Infectious Mononucleosis [Kissing Disease] 

- vs -

Chronic Fatigue Syndrome [CFS]

I. Infectious Mononucleosis - Kissing Disease

Infectious mononucleosis (mono), or glandular fever, is often called the kissing disease. The label is only partly true. Kissing can spread the virus that causes this disease, but more commonly coughing, sneezing, or sharing a glass or cup transmits mononuviruscleosis. It's not highly contagious. It is on oe fht eetiological factors of Mononucleosis is caused by the Epstein-Barr virus. EBV is a member of the herpes virus family. It's one of the most common viruses that affect humans. Most people have been exposed to EBV by age 35 and have developed antibodies to it. As a result, they're immune and rarely get it again. It was once thought that EBV may cause chronic fatigue syndrome/CFS which is similar to chronic mononucleosis. But doctors no longer believe this is true. 

Mononucleosis usually isn't very serious, although the virus remains in your body for life. Some people with mono have minimal symptoms, and the infection goes unrecognized. 

FM: Considered as one of the entities forming the: AIDS-Related Syndromes: Chronic Fatigue Syndrome=CFSChronic Fatigue Syndrome/CFS

Most people have been exposed to the Epstein-Barr virus by the time they're 35 years old and have built up antibodies. They're immune and won't get it again. Full-blown mononucleosis is common in people ages 7 to 35, and the highest incidence is in people between the ages of 15 and 24. In non-Western countries, mononucleosis has become increasingly common in children younger than 3 years.

Etiology or Cause: Infection caused by viruses, the most common being the Epstein-Barr Virus.

Signs and symptoms of mononucleosis may include:

In children between the ages of 4 and 15, the virus may cause a mild illness that resembles a common respiratory infection. In older adults, mono causes more severe symptoms and lasts longer.

The virus has a long incubation period of 30 to 50 days. Once symptoms develop, they usually lessen within 10 days, although fatigue may last for much longer. If symptoms linger more than 2 weeks or recur, see your doctor.

When to seek medical advice: 

If you have been feeling tired and weak; have had a persistent fever, headache, loss of appetite, rash and muscle aches; and have had swollen lymph nodes, tonsils and spleen - these are strong indications that you have mononucleosis. 

If rest and a healthy diet haven't resulted in easing your symptoms within a week or two or if your symptoms recur, see your doctor.

Diagnosis & Screening:

Your doctor may suspect mononucleosis based on your symptoms and a physical examination.

If there's a need for additional confirmation, a Monospot test is generally done. This is a blood test that can indirectly indicate the presence of the Epstein-Barr virus. Occasionally, additional, more specific blood tests are needed to diagnose mononucleosis.

Complications: Significant complications of mononucleosis include:

Splenomegaly and, in extreme cases, the spleen may rupture, causing sharp, sudden pain in the left side of your upper abdomen. If such pain occurs, seek medical attention immediately - you may need to have surgery.

Mononucleosis can also result in the following other complications:

Researchers are investigating a possible link between mononucleosis and an increased risk of developing multiple sclerosis - a muscle-weakening disease of unknown cause. In one study, women who had mononucleosis as teenagers were more than twice as likely to receive a diagnosis of multiple sclerosis than were women who never had the infectious disease. In another study of more than 60,000 women, researchers found that study participants who had multiple sclerosis had higher antibody levels to the Epstein-Barr virus in their blood compared with those without multiple sclerosis. However, because so few people exposed to the Epstein-Barr virus ever develop multiple sclerosis, scientists point out that other factors must be involved in causing the disease.

Treatment:

There's no specific therapy available to treat infectious mononucleosis. Antibiotics don't work against viral infections such as mononucleosis. Treatment mainly involves bed rest and adequate fluid intake.

Occasionally, a streptococcal (strep) infection accompanies the sore throat of mononucleosis. You may also develop a sinus infection or an infection of your tonsils (tonsillitis). If so, you may need treatment with antibiotics for these accompanying bacterial infections. 

To treat some of the complications of mononucleosis, your doctor may prescribe a corticosteroid medication such as prednisone. Corticosteroids may ease symptoms but won't shorten the overall course of the disease.

Prevention:

The Epstein-Barr virus spreads by intimate contact. If you have mononucleosis, you can help prevent spreading the virus to others by not kissing them and by not sharing food, dishes, glasses and utensils until several days after your fever has subsided. If you've had infectious mononucleosis, don't donate blood for at least 6 months after the onset of the illness. There's no vaccine to prevent mononucleosis.

Self Care:

In addition to getting plenty of bed rest, these steps can help relieve symptoms:

Drink plenty of water and fruit juices. Fluids help relieve fever and sore throat and prevent dehydration. 
Take an over-the-counter pain reliever. Use pain relievers such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) as needed. But don't give aspirin to a child under age 16. Aspirin may trigger a rare but potentially fatal disorder known as Reye's syndrome.
Gargle with salt water. Do this several times a day to relieve sore throat. Mix one-half teaspoon salt in a glass of warm water.

