Friday, 11 October 2013

Lip locking, tonsil tennis and infectious mononucleosis: stop smooching?

by Chloe Palmer 

Infectious mononucleosis (IM), more commonly known as glandular fever or ‘the kissing disease’ is an extremely contagious viral disease predominantly caused by the Epstein-Barr Virus (EBV).  Sprunt and Evans in the Bulletin of the Johns Hopkins Hospital first described IM in 1920, however the association between this and EBV was not defined until the late 1960’s. EBV is a type of Herpes virus (Human Herpes Virus-4) containing double-stranded DNA, an icosahedral capsid and a glycoprotein-containing envelope. IM is spread via saliva, and just like all Herpes viruses they become a life companion…or not. The virus has an initial incubation period so an individual may be unaware that they are infected until 4-8 weeks later.  By this point, however, you can be sure that your oropharangeal epithelial cells and B-lymphocytes have taken a massive beating.

IM primarily and most commonly affects teenagers and young adults between the ages of 15-25, probably because school socials and university are saliva-swapping playgrounds (unless you do a science degree in which case you probably don’t get out as much). Initially this sub-clinical infection is asymptomatic but as it progresses characteristic symptoms include a sore throat, fatigue, prolonged malaise, swollen lymph nodes, vomiting, muscle and headaches high fever, a lack of energy and a loss of appetite. Diagnosis may be clear from the symptoms but this can be confirmed by a blood test.

Although both mortality and morbidity rates are low, according to the World Health Organization (WHO) serologic tests have shown that approximately 95% of adults worldwide have been infected with EBV.

There is currently no available treatment for this viral infection, however an EBV vaccine is currently in clinical trials, targeting its envelope glycoproteins (gp350/220). Not only will this be a break-through in preventing IM but also decrease the risk of other associated EBV infections such as Burkitt’s lymphoma and nasopharangeal carcinoma. For now pain relief pills...yes, the same ibuprofen that matron gave you at school may be ‘prescribed’ but as any G.C.S.E science student could inform you, antibiotics would have no effect (bar an unwanted red rash) since this is not a bacterial disease. The question still remains when to vaccinate individuals: pre-infection, post-infection or therapeutically, not aided by the fact that EBV expresses different proteins during its lytic and latent phases.