Infectious mononucleosis, glandular fever or simply mono is among the most common viral infections in children and adolescents  caused by Epstein Barr virus. However, other viruses can also cause this disease, namely cytomegalovirus, Rubella virus, HIV, Adenovirus, and a parasite called Toxoplasma gondii. If it is encountered in early childhood, the symptoms are generally mild and they usually waver off early as compared to the disease occurring in adolescents.

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It is called the kissing disease as it is transmitted through saliva and therefore, is very common among adolescents. In the developing countries, the infection occurs in infancy or early childhood most commonly, whereas in the developed countries it is encountered in adolescence.
About 95% adults have already been infected by this virus and harbor it in their bodies. Sometimes, this virus becomes active again for sometime and the person becomes infectious.

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Ultimate Guide for Infectious Mononucleosis in Kids

SYMPTOMS:

The symptoms of mono are very vague and resemble those of a  common viral infection and therefore, may pose a problem in diagnosis. The symptoms are also less intense in children, in fact, lesser the age of the child, lesser is the intensity of the symptoms. The incubation period is approximately six weeks. That means the symptoms will appear six weeks after you have acquired the virus.

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These symptoms include fever, which is high 104-105˚C and lasts for 1-2 weeks, a severe sore throat is developed which might be confused with streptococcal(bacterial) throat infection. This is accompanied by severe swollen glands in the neck, an enlarged liver and enlarged spleen. Swollen glands in the neck may cause difficulty in swallowing and breathing and if this gets really severe, you should immediately take the child to the hospital. Other lymph nodes in the body, e.g. of the groin, underarms, etc might be enlarged. You should make sure that the child takes rest according to needs.

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If the child has very mild symptoms, the is no need of complete bed rest.
Other symptoms are nausea, muscle pain, loss of appetite,  continuous fatigue and the feeling of being unwell, etc. The symptoms may last for about 2 months and may extend for up to 4 months. The symptoms would then resolve and the virus becomes latent. This virus may pose problems later in life but these are generally rare. These later consequences are nasopharyngeal carcinoma and Burkitt lymphoma, both are types of cancers. These are caused by Epstein Barr virus but are not very common and are more commonly found in America and other developed countries.

DIAGNOSIS

The diagnosis of mono is often based on suspicion. If the symptoms are very mild, the diagnosis of infectious mononucleosis might not even be made and it will be converted into a latent infection without even being noticed.
Usually there is a confusion between Streptococcal throat infection and mononucleosis, for which a strep throat test is performed. We can rule out the possibility of bacteria once this test is confirmed negative.
Complete blood count is done to check the presence of  atypical lymphocytes in the blood picture. This should increase the possibility of this disease. The number or lymphocytes is also increased. Neutrophils and platelets are lower than normal. The liver may not function properly and the liver function tests may be abnormal.
A monospot test, specific for infectious mononucleosis is also available. The problem with this test is that it is not positive during early infection and therefore there is not benefit of performing this test during an early disease.

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TREATMENT

Since this is a viral infection, antibiotics are not given for the treatment. Infact, if the infection is confused with a bacterial infection and antibiotics are given for treatment, the patient mat develop a generalized rash on the body as a reaction. Although some antiviral medications are available in the market, they are not very effective and the treatment is generally symptomatic.
The symptoms are treated accordingly. To reduce fever, Paracetamol is given(dose should be monitored in children and a doctor should be consulted before giving the medication). Aspirin should not be given in any case because it may lead to a very serious complication called Reye’s syndrome . Lots of rest is the key in getting better with time and reduction of symptoms. Sore throat is treated with Benadryl or some other soothing medication. Plenty of fluids should be given to the patient to prevent dehydration.
If the tonsils get very enlarged and the patient is taken in emergency, a surgery might be performed to remove the tonsils or they may control the condition with steroids. However, this is not very common and the doctors handle it accordingly.

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COMPLICATIONS

• Usually the symptoms of mono are mild and do not pose a threat to life, but some of the complications of mono might be severe and might be a cause of emergency or fatality. These are severely enlarged tonsils causing difficulty in swallowing and breathing and is an emergency condition. Severe dehydration may also be a condition of emergency and fluid replacement has to be started.
• Enlarged spleen is a symptom of infectious mononucleosis. A blow to the spleen or blow on the upper left side of the abdomen may result in a ruptured spleen which is usually fatal and therefore an emergency condition.
• There is no known association with pregnancy and the child born to a mother who is suffering or has suffered from this disease does not show any malformation or any sign of the disease itself. The child born is healthy.
• Other rare complications of infectious mononucleosis are aseptic meningitis(viral meningitis), inflammation of the heart muscle, Guillian Barre syndrome( Syndrome involving the muscles of the body, causes extreme weakness)

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PREVENTION:

Unfortunately, there is no vaccine available for Epstein Barr virus infections. The disease spreads through saliva, therefore it is common in adolescents and young adults, but it may also be transmitted through contaminated fingers, utensils sharing straws, toothbrushes, etc.
The basic prevention of this disease is keeping away from people with active disease who might spread the infection. Hygiene should be maintained and the utensils should be properly cleaned.
It should be seen that the child is protected from the infection because once a person is infected, she will carry the infection throughout her life.

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