Infectious mononucleosis - popularly known as "kiss disease" - is transmitted by direct contact with the saliva of an infected person. You can get the virus that causes mononucleosis by kissing, but you can also get it if you are exposed to coughing or sneezing or by sharing a cup or utensil with someone who has mononucleosis.

What is mononucleosis and what is the cause of this disease?

Infectious mononucleosis is a disease that often occurs in the general population. It is an infectious disease caused by a virus. It most often occurs in teenagers and young people, which is why it is called "kiss disease". In 90% of cases the cause is Epstein-Barr virus, and in 10% of cases cytomegalovirus. It is estimated that one in four infected people develops symptoms of the disease. And it is estimated that 80 to 90 percent of adults become carriers of the virus by the age of 40.

How is mononucleosis transmitted and how long does incubation last after infection?

Although it is considered a disease of teenagers and young people, infectious mononucleosis often occurs in early childhood in children up to six years. In young children it usually passes asymptomatically or in a mild form of the disease and therefore often remains undiagnosed. The severity of the disease can be the same as in adolescents and can cause moderate to severe forms of the disease. The virus is spread through close contact with the saliva of an infected person. In younger children, the virus can be transmitted by sharing cutlery, drinking glasses or toys in kindergarten. The virus can also be spread by coughing or sneezing, so children can often become infected through interaction with children in kindergarten, daycare or school. The incubation period is two to eight weeks after infection.

What are the symptoms of mononucleosis?

- The symptoms of mononucleosis can be similar to other conditions, so the infection often goes undiagnosed. Every child or adult can have different symptoms of the disease. Young children usually have a mild and short-lived form of the disease, which is usually with signs of a sore throat and a slight fever. However, in children up to six years of age, as well as in older children, the disease can manifest itself in a more severe form of the disease. More severe forms of the disease show signs of fever, chills, headache, malaise, sore throat, enlarged glands, especially in the neck, enlarged spleen and / or liver. Symptoms usually last for five to seven days, but in adolescents and young people with more common and severe forms of the disease, the symptoms can last up to several weeks after the onset of the disease. In severe cases of the disease, there is a pronounced swelling of the tonsils with the presence of pseudomembranous deposits. In some cases, both young children and adults may additionally have pathogenic bacteria in their throat that cause a secondary bacterial infection. Enlarged glands in the neck appear in all patients, both children and adults, and in some enlarged glands appear in other areas of the body (groin, armpits). An enlarged spleen occurs in 50 to 75 per cent of patients, and an enlarged liver is less common.

How is mononucleosis diagnosed?

- The diagnosis of the disease is usually based on the symptoms and can be confirmed by general laboratory tests and specific tests. The diagnosis of the disease is confirmed by proving the presence of antibodies to Epstein-Barr virus in the blood (Paul-Bunnell test).

How is this disease treated?

- Treatment of mononucleosis is symptomatic because the disease is caused by a virus. Treatment includes increased fluid intake and rehydration, antipyretics and analgesics, preservatives, foods rich in vitamins, minerals and fresh nutrients, and rest, especially in cases of enlarged spleen or liver. In cases where a secondary bacterial infection in the throat has been demonstrated, especially with beta-haemolytic streptococcus, it is necessary to include antibiotic therapy with penicillin for ten days or another antibiotic in people who are allergic to penicillin.

What should be considered and what measures should be taken to prevent the spread of the disease?

- Recovery and withdrawal of symptoms occurs gradually, usually within three to five weeks from the onset of the disease, and in severe cases longer. Because it is a viral disease that is primarily transmitted through the saliva of a patient, greater hygiene measures are needed to prevent the spread of the disease. This is especially important to prevent the spread of the infection in kindergartens and day care for children where the possibility of spreading through toys and cutlery is greater.

The prognosis of the disease is good and recovery is complete in all children and young people. However, infectious mononucleosis is a disease that, despite its good prognosis and easy course, requires a serious approach to treatment to achieve complete recovery. Therefore, timely diagnosis of the disease and appropriate treatment are necessary for faster and complete recovery.

Elena Manoleva Nikolovska, PhD
Specialist pediatrician