Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Having a sore throat can be a symptom of many conditions, and many people
wonder if their own sore throat might be a sign of something more serious than
the common cold. Specifically, infectious mononucleosis ("mono") and infection
with Streptococcus bacteria ("Strep throat") are two conditions that both
produce an extremely painful sore throat.
Like the common cold, infectious mononucleosis is caused by a viral
infection. The virus responsible for mono is called the Epstein-Barr virus,
abbreviated EBV. EBV is a very common virus worldwide, and studies show that up
to 95% of the U.S. population has been infected with EBV at some point in their
lives. EBV infection, especially if it occurs early in childhood, does not
always cause illness, or it may cause a very mild illness that is not
distinguishable from colds or other mild illnesses of childhood. However, when
infection first occurs during the teen years or in young adulthood, infectious
mononucleosis will develop in up to 50% of cases.
Symptoms of mono include fatigue, sore throat, swollen lymph nodes, and
fever. Enlargement of the spleen and inflammation of the liver may also occur.
Severe complications are very rare, and the condition gradually resolves on its
own. Since mono is caused a virus and not a bacteria, antibiotics are of no
benefit. Therefore, treatment is directed at relieving the symptoms, which may
persist for one to two months.
The diagnosis of mono is confirmed by blood tests.
Mono can cause liver inflammation (hepatitis) and
enlargement of the spleen.
People who have had mono can continue to shed virus
particles in their saliva during reactivations of the viral infection
throughout their lifetime.
Vigorous contact sports should be avoided in the illness and recovery
phase to prevent rupture of the spleen.
What is infectious mononucleosis?
Infectious mononucleosis, "mono," "kissing disease," and glandular fever are all terms popularly used for the very common infection caused by the Epstein-Barr virus
(EBV). EBV is a member of the herpesvirus family. The characteristic symptoms of infection with EBV include fever,
fatigue, malaise, and sore throat. The designation "mononucleosis" refers to an increase in a particular type of white blood cells (lymphocytes) in the bloodstream relative to the other white blood cells as a result of the EBV infection.
The disease was first described in 1889 and was referred to as "Drüsenfieber," or glandular fever. The term infectious mononucleosis was first used in 1920 when an increased number of lymphocytes were found in the blood of a group of college students who had fever and symptoms of the condition.
What is the cause of mono?
The EBV that causes mono is found throughout the world. By the time most people reach adulthood, an antibody against EBV can be detected in their blood. In the U.S., up to 95% of adults 35-40
years of age have antibodies directed against EBV. This means that most people, sometime in their lives, have been infected with EBV.
The body's immune system produces antibodies to attack and help destroy invading
viruses and bacteria. These specific antibodies can be detected in the blood of
people who have been infected.
When infection occurs in childhood, the virus most often produces no symptoms. It is estimated that only about 10% of children who become infected with EBV develop the illness. Likewise, probably because of immunity from prior infection, adults typically do not develop the illness. Most cases of infectious mononucleosis occur in the 15-24 age group.
While there are other illnesses falling under the broad classification of mononucleosis that can cause similar symptoms (cytomegalovirus
[CMV] infection is one example) and an increase in blood lymphocytes, the form caused by the EBV is by far the most common.
What are the risk factors for mono?
The EBV can infect any person. As previously discussed, the majority of people have become infected with the virus by the time that they reach adulthood, and the majority of these infections produce no symptoms or are not recognized as mono. Mono is most often diagnosed in adolescents and young adults, with a peak incidence at 15-17 years of age. However, it can also be seen in children. Generally, the illness is less severe in young children and may mimic the symptoms of other common childhood illnesses, which may explain why it is less commonly diagnosed or recognized in this younger age group.
Infectious mononucleosis symptoms and signs
How is mono transmitted or spread?