Most symptoms of mono ease within 10 days, but don't expect to return to your normal activities for 2 to 3 weeks. And it may be 2 to 3 months before you feel completely normal. 

Returning to your usual schedule too soon can increase the risk of a relapse. If you're an athlete, you need to be cautious about returning to strenuous activities, such as contact sports, when your spleen is enlarged because of the increased risk of rupturing the spleen. Children with mononucleosis and an enlarged spleen shouldn't engage in vigorous activities, roughhousing or contact sports for the same reason. Rupture of the spleen results in severe bleeding and is a medical emergency.

Although you may not be able to return to vigorous activities right away, your doctor may recommend gradual exercise to help you rebuild your strength as you recover from mononucleosis. Some people appear to develop chronic fatigue syndrome - a disorder characterized by persistent fatigue, painful joints and sore muscles - following mononucleosis infection. Doctors aren't sure why, but at least one study points to deconditioning as a possible cause.

Coping Skills:

Mononucleosis can be a prolonged condition, keeping you at home for weeks as you recover. But be patient with your body as it fights the infection. 

For the first week, you may be so fatigued that you feel too weak to even get out of bed. But the tiredness lessens with time. Throat soreness is generally the worst for the first 5 to 7 days of illness, but then it subsides. Your swollen lymph glands should return to normal size by the third week of infection. 

For young people, having mononucleosis will mean some missed activities - missed classes, team practices and parties. Without doubt, you'll need to take it easy for a while.

If you have mononucleosis, you don't necessarily have to be quarantined. Many people are already immune to the Epstein-Barr virus that causes the disease because of prior exposure to the virus as a child. But plan on staying home from class and other activities until you're feeling better. 

Seek the help of friends and family as you recover from mononucleosis. College students should also contact the campus student health center staff for assistance or treatment, if necessary.

II. Chronic fatigue syndrome: CFS

CFS is a complicated disorder characterized by profound fatigue that doesn't improve with bed rest and may worsen with physical or mental activity. Of all chronic illnesses, CFS is one of the most mysterious. Unlike infections, it has no clear cause. Unlike conditions such as diabetes or anemia, there's essentially nothing to measure. And unlike conditions such as heart disease, there are relatively few treatment options.

CFS may occur after an infection such as a cold, bronchitis, mononucleosis, hepatitis or intestinal illness. It can start during or shortly after a period of high stress or come on gradually without any clear starting point and any obvious cause. CFS is a flu-like condition that can drain your energy and sometimes last for years. People previously healthy and full of energy may experience extreme fatigue, weakness and headaches as well as painful joints, muscles and lymph nodes.

Women are diagnosed with CFS two to four times as often as men are. However, it's unclear whether CFS affects women more frequently or if women report it to their doctors more often than men do. An estimated 500,000 people in the United States have a CFS-like condition. CFS can affect a person of any age or race.

Etiology-Cause: Doctors don't know the cause of CFS. Several possible causes have been proposed, including:

Mechanism: probably due to an inflammation of the pathways of the nervous system as a response to an autoimmune process, but with nothing measurable in the blood like in other autoimmune diseases such as rheumatoid arthritis or lupus. CFS may also occur when a viral illness is complicated by a dysfunctional immune system. Some people with CFS may have a low blood pressure disorder that triggers the fainting reflex.

In most cases, however, no serious underlying infection or disease is proved to specifically cause CFS. Lack of medical knowledge and understanding of CFS has made determining and describing the characteristics of CFS difficult.

Risk Factors: Women are diagnosed with CFS two to four times as often as men are, but sex isn't a proven risk factor for the condition. Because the cause of CFS is unknown, doctors have yet to determine and confirm definite risk factors for the disease.

Signs & Symptoms:

CFS exhibits signs and symptoms similar to those of most common viral infections. Unlike flu (influenza) symptoms, which usually subside in a few days or weeks, the signs and symptoms of CFS can last for months or years. They may come and go frequently with no identifiable pattern.

According to the International Chronic Fatigue Syndrome Study Group - a group of scientists, researchers and doctors brought together by the Centers for Disease Control and Prevention (CDC) to determine a standard method for defining and diagnosing CFS - a person meets the diagnostic criteria of CFS when unexplained persistent fatigue occurs for six months or more with at least four of the eight primary symptoms also present.

Signs & symptoms include:

People with CFS usually experience the most severe symptoms within the first one to two months of illness. After that, a small number of those affected recover completely while a small percentage of others become incapacitated by their symptoms. However, for most people a gradual improvement occurs, although those affected by CFS often don't regain their normal level of energy.

When to seek medical advice: 

Fatigue can be a symptom of many illnesses such as infections or psychological disorders. In general, see your doctor if you have fatigue that is excessive or persists for several weeks. Severe fatigue that prevents you from fully participating in activities at home, work or school may be a sign of an underlying medical condition.

Diagnosis & Screening:


A diagnosis of CFS is based on exclusion. This means that before diagnosing CFS, a doctor has ruled out any other disease or condition that may be causing your fatigue and related symptoms. 

