Works Cited

Bushak, L. (2014 May). Mono a Mono: How the Kissing Disease Knocked Me Off My

Feet and Taught Me Personal Health. Medical Daily. Retrieved June 19, 2015 from http://www.medicaldaily.com/mono-mono-how-kissing-disease-knocked-me-my-feet-and-taught-me-personal-health-283140

CDC (n.d.). About Infectious Mononucleosis. Retrieved on June 19, 2015 from

http://www.cdc.gov/epstein-barr/about-mono.html

Chamberlain, N. (2014 November). Infectious Mononucleosis. Retrieved June 19,

2015 from http://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/mono.htm

Hosoi, H., Soniki, T., Murata, S., Mushino, T., Kuriyama, K., Nishikawa, A., Hanaoka, N.,

Ohshima, K., Imadome, K., Nakakuma, H. (2015). Successfule Immunosuppressive Therapy for Severe Infectious Mononucleosis in a Patient with Clonal Proliferation of EBV-infected and CD8-positve Cells. Internal Medicine, 54, 1537-1541. Retrieved June 19, 2015 from https://www-jstage-jst-go-jp.proxy-um.researchport.umd.edu/article/internalmedicine/54/12/54_54.3201/_pdf

Ebell, M. (2004 October). Epstein-Barr Virus Infectious Mononucleosis. American

Family Physician. 70(7), 1279-1287. Retrieved June 19, 2015 from http://www.aafp.org/afp/2004/1001/p1279.html

Padiatr, K., (1991). 100 Years of Pfeiffer’s Glandular Fever. Klinische Padiatrie.

203(3), 187-190. Retrieved June 19, 2015 from http://www.ncbi.nlm.nih.gov/pubmed/1857056

Review of Media Article

Photo from Shutterstock

Mono a Mono: How the Kissing Disease Knocked Me Off My Feet and Taught Me Personal Health 

This is an article written by Lecia Bushak. It was published on a website called Medical Daily in May of 2014. Lecia writes about the truths of mononucleosis and how the disease affected her physically and emotionally. Lecia was diagnosed with mononucleosis when she was twenty three. At the time she was an avid exerciser and hard worker. She biked, swam, and ran all before she would go to her full time job. Her first week with mononucleosis she felt extreme fatigue after doing all of her daily activities which was unusual for her. She also became depressed and was feeling feverish. She went to the doctor where she received blood tests and was diagnosed with mononucleosis. She was told she needed to drink plenty of fluids and get rest to flush the virus out. As the infection progressed, Lecia was barely eating, could barely do daily activities due to extreme fatigue, and had severe abdominal pain because of her enlarged spleen. She began feeling more depressed because Lecia couldn't live her active lifestyle. Her symptoms began to decrease as the infection was being flushed out but she still suffered from fatigue for around three months. Although during her infection she felt feelings of unproductiveness and depression, Lecia learned a lot through this experience. She learned how to relax and manage her stress and health. When she was diagnosed with mononucleosis Lecia was stressed at work and was running her body into the ground due to lack of rest. Mononucleosis helped her slow down and learn to take care of herself.

After reading this article, I found it to be an extremely helpful article to those infected and suffering from mononucleosis. Not only did this article provide scientific facts about mononucleosis but it also provided a personal experience that people could relate to. By sharing her story, Lecia provided people with truthful knowledge about what they might go through when diagnosed with mononucleosis. Lecia also provided insightful knowledge about how to cope with not being able to be as active as one might have been before being infected. Although multiple websites provide the symptoms of mononucleosis, it is hard to imagine how that affects your body. Lecia successfully portrayed the effects mononucleosis had on her and made it easier to imagine going through that experience. 

Review of Primary Article

Successful Immunosuppressive Therapy for Severe Infectious Mononucleosis in a Patient with Clonal Proliferation of EBV-infected CD8-postive Cells 

This is a study conducted in 2015 and was published in Internal Medicine. The study focuses on a treatment for a rare form of mononucleosis. Normally, mononucleosis infects beta lymphocytes and other Epstein-Barr viruses (EBV) infect T-cells, which can result in death. It is important to decipher which lymphoid cells are being infected because that determines the type of treatment needed. Immunological responses to EBV-infected cells can cause organ damage and hemophagocytic lymphohistiocytosis (HLH). This can be treated with immunosuppressive therapy to reduce excessive immune response. Sometimes EBV-infected cells go through clonal proliferation leading to EBV-associated malignant lymphoma, which is treated with chemotherapy. Southern Blots are used to detect the clonal proliferation of infected cells. The clonal proliferation is a characteristic of malignancy and supports the indication for chemotherapy.

The researchers studied a case where a woman contained clonal proliferation EBV-infected T-cells that responded to immunosuppressive therapy instead of chemotherapy. A thirty year old woman was admitted to the hospital with a sore throat, fever, HLH, elevated lymphoid cells, and elevated liver enzymes. Based on these features she was diagnosed with mononucleosis; however, there was expansion in her CD8-postive T-cells indicating clonal proliferation. To further determine if the patient had mononucleosis or lymphoma, a biopsy was taken of her lymph nodes. It was determined that she was suffering from mononucleosis. She was treated with immunosuppressive therapy. This resulted in reduction of HLH, decrease in liver damage, and decrease in infected CD8-positive T-cells. After four months the EBV was undetectable in the cells and the antibody IgM titer became negative. This study concluded that clonal proliferation of CD8-positve T-cells doesn't always indicate malignant lymphoma and can be treated with immunosuppressive therapy instead of chemotherapy.

