infectious mononucleosis (IM or Mono) is usually caused by the Epstein–Barr virus (EBV), which is a member of the herpes virus family.
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