Mononucleosis: when it affects the little ones

It’s known as the “kissing disease,” but it’s certainly not just about the health of lovers. We are talking about mononucleosis, a contagious infectious disease, which mainly affects adolescents between 15 and 18 years old. However, there are also some cases among adults and younger children.

Viruses and mononucleosis

Among the causes of mononucleosis, the most frequent and undoubtedly the best known is the infection of the Epstein Barr virus (EBV), also known as Human herpesvirus 4 (HHV-4). It is a rather common and widespread microorganism, belonging to the herpes virus family, the same that causes chickenpox. However, other viral agents, such as cytomegalovirus (CMV), are also capable of causing symptoms very similar to those of mononucleosis.

How is it transmitted?

Contagion occurs through the exchange of saliva with an infected person, which can occur directly (a kiss, sneeze or cough) or indirectly. The latter case occurs for example by drinking with a glass previously used by an infected patient.

In the case of younger children, infection occurs very often by putting a toy or kitchen utensil, such as a spoon, in the mouth that has been touched by someone exposed to EBV.

When you come into contact with the pathogen, it enters the body and escapes the action of the immune system thanks to its ability to “hide” inside our cells. There he can remain, silent, for the rest of his life, sometimes without manifesting any symptoms of this disease. However, asymptomatic patients can also be a source of infection. Those who have never developed mononucleosis, despite having been exposed to the virus, will probably never experience it.

How contagious is mononucleosis?

Enough, especially in the early stages of infection. Typically, however, the amount of virus in saliva decreases dramatically already after 5-7 days from the onset of symptoms, although many people continue to present traces of the pathogen in saliva even long after infection.

What are the symptoms?

Mononucleosis does not occur immediately after contact with the Epstein Barr virus: the virus, in fact, remains latent in the body for an incubation time that can vary from 30 days, in the case of younger children, up to a few months in adults.

In young children or very young people exposed to infection, the symptoms are often rather mild, or even absent. Mononucleosis typically occurs only in rare cases during early childhood, while about 25% of adolescents or young adults who come into contact with Epstein Barr’s virus will develop mononucleosis with obvious and recognizable symptoms.

When and if the disease manifests itself, it causes a general malaise, which is often compared to a flu-like syndrome. The symptoms that testify to the acute phase of this disease are:

• fever (37°C) or fever (up to 39-40°C) which may persist for 8-15 days
• fatigue, which can manifest itself as real exhaustion
• loss of appetite
• swelling and irritation of the tonsils
• muscle pain
• sore throat
• headache
• spleen or liver swelling
• measles-like skin lesions
• abdominal pain
• enlargement of the lymph nodes at the level of the neck.

The latter are often painful, especially on palpation, and can reach the size of a walnut. They are affected in particular those located in the neck region (both laterally and posteriorly), but it is possible that lymph nodes of other body regions (groin or armpits) are also involved.

In children under the age of 5 years, complications may occur in some cases such as:

• eyelid edema
• gastroenteritis.

These flu-like conditions tend to subside spontaneously over a few weeks. It is not a disease with a tendency to become chronic, even if, in some situations, the feeling of weakness can last for a few months.

How is the diagnosis made?

To arrive at a diagnosis of mononucleosis and to begin the related therapy it is essential to contact the doctor or pediatrician who, during the visit, performs a physical examination, analyzing the patient’s symptoms and observing his physical condition.

Usually, to reach the diagnosis of mononucleosis, the recognition of distinctive signs is sufficient, including:

• the presence of yellowish-white plaques on the tonsils
• the swelling at the level of the spleen and liver.

In doubtful cases, your doctor may also request some laboratory tests, which can rule out or confirm the suspicion of EBV disease, including:

• blood tests to search for antibodies against the virus and for the count of lymphocytes, cells of the immune system involved in the body’s fight against an infection
• analysis of transaminase levels, whose values in the blood can provide useful information about the activity and health status of the liver
• bilirubin, a substance that results from the process of degradation of hemoglobin, whose blood levels also provide indications on liver function.

With particular regard to the search for antibodies, the following table describes the antibody profile in case of absence of infection or in its different phases (acute, subacute, etc.). The antibodies analyzed are those against the viral capsid antigen (anti-VCA, viral capsid antigen) and those against the Epstein-Barr virus nuclear antigen (anti-EBNA, Epstein-Barr nuclear antigen).

And the therapies…?

Being a disease of viral origin, the cure for mononucleosis does not pass through the administration of antibiotics, which can only be used for diseases caused by bacterial agents.

Although, even today, there is no real therapy against this infection, it is a disease that proceeds spontaneously towards healing. In most patients, in fact, the symptoms are exhausted without the need for any specific intervention.

Of course, it is possible to do something to alleviate the discomfort of young sufferers, applying what is called supportive therapy: in other words, the idea is to help the body and its immune system to act against the pathogen, to achieve complete recovery.

The strategy in these cases is mostly based on:

• complete and prolonged rest, preferably in bed
• balanced diet, rich in fruits and vegetables
• good hydration, thanks to the intake of water and plenty of fluids

In some cases it is also possible to use pharmacological support, such as:

• steroidal anti-inflammatory drugs
• NSAIDs (nonsteroidal anti-inflammatory drugs)
• antipyretics, such as paracetamol.

In severe cases, such as in the presence of breathing problems, it is possible to take corticosteroid drugs, always after consulting your doctor or pediatrician. Acetylsalicylic acid, which can cause a dangerous complication known as Reye’s syndrome, a potentially fatal disease that causes severe brain and liver damage, should be avoided.

In short, except for a few particularities, these are the same tips that are valid in the case of any illness similar to the flu, with particular attention to rest, which seems to be the most important factor to achieve complete healing and, above all, to avoid complications.

The most feared complications…

One of the most feared, although fortunately quite rare, complications of mononucleosis is the rupture of the spleen: this can occur following the enlargement of this organ. That is why rest, which doctors so much recommend as the true cure for this disease, is crucial.

This is especially true for athletes, who are exposed to a higher risk. The return to full activity after a period of absence from sport due to this disease must be gradual: in some sports, especially those that involve a lot of physical contact, possible abdominal trauma could cause rupture of the spleen.

… also to the nervous system

It is possible that the virus also affects the central nervous system, causing complications such as meningitis or encephalitis. When the peripheral nervous system is attacked, syndromes such as Guillan-Barrè can develop, which can lead to paralysis of the limbs and even respiratory muscles.

EBV can also affect other organs, such as the heart and lungs. However, these are extremely rare situations: in fact, one in 100 children is suffering from mononucleosis. In addition, these disorders have a generally favorable course, provided that they are detected quickly and accurately.

Here is therefore the importance of avoiding do-it-yourself treatments and always prefer the comparison with the pediatrician, who will be able to show you the best way to follow for the health of your child.

Prevention is better!

As with most diseases, prevention is also crucial in the case of EBV disease. The first rule to defend your child from this and other diseases is certainly to strengthen his immune system, for example thanks to a balanced and complete diet. The use of supplements or the intake of specific vitamins cannot be excluded, always on the advice of the pediatrician.

Secondly, direct and indirect contact with infected people must be avoided, not only during the period of the disease, but also in the days following the disappearance of symptoms.

In particular, avoid contact of the child, especially by mouth, with objects such as:

• contaminated crockery, glasses and toothbrushes
• potentially infected toys or surfaces.

For any doubts it is essential to consult your doctor or pediatrician, who will be able to answer all your questions, explaining in detail how to deal with one of the most common diseases, and fortunately less dangerous, that can affect children and adolescents.