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href="#Incubation_period"> <div class="vector-toc-text"> 1.5 Incubation period </div> </a> <ul id="toc-Incubation_period-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Cause" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Cause"> <div class="vector-toc-text"> 2 Cause </div> </a> <button aria-controls="toc-Cause-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Cause subsection </button> <ul id="toc-Cause-sublist" class="vector-toc-list"> <li id="toc-Epstein–Barr_virus" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Epstein–Barr_virus"> <div class="vector-toc-text"> 2.1 Epstein–Barr virus </div> </a> <ul id="toc-Epstein–Barr_virus-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cytomegalovirus" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cytomegalovirus"> <div class="vector-toc-text"> 2.2 Cytomegalovirus </div> </a> <ul id="toc-Cytomegalovirus-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other_causes" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other_causes"> <div class="vector-toc-text"> 2.3 Other causes </div> </a> <ul id="toc-Other_causes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Transmission" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Transmission"> <div class="vector-toc-text"> 2.4 Transmission </div> </a> <ul id="toc-Transmission-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> 3 Pathophysiology </div> </a> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> 4 Diagnosis </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Diagnosis subsection </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Physical_examination" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Physical_examination"> <div class="vector-toc-text"> 4.1 Physical examination </div> </a> <ul id="toc-Physical_examination-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Heterophile_antibody_test" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Heterophile_antibody_test"> <div class="vector-toc-text"> 4.2 Heterophile antibody test </div> </a> <ul id="toc-Heterophile_antibody_test-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Serology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Serology"> <div class="vector-toc-text"> 4.3 Serology </div> </a> <ul id="toc-Serology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other_tests" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other_tests"> <div class="vector-toc-text"> 4.4 Other tests </div> </a> <ul id="toc-Other_tests-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Differential_diagnosis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Differential_diagnosis"> <div class="vector-toc-text"> 4.5 Differential diagnosis </div> </a> <ul id="toc-Differential_diagnosis-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> 5 Treatment </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Treatment subsection </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Medications" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medications"> <div class="vector-toc-text"> 5.1 Medications </div> </a> <ul id="toc-Medications-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Observation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Observation"> <div class="vector-toc-text"> 5.2 Observation </div> </a> <ul id="toc-Observation-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> 6 Prognosis </div> </a> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> 7 History </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 8 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 9 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Infectious mononucleosis</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 53 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-53" aria-hidden="true" > 53 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%83%D8%AB%D8%B1%D8%A9_%D8%A7%D9%84%D9%88%D8%AD%D9%8A%D8%AF%D8%A7%D8%AA_%D8%A7%D9%84%D8%B9%D8%AF%D9%88%D8%A7%D8%A6%D9%8A%D8%A9" title="كثرة الوحيدات العدوائية – Arabic" lang="ar" hreflang="ar" data-title="كثرة الوحيدات العدوائية" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-azb mw-list-item"><a href="https://azb.wikipedia.org/wiki/%D9%85%D9%88%D9%88%D9%86%D9%88%DA%A9%D9%84%DB%8C%D9%88%D8%B2_%D8%B9%D9%88%D9%81%D9%88%D9%86%D8%AA%DB%8C" title="موونوکلیوز