Mononucleosis

Pathophysiology

Causative agent: EBV (Epstein-Barr virus) in 90% of cases. Cytomegalovirus (CMV) accounts for most remaining cases
Infection pathway: Virus invades epithelial tissue of throat and salivary glands, then infects B-lymphocytes. Infected B cells become so enlarged and abnormal they resemble monocytes (hence "mononucleosis")
Dissemination: Infected B cells carry the virus to lymph nodes, liver, and spleen via the lymphatic system
Incubation: Unusually long incubation period of 4-6 weeks
Lifelong latency: EBV remains dormant in B cells for life. Intermittent reactivation makes the person contagious even when asymptomatic
No specific treatment: Does not respond to antibiotics or antivirals. Treatment is rest, hydration, and symptom relief
Penicillin reaction: Giving penicillin-family antibiotics to a mono patient triggers a characteristic measly rash (strep throat co-infection is common and often treated empirically)

Classic triad: Fever (102-104F), extremely sore throat, and swollen lymph nodes (cervical, submandibular, axillary, inguinal)
Profound fatigue and low stamina persisting for weeks to months
Puffy, swollen eyelids. Splotchy rash. Jaundice (liver involvement)
Difficulty breathing or swallowing (severe cervical lymphadenopathy blocking airways)
Deep tenderness or palpable mass in upper left quadrant (splenomegaly)
Palatal petechiae (tiny red spots on roof of mouth)

Severe cervical lymphadenopathy blocking airways — difficulty breathing or swallowing requires emergency evaluation
Sudden sharp left upper quadrant pain — may indicate splenic rupture. Call 911 immediately
High fever with extreme sore throat and palpable node swelling in an undiagnosed client — refer to physician to rule out airway obstruction and splenic involvement
Contact sports or heavy lifting during recovery — must be avoided to prevent splenic injury. Counsel clients

Acute phase: Rigorous circulatory massage is strictly contraindicated while the client is fighting the infection. The immune system must not be taxed
Splenic rupture risk: Deep abdominal work is inappropriate — an enlarged spleen can rupture from even minor trauma, leading to internal hemorrhage. Avoid abdominal massage for the full duration of splenomegaly
Lymphatic accommodation: Bodywork must respect the risk of lymphatic congestion and organ involvement. Avoid aggressive techniques that drive lymphatic flow
Recovery phase: Gentle energetic work or light massage that supports healing without taxing the immune system. Focus on managing the profound lingering fatigue
Referral trigger: Any client with high fever, extreme sore throat, and palpable node swelling who has not seen a physician should be referred
Activity restrictions: Clients recovering from mono must avoid contact sports and heavy lifting for several weeks to prevent splenic injury

Classic triad (fever, sore throat, lymphadenopathy) with unusually long incubation period (4-6 weeks)
Monospot test (positive for heterophile antibodies) is the definitive diagnostic test
Splenomegaly in ~50% of cases. Splenic rupture is life-threatening
Penicillin-family antibiotics in a mono patient trigger a measly rash (strep co-infection is common)
EBV remains dormant for life with intermittent reactivation

Mononucleosis is caused by EBV in 90% of cases. The classic triad is fever, sore throat, and lymphadenopathy with a 4-6 week incubation period.
Rigorous circulatory massage is strictly contraindicated during the acute phase. Deep abdominal work is dangerous due to splenic rupture risk.
Splenomegaly occurs in about 50% of cases. Clients must avoid contact sports and heavy lifting during recovery.
EBV remains dormant for life and may intermittently reactivate, making the person contagious even when asymptomatic.
Giving penicillin-family antibiotics to a mono patient triggers a characteristic measly rash.