![]() ![]() Infectious mononucleosis should be suspected in patients who are 10 to 30 years of age who present with sore throat and significant fatigue, palatal petechiae, posterior cervical or auricular adenopathy, or generalized adenopathy, including inguinal adenopathy.Ītypical lymphocytosis of at least 20%, or atypical lymphocytosis of at least 10% plus lymphocytosis of at least 50%, strongly supports the diagnosis, as does a positive heterophil antibody test. Similar mono-like illnesses can be caused by other infectious agents, including cytomegalovirus, streptococcal infection, adenovirus, and Toxoplasma gondii. It is when the primary infection is delayed until adolescence or beyond that clinical illness is caused by an intense immunopathologic reaction. It is commonly assumed that those who remain uninfected throughout childhood generally become infected as adolescents through kissing (thus, it is called the kissing disease). ![]() In most cases, primary infection occurs subclinically during childhood, often spread between family members via salivary contact. The incubation period for infectious mononucleosis is 4 to 8 weeks. After an acute infection, a patient can shed and transmit virus through saliva for up to 3 months, and persistent virus shedding has been reported for up to 18 months. EBV establishes a harmless lifelong infection in almost everyone worldwide and rarely causes disease unless the host-virus balance is upset. EBV is a tumorigenic herpes virus that is ubiquitous in the adult population. Infectious mononucleosis is caused by Epstein-Barr virus (EBV).
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