عوفونتی – South Azerbaijani" lang="azb" hreflang="azb" data-title="موونوکلیوز عوفونتی" data-language-autonym="تۆرکجه" data-language-local-name="South Azerbaijani" class="interlanguage-link-target">تۆرکجه</a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%98%D0%BD%D1%84%D0%B5%D0%BA%D1%86%D0%B8%D0%BE%D0%B7%D0%BD%D0%B0_%D0%BC%D0%BE%D0%BD%D0%BE%D0%BD%D1%83%D0%BA%D0%BB%D0%B5%D0%BE%D0%B7%D0%B0" title="Инфекциозна мононуклеоза – Bulgarian" lang="bg" hreflang="bg" data-title="Инфекциозна мононуклеоза" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target">Български</a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Infektivna_mononukleoza" title="Infektivna mononukleoza – Bosnian" lang="bs" hreflang="bs" data-title="Infektivna mononukleoza" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target">Bosanski</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Mononucleosi_infecciosa" title="Mononucleosi infecciosa – Catalan" lang="ca" hreflang="ca" data-title="Mononucleosi infecciosa" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Infek%C4%8Dn%C3%AD_mononukle%C3%B3za" title="Infekční mononukleóza – Czech" lang="cs" hreflang="cs" data-title="Infekční mononukleóza" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target">Čeština</a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Mononukleose" title="Mononukleose – Danish" lang="da" hreflang="da" data-title="Mononukleose" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target">Dansk</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Pfeiffer-Dr%C3%BCsenfieber" title="Pfeiffer-Drüsenfieber – German" lang="de" hreflang="de" data-title="Pfeiffer-Drüsenfieber" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Mononukleoos" title="Mononukleoos – Estonian" lang="et" hreflang="et" data-title="Mononukleoos" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target">Eesti</a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%9B%CE%BF%CE%B9%CE%BC%CF%8E%CE%B4%CE%B7%CF%82_%CE%BC%CE%BF%CE%BD%CE%BF%CF%80%CF%85%CF%81%CE%AE%CE%BD%CF%89%CF%83%CE%B7" title="Λοιμώδης μονοπυρήνωση – Greek" lang="el" hreflang="el" data-title="Λοιμώδης μονοπυρήνωση" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target">Ελληνικά</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Mononucleosis_infecciosa" title="Mononucleosis infecciosa – Spanish" lang="es" hreflang="es" data-title="Mononucleosis infecciosa" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Mononukleozo" title="Mononukleozo – Esperanto" lang="eo" hreflang="eo" data-title="Mononukleozo" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target">Esperanto</a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Mononukleosi_infekzioso" title="Mononukleosi infekzioso – Basque" lang="eu" hreflang="eu" data-title="Mononukleosi infekzioso" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target">Euskara</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%85%D9%88%D9%86%D9%88%D9%86%D9%88%DA%A9%D9%84%D8%A6%D9%88%D8%B2_%D8%B9%D9%81%D9%88%D9%86%DB%8C" title="مونونوکلئوز عفونی – Persian" lang="fa" hreflang="fa" data-title="مونونوکلئوز عفونی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Mononucl%C3%A9ose_infectieuse" title="Mononucléose infectieuse – French" lang="fr" hreflang="fr" data-title="Mononucléose infectieuse" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Fiabhras_faireogach" title="Fiabhras faireogach – Irish" lang="ga" hreflang="ga" data-title="Fiabhras faireogach" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target">Gaeilge</a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Mononucleose_infecciosa" title="Mononucleose infecciosa – Galician" lang="gl" hreflang="gl" data-title="Mononucleose infecciosa" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target">Galego</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EA%B0%90%EC%97%BC%EC%84%B1_%EB%8B%A8%ED%95%B5%EA%B5%AC%EC%A6%9D" title="감염성 단핵구증 – Korean" lang="ko" hreflang="ko" data-title="감염성 단핵구증" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D4%BB%D5%B6%D6%86%D5%A5%D5%AF%D6%81%D5%AB%D5%B8%D5%B6_%D5%B4%D5%B8%D5%B6%D5%B8%D5%B6%D5%B8%D6%82%D5%AF%D5%AC%D5%A5%D5%B8%D5%A6" title="Ինֆեկցիոն մոնոնուկլեոզ – Armenian" lang="hy" hreflang="hy" data-title="Ինֆեկցիոն մոնոնուկլեոզ" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target">Հայերեն</a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Mononukleoza" title="Mononukleoza – Croatian" lang="hr" hreflang="hr" data-title="Mononukleoza" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target">Hrvatski</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Demam_kelenjar" title="Demam kelenjar – Indonesian" lang="id" hreflang="id" data-title="Demam kelenjar" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/Einkirningas%C3%B3tt" title="Einkirningasótt – Icelandic" lang="is" hreflang="is" data-title="Einkirningasótt" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target">Íslenska</a></li><li class="interlanguage-link interwiki-it badge-Q17437796 badge-featuredarticle mw-list-item" title="featured article badge"><a href="https://it.wikipedia.org/wiki/Mononucleosi_infettiva" title="Mononucleosi infettiva – Italian" lang="it" hreflang="it" data-title="Mononucleosi infettiva" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%9E%D7%95%D7%A0%D7%95%D7%A0%D7%95%D7%A7%D7%9C%D7%90%D7%95%D7%96%D7%99%D7%A1_%D7%96%D7%99%D7%94%D7%95%D7%9E%D7%99" title="מונונוקלאוזיס זיהומי – Hebrew" lang="he" hreflang="he" data-title="מונונוקלאוזיס זיהומי" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-ky mw-list-item"><a href="https://ky.wikipedia.org/wiki/%D0%96%D1%83%D0%B3%D1%83%D1%88%D1%82%D1%83%D1%83_%D0%BC%D0%BE%D0%BD%D0%BE%D0%BD%D1%83%D0%BA%D0%BB%D0%B5%D0%BE%D0%B7" title="Жугуштуу мононуклеоз – Kyrgyz" lang="ky" hreflang="ky" data-title="Жугуштуу мононуклеоз" data-language-autonym="Кыргызча" data-language-local-name="Kyrgyz" class="interlanguage-link-target">Кыргызча</a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Infekcioz%C4%81_mononukleoze" title="Infekciozā mononukleoze – Latvian" lang="lv" hreflang="lv" data-title="Infekciozā mononukleoze" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target">Latviešu</a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Infekcin%C4%97_mononukleoz%C4%97" title="Infekcinė mononukleozė – Lithuanian" lang="lt" hreflang="lt" data-title="Infekcinė mononukleozė" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target">Lietuvių</a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Mononucleosis_infectiosa" title="Mononucleosis infectiosa – Hungarian" lang="hu" hreflang="hu" data-title="Mononucleosis infectiosa" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target">Magyar</a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%98%D0%BD%D1%84%D0%B5%D0%BA%D1%82%D0%B8%D0%B2%D0%BD%D0%B0_%D0%BC%D0%BE%D0%BD%D0%BE%D0%BD%D1%83%D0%BA%D0%BB%D0%B5%D0%BE%D0%B7%D0%B0" title="Инфективна мононуклеоза – Macedonian" lang="mk" hreflang="mk" data-title="Инфективна мононуклеоза" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target">Македонски</a></li><li class="interlanguage-link interwiki-arz mw-list-item"><a href="https://arz.wikipedia.org/wiki/%D9%83%D8%AB%D8%B1%D8%A9_%D8%A7%D9%84%D9%88%D8%AD%D9%8A%D8%AF%D8%A7%D8%AA_%D8%A7%D9%84%D8%B9%D8%AF%D9%88%D8%A7%D8%A6%D9%8A%D9%87" title="كثرة الوحيدات العدوائيه – Egyptian Arabic" lang="arz" hreflang="arz" data-title="كثرة الوحيدات العدوائيه" data-language-autonym="مصرى" data-language-local-name="Egyptian Arabic" class="interlanguage-link-target">مصرى</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Klierkoorts" title="Klierkoorts – Dutch" lang="nl" hreflang="nl" data-title="Klierkoorts" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E4%BC%9D%E6%9F%93%E6%80%A7%E5%8D%98%E6%A0%B8%E7%90%83%E7%97%87" title="伝染性単核球症 – Japanese" lang="ja" hreflang="ja" data-title="伝染性単核球症" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target">日本語</a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Mononukleose" title="Mononukleose – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Mononukleose" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target">Norsk bokmål</a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Kyssesjuke" title="Kyssesjuke – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Kyssesjuke" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target">Norsk nynorsk</a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%87%E0%AC%A8%E0%AC%AB%E0%AD%87%E0%AC%95%E0%AD%8D%E2%80%8C%E0%AC%B8%E0%AC%B8%E0%AD%8D_%E0%AC%AE%E0%AD%8B%E0%AC%A8%E0%AD%8B%E0%AC%A8%E0%AD%8D%E0%AD%9F%E0%AD%81%E0%AC%95%E0%AD%8D%E0%AC%B2%E0%AC%BF%E0%AC%93%E0%AC%B8%E0%AC%BF%E0%AC%B8" title="ଇନଫେକ୍‌ସସ୍ ମୋନୋନ୍ୟୁକ୍ଲିଓସିସ – Odia" lang="or" hreflang="or" data-title="ଇନଫେକ୍‌ସସ୍ ମୋନୋନ୍ୟୁକ୍ଲିଓସିସ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target">ଓଡ଼ିଆ</a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Infeksion_mononukleoz" title="Infeksion mononukleoz – Uzbek" lang="uz" hreflang="uz" data-title="Infeksion mononukleoz" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target">Oʻzbekcha / ўзбекча</a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Mononukleoza_zaka%C5%BAna" title="Mononukleoza zakaźna – Polish" lang="pl" hreflang="pl" data-title="Mononukleoza zakaźna" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target">Polski</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Mononucleose_infecciosa" title="Mononucleose infecciosa – Portuguese" lang="pt" hreflang="pt" data-title="Mononucleose infecciosa" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Mononucleoz%C4%83_infec%C8%9Bioas%C4%83" title="Mononucleoză infecțioasă – Romanian" lang="ro" hreflang="ro" data-title="Mononucleoză infecțioasă" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target">Română</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%98%D0%BD%D1%84%D0%B5%D0%BA%D1%86%D0%B8%D0%BE%D0%BD%D0%BD%D1%8B%D0%B9_%D0%BC%D0%BE%D0%BD%D0%BE%D0%BD%D1%83%D0%BA%D0%BB%D0%B5%D0%BE%D0%B7" title="Инфекционный мононуклеоз – Russian" lang="ru" hreflang="ru" data-title="Инфекционный мононуклеоз" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Glandular_fever" title="Glandular fever – Simple English" lang="en-simple" hreflang="en-simple" data-title="Glandular fever" 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from <a href="/w/index.php?title=Mononucleosis&redirect=no" class="mw-redirect" title="Mononucleosis">Mononucleosis</a>)</div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Common viral infectious disease</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">"Mononucleosis" redirects here. For excessive monocyte counts more generally, see <a href="/wiki/Monocytosis" title="Monocytosis">Monocytosis</a>.</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Not to be confused with <a href="/wiki/Pfeiffer_syndrome" title="Pfeiffer syndrome">Pfeiffer syndrome</a> (a genetic disorder).</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox infobox-has-images-with-white-backgrounds"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Infectious mononucleosis</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Glandular fever, Pfeiffer's disease, Filatov's disease,<a href="#cite_note-wni1811-1">[1]</a> kissing disease</td></tr><tr><td colspan="2" class="infobox-full-data"><a href="/wiki/File:Lymphadanopathy.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/cf/Lymphadanopathy.JPG/220px-Lymphadanopathy.JPG" decoding="async" width="220" height="186" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/cf/Lymphadanopathy.JPG/330px-Lymphadanopathy.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/cf/Lymphadanopathy.JPG/440px-Lymphadanopathy.JPG 2x" data-file-width="2680" data-file-height="2271" /></a></td></tr><tr><td colspan="2" class="infobox-full-data"><a href="/wiki/Lymphadenopathy" title="Lymphadenopathy">Swollen lymph nodes</a> in the neck of a person with infectious mononucleosis</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Infectious_disease_(medical_specialty)" class="mw-redirect" title="Infectious disease (medical specialty)">Infectious disease</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><a href="/wiki/Fever" title="Fever">Fever</a>, sore throat, <a href="/wiki/Lymphadenopathy" title="Lymphadenopathy">enlarged lymph nodes</a> in the neck, <a href="/wiki/Fatigue_(medical)" class="mw-redirect" title="Fatigue (medical)">fatigue</a><a href="#cite_note-CDC2014Eb-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data">Swelling of the <a href="/wiki/Liver" title="Liver">liver</a> or <a href="/wiki/Spleen" title="Spleen">spleen</a><a href="#cite_note-CDC2014Mono-3">[3]</a></td></tr><tr><th scope="row" class="infobox-label">Duration</th><td class="infobox-data">2–4 weeks<a href="#cite_note-CDC2014Eb-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data"><a href="/wiki/Epstein%E2%80%93Barr_virus" title="Epstein–Barr virus">Epstein–Barr virus</a> (EBV) usually spread via <a href="/wiki/Saliva" title="Saliva">saliva</a><a href="#cite_note-CDC2014Eb-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on symptoms and blood tests<a href="#cite_note-CDC2014Mono-3">[3]</a></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data">Drinking enough fluids, getting sufficient rest, <a href="/wiki/Pain_medications" class="mw-redirect" title="Pain medications">pain medications</a> such as <a href="/wiki/Paracetamol" title="Paracetamol">paracetamol</a> (acetaminophen) and <a href="/wiki/Ibuprofen" title="Ibuprofen">ibuprofen</a><a href="#cite_note-CDC2014Eb-2">[2]</a><a href="#cite_note-Eb2016-4">[4]</a></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">45 per 100,000 per year (U.S.)