The “Kissing Disease”
“Kissing disease” is referred to as infectious mononucleosis, also known as "mono". It is a viral infection caused by Epstein-Barr virus (EBV), which most commonly occurs in adolescents and young adults.
In general, mononucleosis is not considered a serious illness. However, mononucleosis can lead to significant loss of time from school or work due to profound fatigue and, on rare occasions, can cause severe or even life-threatening illness.
Symptoms of kissing disease
Most young children who become infected with EBV do not develop symptoms. In contrast, people who are first exposed to EBV as adolescents or adults are more likely to develop symptomatic infection due to the way their immune systems respond to the virus at older ages.
It may take 4 to 8 weeks after initially acquiring the virus for the first symptoms (body aches, headache, low-grade fever) to appear. The most common symptoms include:
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Fever
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Sore throat
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Enlarged lymph nodes (glands) in the neck
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Fatigue, which may be severe and can occasionally last for more than a month
Some people have all of these symptoms, while others have only one or two symptoms, such as sore throat or fever and enlarged lymph nodes. Young children and older adults may have only a fever and muscle aches.
Sometimes, people with EBV have enlarged spleen (located in the left upper abdomen, as shown in the picture below). If the spleen becomes enlarged, doctors recommend avoiding contact sports or heavy lifting for a few weeks. This advice is given to prevent the rare complication of splenic rupture that can occur after trauma but can also happen spontaneously. Symptoms of rupture include sudden, sharp pain in the abdomen. This is a potentially life-threatening complication that requires immediate medical treatment.
You might need to visit a doctor if you have sudden, sharp pain on the left side of the abdomen, peeing very little urine, having trouble breathing, or your symptoms do not go away after 4 to 6 weeks of infection.
How did you get kissing disease?
EBV can spread through contact with saliva from an infected person; for example, you can get it through kissing, sharing eating utensils with, or drinking from the same glass as someone who is infected with the virus. Hence to avoid the infection is to stay away from the ones who catch the disease. Do not share items.
Many people are exposed to EBV at some point during childhood, although they may not realize it at the time. For adolescents and young adults who were not infected as a child, exposure often results from contact with an infected person's saliva. After a person has been exposed, it is possible for the virus to remain in their body for months or even years, meaning they could spread the infection to others during this time without realizing they are contagious. In addition, it may also be possible to spread the virus through other bodily fluids, such as semen or vaginal secretions.
How is it treated?
The goal of the treatment is to ease the symptoms while the immune system contains the virus.
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Pain and fever — Sore throat, muscle aches, and fever can be treated with over the counter over-the-counter medications, such as paracetamol (sample brand name: Panadol) or some painkillers such as NSAIDs (sample brand names: Nurofen, Voltaren).
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Rest — Kissing disease can cause severe fatigue, although most people recover within 2 to 4 weeks. For some, significant tiredness lasts for weeks to months.For early stages in the infection, it is important to get adequate rest, although complete bed rest is unnecessary.
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Diet — Feeling ill often causes a loss of appetite. This is normal and usually improves as the infection resolves. It is essential, even if you have no appetite, to drink an adequate amount of fluids. How do you know that you are drinking adequate fluids? - your urine is a pale yellow colour and your oral mucosa is moist.
Note: Antibiotics (which are used to treat bacterial infections) are not helpful because it is a viral infection. There are no antiviral medications that are known to treat or cure EBV effectively.
When can you go back to work or school?
Many people with EBV develop an enlarged spleen, which can last for a few weeks or longer. Although you can return to school or work when you are feeling better, it's important to avoid activities that can cause injury to the spleen.
Experts generally recommend that athletes not participate in contact or vigorous sport activities for at least the first 3 to 4 weeks of the illness. Your health care provider should determine when it is safe for you to participate in strenuous activities or contact sports.
When you do begin participating in sports activities again, it is recommended to start slowly, and increase the activity gradually. Even highly trained athletes may not feel as fit after infection as they did before the illness.
Medically reviewed by Ashwini Nair, MB BCh BAO.
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References:
1. Patient education: Infectious mononucleosis (mono) in adults and adolescents (Beyond the Basics) - UpToDate. Accessed May 7, 2022. https://www.uptodate.com/contents/infectious-mononucleosis-mono-in-adults-and-adolescents-beyond-the-basics?search=kissing%20disease%20patient%20education&source=search_result&selectedTitle=3~73&usage_type=default&display_rank=3#H1
2. Infectious mononucleosis - UpToDate. Accessed May 7, 2022. https://www.uptodate.com/contents/infectious-mononucleosis?search=kissing%20disease&source=search_result&selectedTitle=1~73&usage_type=default&display_rank=1#H45