Mono is spread by person-to-person contact. Saliva is the primary method of transmitting mono, which leads to the infection of B lymphocytes in the mouth and throat. Infectious mononucleosis developed its common name of "kissing disease" from this prevalent form of transmission among teenagers. It typically takes between four to eight weeks for symptoms of mono to appear after the initial infection with EBV. A person with mono can also pass the disease by coughing or sneezing, causing small droplets of infected saliva and/or mucus to be suspended in the air which can be inhaled by others. Sharing food or beverages from the same container or utensil can also transfer the virus from one person to another since contact with infected saliva may result.
Most people have been exposed to the virus as children, and as a result of
the exposure, they have developed immunity to the virus. It is of note that most people who are
exposed to the EBV don't ever develop mononucleosis. The incubation period for
mono, meaning the time from the initial viral infection until
the appearance of symptoms, is between four and eight weeks. During an infection,
a person is likely able to transmit the virus to others for at least a few
weeks and possibly longer, even after symptoms have disappeared (see below).
Research has shown that, depending on the method used to detect the virus, anywhere from 20%-80% of people who have had mononucleosis and have recovered will continue to secrete the EBV in their saliva for years due to periodic "reactivations" of the viral infection. Since healthy people without symptoms also secrete the virus during reactivation episodes throughout their lifetime, isolation of people infected with EBV is not necessary. It is currently believed that these healthy people, who nevertheless secrete EBV particles, are the primary reservoir for transmission of EBV among humans.
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Most sore throats are caused by viruses or mechanical causes (such as mouth breathing) and can be treated successfully at home. However, a person should be seen by a health care professional if they have a sore throat that has a rapid onset, and is associated with a fever or tenderness of the front of the neck; a sore throat that causes the person to have difficulty swallowing (not just pain swallowing) or breathing; or if a sore throat lasts for more than a week.
Strep throat is a sore throat caused by a bacterium called streptococcus (strep) that can be treated through antibiotics. Common symptoms of strep throat include pinkeye, runny nose, skin rash, cough, hoarseness, diarrhea and more. Complications of untreated strep throat include middle ear infections, meningitis, pneumonia, rheumatic fever, and more.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
An upper respiratory infection is a contagious infection of the structures of the upper respiratory tract, which includes the sinuses, nasal passages, pharynx, and larynx. Common causes of an upper respiratory infection include bacteria and viruses such as rhinoviruses, group A streptococci, influenza, respiratory syncytial, whooping cough, diphtheria, and Epstein-Barre. Examples of symptoms of upper respiratory infection include sneezing, sore throat, cough, fever, and nasal congestion. Treatment of upper respiratory infection are generally with OTC medication and home remedies.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
The spleen enlarges if it is asked to do excessive work in filtering or manufacturing blood cells, if there is abnormal blood flow to it, or if it is invaded with abnormal cells or deposits. Symptoms of an enlarged spleen may include weakness and fatigue, easy bleeding, and poor white blood cell function. Treatment of an enlarged spleen is focused toward the cause of the splenomegaly. Surgery may be required to remove the spleen.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Neuropathic pain is chronic pain resulting from injury to the nervous system. The injury can be to the central nervous system (brain and spinal cord) or the peripheral nervous system (nerves outside the brain and spinal cord).
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Children's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health and community health.
What are noninfectious, common rashes localized to a
particular anatomical area?
Common, noninfectious rashes are listed below. Since these conditions are not caused by infectious organisms, it is reasonable to attempt to treat them with
over-the-counter 1% hydrocortisone cream for a week or so prior to seeking medical attention.
Seborrheic dermatitis: Seborrheic dermatitis is the single most common rash affecting adults. It produces a red, scaling eruption that characteristically affects the scalp, forehead, brows, cheeks, and external ears.
Atopic dermatitis: Atopic dermatitis, often called eczema, is a common disorder of childhood which produces red, itchy, weeping rashes on the inner aspects of the elbows and in back of the knees as well as the cheeks, neck, wrists, and ankles. It is commonly found in patients who also have asthma and hay fever.
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