<a href="#cite_note-Ty2016-5">[5]</a></td></tr></tbody></table><style data-mw-deduplicate="TemplateStyles:r1236303919">@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-has-images-with-white-backgrounds img{background:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-has-images-with-white-backgrounds img{background:white}}</style> Infectious mononucleosis (IM, mono), also known as glandular fever, is an infection usually caused by the <a href="/wiki/Epstein%E2%80%93Barr_virus" title="Epstein–Barr virus">Epstein–Barr virus</a> (EBV).<a href="#cite_note-CDC2014Eb-2">[2]</a><a href="#cite_note-CDC2014Mono-3">[3]</a> Most people are infected by the virus as children, when the disease produces few or no symptoms.<a href="#cite_note-CDC2014Eb-2">[2]</a> In young adults, the disease often results in <a href="/wiki/Fever" title="Fever">fever</a>, sore throat, <a href="/wiki/Lymphadenopathy" title="Lymphadenopathy">enlarged lymph nodes</a> in the neck, and <a href="/wiki/Fatigue_(medical)" class="mw-redirect" title="Fatigue (medical)">fatigue</a>.<a href="#cite_note-CDC2014Eb-2">[2]</a> Most people recover in two to four weeks; however, feeling tired may last for months.<a href="#cite_note-CDC2014Eb-2">[2]</a> The <a href="/wiki/Liver" title="Liver">liver</a> or <a href="/wiki/Spleen" title="Spleen">spleen</a> may also become swollen,<a href="#cite_note-CDC2014Mono-3">[3]</a> and in less than one percent of cases <a href="/wiki/Splenic_rupture" class="mw-redirect" title="Splenic rupture">splenic rupture</a> may occur.<a href="#cite_note-6">[6]</a> While usually caused by the Epstein–Barr virus, also known as human herpesvirus 4, which is a member of the <a href="/wiki/Herpesviridae" title="Herpesviridae">herpesvirus family</a>,<a href="#cite_note-CDC2014Mono-3">[3]</a> a few other viruses<a href="#cite_note-CDC2014Mono-3">[3]</a> and the <a href="/wiki/Protozoon" class="mw-redirect" title="Protozoon">protozoon</a> <a href="/wiki/Toxoplasma_gondii" title="Toxoplasma gondii">Toxoplasma gondii</a><a href="#cite_note-jms1978-7">[7]</a> may also cause the disease. It is primarily spread through <a href="/wiki/Saliva" title="Saliva">saliva</a> but can rarely be spread through <a href="/wiki/Semen" title="Semen">semen</a> or <a href="/wiki/Blood" title="Blood">blood</a>.<a href="#cite_note-CDC2014Eb-2">[2]</a> Spread may occur by objects such as drinking glasses or toothbrushes or through a cough or sneeze.<a href="#cite_note-CDC2014Eb-2">[2]</a><a href="#cite_note-8">[8]</a> Those who are infected can spread the disease weeks before symptoms develop.<a href="#cite_note-CDC2014Eb-2">[2]</a> Mono is primarily diagnosed based on the symptoms and can be confirmed with blood tests for specific <a href="/wiki/Antibodies" class="mw-redirect" title="Antibodies">antibodies</a>.<a href="#cite_note-CDC2014Mono-3">[3]</a> Another typical finding is <a href="/wiki/Increased_blood_lymphocytes" class="mw-redirect" title="Increased blood lymphocytes">increased blood lymphocytes</a> of which more than 10% are reactive.<a href="#cite_note-CDC2014Mono-3">[3]</a><a href="#cite_note-JAMA2016-9">[9]</a> The <a href="/wiki/Monospot" class="mw-redirect" title="Monospot">monospot</a> test is not recommended for general use due to poor accuracy.<a href="#cite_note-CDC2014Diag-10">[10]</a> There is no <a href="/wiki/Vaccine" title="Vaccine">vaccine</a> for EBV; however, there is <a href="/wiki/Epstein%E2%80%93Barr_virus_vaccine" title="Epstein–Barr virus vaccine">ongoing research</a>.<a href="#cite_note-11">[11]</a><a href="#cite_note-12">[12]</a> Infection can be prevented by not sharing personal items or saliva with an infected person.<a href="#cite_note-CDC2014Eb-2">[2]</a> Mono generally improves without any specific treatment.