Catching the kissing disease twice

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Ask Dr. Jeff

Catching the kissing disease twice

This piece represents the opinion of the author:

March 4, 2005

Dear Dr. Jeff: I was just seen at the Health Center for a sore throat and diagnosed with mono. I already had mono in high school. Can you really get it twice? K.P.

Dear K.P.: We're in the midst of yet another epidemic wave of mono (the third for the academic year!), and in spite of years of experience with the disease, we're continuing to learn new things about it. Let's review the basics.

Mono is caused by Epstein Barr Virus (EBV), a member of the Herpesvirus family. EBV infects the cells that line your nose and throat, as well as B cell lymphocytes (one type of white blood cell). Viral DNA is incorporated into B cell DNA, and these transformed B cells carry the infection to other organs in your body, especially your liver and spleen.

Some of these infected B cells become "immortalized," forever harboring the viral genome. The full import of this transformation is not yet well understood, but it has been linked to a variety of disorders, including chronic fatigue syndrome and depression in this country, and certain childhood malignancies in Africa.

Antibodies directed against EBV are made soon after infection, and consist of two types. IgM antibodies are made first. They help to fight off the current infection, and then they fade away. IgG antibodies are made weeks later, and then they remain detectable in your blood virtually forever. IgG antibodies confer long-term immunity, and have been thought to protect you against subsequent EBV infections.

The presence of IgM antibodies in your blood is straightforwardly diagnostic of an acute EBV infection. The presence of IgG antibodies is diagnostic of past infection. Unfortunately, they can be detected only by laboratory tests which are less common, and far more expensive, than the usual "monospot" test most commonly performed.

At the Health Center, we have now seen three students who clinically appear to be sick with mono, and who, early in their illnesses, tested positive by monospot and tested postive for anti-EBV IgM and anti-EBV IgG. In other words, they have clinical and serologic evidence of both current and past infection.

One interesting possibility to consider is whether or not their "new" mono is really "new" or rather a reactivation of their "old" mono. After all, EBV's Herpesvirus family relatives, like the herpes viruses that cause fever blisters, genital infections, or chicken pox, are notoriously well known to cause recurrent infection.

There is no cure for EBV, but fortunately, mono does not usually need to be treated. Most often, treatment is supportiver?rest and plenty of fluids. Mono causes inflammation of your liver, so alcohol and medications which can affect your liver (e.g. Tylenol and Accutane) must be avoided. Inflammation of your liver, in turn, can cause swelling of your spleen, so contact sports should also be avoided.

In the vast majority of cases, transmission of EBV occurs through contact with infected saliva (hence mono as the "kissing disease"). The incubation period is about 30-45 days, and the illness typically lasts two to four weeks. The period of communicability, however, can be quite prolonged. Viral shedding in saliva begins during the incubation period, and can persist for a year or more after the infection has apparently resolved.

Early childhood infection with EBV is common (pretty well the norm in the developing world), and usually results in a barely noticeable "cold." In the U.S., about 30 percent of children have been infected by age five, and another 25 percent by the end of high school. About 12 percent of college-age men and women are infected each year with EBV, and about half of them develop full-blown mono. That means that nearly one in 40 college students comes down with mono every year.

So, K.P., I believe it is definitely possible to get mono again, although diagnosis can be a little tricky. Usually, with a little time and repeat lab tests, we can sort it out. Mono may cause its fair share of misery, but it is, fortunately, almost always self-limited and short-lived. This seems to be particularly true the second time around! Be well!

Jeff Benson, M.D.

Dudley Coe Health Center

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