This is a table from the study demonstrating the positive effect immunosuppressive therapy had on the patient.

After reading this study, I suggest that scientists research other treatments that can effectively stop the clonal proliferation of CD8-positive T-cells. If further research is conducted on more treatments then there will be more options for treatment of extreme cases of mononucleosis and maybe even malignant lymphoma.

Transmission, Treatment, and Prevention

Transmission 

Mononucleosis is transmitted from person to person. It can be transmitted through infected cervical secretions. Mononucleosis is mainly transmitted, however, through oral secretions, especially saliva. Due to the main form of transmission, mononucleosis is also known as "the kissing disease" (Chamberlain). Mononucleosis has the highest rates of incidence in young adults between the ages of fifteen and twenty five. 

Treatment 

The main form of treatment is hydration, nonsteroidal anti-inflammatory drugs or acetaminophen to reduce fever and pain, throat lozenges, and gargling with salt water to reduce pharyngeal discomfort, and plenty of rest (Ebell). Mononucleosis contains similar symptoms to bacterial pharyngitis or strep throat. If doctors only base their diagnosis on clinical symptoms, the patient with mononucleosis may receive antibiotic treatment like ampicillin or amoxicillin. If prescribed these drugs, patients with mononucleosis can develop rashes on their bodies which mislead physicians into thinking the patients are allergic to these antibiotics (Chamberlain). 

Prevention 

There is no vaccine to prevent mononucleosis. To protect yourself from contracting this disease, you should not kiss or share drinks, food, and personal items with someone who is infected with mononucleosis (CDC).

Picture retrieved from RBSS Infectious Diseases

I think these preventative and treatment methods are effective. Antibiotic resistance is a problem in the world that is becoming increasingly larger due to the overuse of antibiotics. Mononucleosis is effectively treated without the use of antibiotics and is therefore not contributing the the overuse of antibiotics creating the problematic antibiotic resistance.

Symptoms, Statistics , Etiology, and Diagnostic Tests

Symptoms and Statistics

Mononucleosis is a viral infection caused by Epstein-Barr virus (EBV). This disease is common in children and adolescents. Typical symptoms of mononucleosis are fever, pharyngitis, swollen lymph nodes, atypical lymphocytosis, enlarged spleen, sore throat, and fatigue (Ebell). Most young children are asymptomatic whereas symptoms are more pronounced in young adults (Chamberlain). Mononucleosis has the highest rates of incidence in young adults between ages fifteen and twenty five. The incidence rates range from eleven to forty eight cases per one thousand persons. The incidence rate in people younger than ten years old and older than thirty years old is less than one case per one thousand people (Ebell).

Picture retrieved from www.medicinenet.com

Etiology 

EBV is a virus that replicates in beta lymphocytes. The incubation period for EBV is around four to eight weeks. EBV invades beta lymphocytes by means of their CD21 receptors and within eighteen to twenty four hours the EBV antigens are detectable. The infected beta lymphocytes spread the disease throughout the reticuloendothelial system (liver, spleen, peripheral lymph nodes). EBV initiates beta lymphocyte proliferation and immortalization causing the lymphocytes to become antibody-producing plasma cells. Some of the antibody-producing plasma cells produce antibodies that react with EBV antigens and some do not. During the acute phase, twenty percent of circulating beta lymphocytes will produce EBV antigens (Chamberlain).

Diagnosis

Diagnosis of mononucleosis involves the detection of atypical lymphocytes in peripheral blood smears. During acute mononucleosis, the number of lymphocytes increases around sixty percent in the peripheral blood. Of those lymphocytes, around ten percent are atypical lymphocytes. The presence of atypical lymphocytes in the blood is the earliest indication of mononucleosis infection. As previously mentioned, EBV causes beta lymphocytes to produce antibodies called immunoglobin. Some of these plasma cells multiple and produce immunoglobin M (IgM) which does not react with EBV antigens but does react with antigens on sheep. IgM antibodies are then called heterophile antibodies because they react with something other than the EBV antigens. The heterophile antibodies are greatest in number during the first four weeks of infection. Heterophile antibody tests are used to detect the heterophiles antibodies. If heterophiles antibodies cannot detected, blood testing for specific EBV antibodies can be conducted (Chamberlain).

This table is an example of the table used when conducting the blood test that tests for specific EBV antibodies. Picture retrieved from Chamberlain.  

History

Mononucleosis was first discovered in the by Emil Pfeiffer in 1889; However, at this time, the disease was known as glandular fever. Pfeiffer characterized the disease as an infectious disease with symptoms of a fever, swelling of the lymph nodes, enlargement of the spleen, and pharyngitis. In 1920, Sprunt and Evans gave glandular fever the term mononucleosis. Then Paul and Bunnell discovered the presence of heterophil antibodies in mononucleosis in 1932. Mononucleosis was then found to have relations to Epstein-Barr virus (EBV) in 1968 by Henle and Henle. With this connection, the pathogenesis of mononucleosis was soon determined ( Padiatr). These important findings allowed for future research into the clinical course of mononucleosis.