How it manifests itself
The incubation period is long - from 4 to 6 weeks, so it is rarely possible to remember the source of infection. The disease often begins gradually: several days of weakness and low-grade fever, and then a characteristic triad unfolds - sore throat, enlarged lymph nodes and fever.
- Severe sore throat, enlarged tonsils, often with massive plaques
- Difficulty in nasal breathing and a nasal voice in the usual absence of a runny nose is a typical sign
- Enlarged lymph nodes, primarily the posterior cervical and occipital ones; they are dense and moderately painful
- Temperature 38–39 °C, which can last 1–2 weeks
- Enlarged liver and spleen
- Severe weakness out of proportion to other symptoms
- Swelling of the eyelids, sometimes a small rash
In young children, the disease often goes away and is not recognized at all: a few days of fever, a slight enlargement of the lymph nodes - and that’s all. The older the person, the brighter and more severe the picture, so teenagers and young adults fall out of their usual rhythm for two to three weeks, and this is expected, and not a sign of complications.
Antibiotic trap
The picture of mononucleosis is very similar to bacterial tonsillitis: high fever, plaque on the tonsils, enlarged lymph nodes. Therefore, the patient is often prescribed ampicillin or amoxicillin. After a few days, a profuse maculopapular rash appears over the entire body and is mistaken for a penicillin allergy.
- A rash due to ampicillin in mononucleosis develops in the vast majority of patients
- This is not a classic allergy, but a special reaction against the background of a viral infection
- An erroneous diagnosis of “penicillin allergy” remains on the chart for decades and deprives a person of the safest and cheapest antibiotics
- Therefore, for a sore throat with enlarged posterior cervical lymph nodes and great weakness, the doctor first excludes mononucleosis
- Antibiotics for uncomplicated mononucleosis are not needed in principle: it is a viral infection
An antibiotic is added only if a bacterial infection is confirmed against the background of mononucleosis - then a drug from a different group is chosen. This decision is made by the doctor based on the results of the examination and tests, and not just on the type of plaque on the tonsils.
Why you can't play sports
The spleen enlarges in most patients, its capsule stretches and becomes fragile. During this period, even a slight blow to the stomach, a sharp jerk or lifting of weight can cause organ rupture - a condition with massive internal bleeding, requiring emergency surgery.
- Контактные виды спорта, единоборства, футбол, баскетбол исключаются минимум на 4 недели от начала болезни, чаще на 4–6 недель.
- Силовые тренировки, подъём тяжестей и упражнения на пресс — под тем же запретом.
- Возвращение к нагрузкам разрешает врач после осмотра, а при значительном увеличении органа — после контрольного УЗИ.
- Разрыв селезёнки может произойти и без явной травмы, поэтому натуживание при запорах в этот период тоже нежелательно.
- Опасный признак — внезапная боль в левом подреберье, отдающая в левое плечо, с нарастающей слабостью и бледностью. Это повод вызывать скорую, а не ждать до утра.
Survey
The diagnosis in a typical case consists of an examination and a routine blood test, and expensive tests are not always needed. It is only important to remember the timing: characteristic changes in the blood do not appear on the first day, so a test taken too early may not provide an answer.
- Общий анализ крови с формулой — ключевой и самый доступный метод: обнаруживаются атипичные мононуклеары, повышение числа лимфоцитов, характерные изменения появляются обычно со второй недели болезни.
- Антитела к вирусу Эпштейна — Барр: наличие иммуноглобулинов M к капсидному антигену говорит об острой инфекции, а иммуноглобулины G к ядерному антигену — о перенесённой ранее.
- ПЦР крови на ДНК вируса — применяется в сомнительных случаях и у пациентов со сниженным иммунитетом.
- Печёночные ферменты: умеренное повышение встречается очень часто и обычно проходит само.
- УЗИ органов брюшной полости — оценка размеров печени и селезёнки.
- Мазок of зева и экспресс-тест на стрептококк — чтобы не пропустить сопутствующую бактериальную ангину.
Treatment and recovery
Treatment of mononucleosis almost entirely comes down to competent care. This is the case when the doctor’s restraint is a sign of qualification, not indifference: extra drugs here only add stress to the liver, which, during this infection, is already working under strain.
- No specific antiviral treatment is required: the body copes on its own, and drugs do not reduce the disease
- The basis is rest, drinking plenty of fluids, painkillers and antipyretics in regular doses.
- For severe sore throat, gargles and local anesthetics help, it is important to continue drinking, even if it hurts to swallow
- Hormonal drugs are used only when there is a threat of blocking the airways due to swollen tonsils and according to the doctor’s decision
- Diet with limited fat during the period of elevated liver enzymes
- Complete abstinence from alcohol until liver function levels return to normal
Weakness is the longest lasting symptom. Fever and sore throat disappear within 1–2 weeks, lymph nodes shrink somewhat longer, and fatigue may persist for 1–2 months. This is an expected course, not a complication, and there is no use in rushing it: attempts to quickly return to the previous rhythm usually end in a rollback.
What is important to know after illness
A whole market of unnecessary examinations and courses of treatment has developed around the Epstein-Barr virus. Let's look at what the test results mean, which are often brought to an appointment years after the illness.
- People don’t get sick with mononucleosis again: after an infection, a strong immunity is formed
- The virus remains in the body for life in an inactive state, like other herpes viruses, and is periodically released in saliva - this is normal and does not require treatment
- Detection of class G antibodies in the blood only means a past infection and cannot be treated in itself
- Most adults are infected with this virus, but for many, infection in childhood went away like a common mild cold.
- Courses of immunomodulators “to combat the Epstein-Barr virus” in a healthy person with antibodies are not justified