In general, doctors find it difficult to diagnose CFS because it has some of the same symptoms as many other diseases. There's no diagnostic or laboratory procedure to confirm the presence of CFS. 

Doctors rule out certain conditions before considering a diagnosis of CFS. These include:

Having an active medical condition that often results in fatigue, such as low levels of thyroid hormones (hypothyroidism) or sleep apnea 
Using medicines that may cause fatigue 
Having a relapse of a previously treated illnesses that can result in fatigue, such as cancer 
Having had a past or current diagnosis of a major depressive disorder or other psychiatric illness such as schizophrenia, dementia or an eating disorder 
Abusing alcohol or another substance 
Being severely obese, as defined by a body mass index (BMI) of 45 or greater

In talking with your doctor, be alert to any new clues or symptoms that may show that the problem is caused by something other than CFS. When other diseases or conditions are ruled out, your doctor may then determine if your illness meets specific criteria.

Complications: Possible complications of CFS include:

The long-term outlook for people with CFS varies and is unpredictable. Some people recover completely after six months to a year. For others, total recovery takes longer.

Treatment: There's no specific treatment for CFS. In general, doctors aim to relieve symptoms by using a combination of the following steps:

Lifestyle changes. Your doctor may encourage you to slow down and to avoid excessive physical and psychological stress. This may save your energy for essential activities at home or work and help you cut back on less important activities. 

Gradual but steady exercise. Often with the help of a physical therapist, you may be advised to begin a graded exercise program in which physical activity gradually increases. This can help prevent or decrease the muscle weakness caused by prolonged inactivity. In addition, your energy level can often improve significantly. 
Treatment of psychiatric problems. Doctors can treat problems often related to CFS, such as depression, with medication, behavior therapy - learning to change your behavior to reduce the symptoms of a certain disease or condition - or a combination of the two. If you're depressed, medications such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may help. Tricyclic antidepressants include amitriptyline (Elavil), desipramine (Norpramin, Pertofrane) and nortriptyline (Aventyl, Pamelor). SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft) and citalopram (Celexa). 

Treatment of existing pain. Acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin, others) may be helpful for headaches, muscle pain and joint pain associated with CFS. 

Treatment of allergy-like symptoms. Antihistamines such as fexofenadine (Allegra) and loratadine (Claritin) and decongestants that contain pseudoephedrine (Sudafed, Dimetapp) may relieve allergy-like symptoms such as runny nose. 

Treatment of low blood pressure (hypotension). The drug fludrocortisone (Florinef), a form of cortisone that retains fluid in the body and raises blood pressure, has been studied as a treatment for CFS. However, the use of this drug, either alone or in combination with hydrocortisone, another corticosteroid, has not been proved to be effective in the treatment of CFS. 

Some medications can cause adverse reactions or side effects that are worse than the original symptoms of CFS. Talk to your doctor before starting any treatment for CFS.

Not everyone with CFS benefits from any or all of the common treatment options. Research shows that both gradually increasing (graded) exercise and behavior therapy can work for some, but not all, people.

Prevention:

Because the cause of CFS remains unknown, there's no way to prevent the illness from occurring. Be aware of CFS and seek the help of your doctor to manage its symptoms.

Self Care:

Learning how to manage fatigue can help you improve your level of functioning and your quality of life despite your symptoms. A rehabilitation medicine specialist can evaluate and teach you how to plan activities to take advantage of times when you usually feel better. 

The lack of proven effective treatment can be frustrating to both you and your doctor. Try to maintain good general health by taking these important self-care steps:

Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. If possible, don't change your routine totally. People who quit work or drop all activity tend to do worse than those who remain active. 
Get enough sleep. Getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits such as going to bed and getting up at the same time each day and limiting daytime napping. 
Exercise regularly. At first, exercise may increase your fatigue and pain. But doing it regularly often improves symptoms. Appropriate exercises include walking, swimming, biking and water aerobics. A physical therapist may help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful. 
Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. 

Maintain a healthy lifestyle. Try to eat a balanced diet, drink plenty of fluids, limit your caffeine intake, stop smoking, get adequate rest and exercise regularly. Find a hobby or career this is enjoyable and fulfilling for you.

Coping Skills:

The course of CFS varies from person to person. For most people, however, the symptoms of CFS are worst early in the course of the illness and then gradually decrease. Some people get better completely over time. Emotional support and counseling can help you and your loved ones cope with the uncertain outlook and the limitations of the illness. 

You may find it therapeutic to join a support group and meet other people with CFS. Support groups aren't for everyone, and you may find that a support group adds to your stress rather than relieves it. Experiment and use your own judgment to determine what's best for you.

Complementary and alternative medicine:

Some makers of various dietary supplements and herbal remedies claim these substances have potential benefits for people with CFS, but the effectiveness of these substances for treating CFS hasn't been proved in controlled studies. 

Contrary to common belief, the "natural" origin of a product doesn't ensure its safety. Dietary supplements and herbal preparations can have potentially harmful side effects and may dangerously interfere or interact with prescription medications. Talk to your doctor before using any unprescribed remedy.