The Many Faces of Infectious Mononucleosis: The Spectrum of Epstein-Barr Virus Infection in Children

Abstract

Infectious mononucleosis is a disease well known to every pediatrician. Who has not seen the previously robust teenager who slowly becomes less active, develops lowgrade fever and a sore throat, and complains of being tired all the time? Upon arriving at the physician's office with these complaints the teenager is usually given a "Mono-Spot" test (almost routinely). The test results are often strongly positive. The pediatrician then must discuss the diagnosis with both the teenager and the parents and must respond to the attendant questions. Is the disease really acquired by kissing? How serious is it? Are there any lasting effects? Will the feeling of tiredness ever go away? Is infectious mononucleosis a form of cancer? Can I have the disease more than once? Is there any therapy? The answers to many of the above questions have changed dramatically over the last 5 to 10 years. The spectrum of infectious mononucleosis continues to be expanded and now includes acute, subacute, and chronic disease states, each with its own separate set of problems. Subclinical disease can now be diagnosed in younger children with an obscure febrile illness. On rare occasions, overwhelming infectious mononucleosis results in death in some young children, especially boys.