<a href="#cite_note-CDC2014Eb-2">[2]</a> Symptoms may be reduced by drinking enough fluids, getting sufficient rest, and taking <a href="/wiki/Pain_medications" class="mw-redirect" title="Pain medications">pain medications</a> such as <a href="/wiki/Paracetamol" title="Paracetamol">paracetamol</a> (acetaminophen) and <a href="/wiki/Ibuprofen" title="Ibuprofen">ibuprofen</a>.<a href="#cite_note-CDC2014Eb-2">[2]</a><a href="#cite_note-Eb2016-4">[4]</a> Mononucleosis most commonly affects those between the ages of 15 and 24 years in the <a href="/wiki/Developed_world" class="mw-redirect" title="Developed world">developed world</a>.<a href="#cite_note-JAMA2016-9">[9]</a> In the <a href="/wiki/Developing_world" class="mw-redirect" title="Developing world">developing world</a>, people are more often infected in early childhood when there are fewer symptoms.<a href="#cite_note-13">[13]</a> In those between 16 and 20 it is the cause of about 8% of sore throats.<a href="#cite_note-JAMA2016-9">[9]</a> About 45 out of 100,000 people develop infectious mono each year in the United States.<a href="#cite_note-Ty2016-5">[5]</a> Nearly 95% of people have had an EBV infection by the time they are adults.<a href="#cite_note-Ty2016-5">[5]</a> The disease occurs equally at all times of the year.<a href="#cite_note-JAMA2016-9">[9]</a> Mononucleosis was first described in the 1920s and is colloquially known as "the kissing disease".<a href="#cite_note-Smart1998-14">[14]</a> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=1" title="Edit section: Signs and symptoms">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Main_symptoms_of_Infectious_mononucleosis.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/4d/Main_symptoms_of_Infectious_mononucleosis.png/290px-Main_symptoms_of_Infectious_mononucleosis.png" decoding="async" width="290" height="276" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/4d/Main_symptoms_of_Infectious_mononucleosis.png/435px-Main_symptoms_of_Infectious_mononucleosis.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/4d/Main_symptoms_of_Infectious_mononucleosis.png/580px-Main_symptoms_of_Infectious_mononucleosis.png 2x" data-file-width="1693" data-file-height="1613" /></a><figcaption>Main symptoms of infectious mononucleosis<a href="#cite_note-MedicineNet2011-15">[15]</a></figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Mononucleosis.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/db/Mononucleosis.JPG/290px-Mononucleosis.JPG" decoding="async" width="290" height="279" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/db/Mononucleosis.JPG/435px-Mononucleosis.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/db/Mononucleosis.JPG/580px-Mononucleosis.JPG 2x" data-file-width="799" data-file-height="770" /></a><figcaption><a href="/wiki/Exudative" class="mw-redirect" title="Exudative">Exudative</a> <a href="/wiki/Pharyngitis" title="Pharyngitis">pharyngitis</a> in a person with infectious mononucleosis</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Cross_Reaction_Rash.JPG" class="mw-file-description"><img alt="Cross reaction rash" src="//upload.wikimedia.org/wikipedia/commons/thumb/6/63/Cross_Reaction_Rash.JPG/290px-Cross_Reaction_Rash.JPG" decoding="async" width="290" height="279" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/63/Cross_Reaction_Rash.JPG/435px-Cross_Reaction_Rash.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/63/Cross_Reaction_Rash.JPG/580px-Cross_Reaction_Rash.JPG 2x" data-file-width="1944" data-file-height="1869" /></a><figcaption>Rash from using penicillin while infected with IM<a href="#cite_note-Harrison-16">[16]</a></figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Rash_of_amoxicillin_use_during_EBV_infection.jpg" class="mw-file-description"><img alt="Maculopapular rash from amoxicillin use during EBV infection" src="//upload.wikimedia.org/wikipedia/commons/thumb/4/43/Rash_of_amoxicillin_use_during_EBV_infection.jpg/220px-Rash_of_amoxicillin_use_during_EBV_infection.jpg" decoding="async" width="220" height="271" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/43/Rash_of_amoxicillin_use_during_EBV_infection.jpg/330px-Rash_of_amoxicillin_use_during_EBV_infection.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/43/Rash_of_amoxicillin_use_during_EBV_infection.jpg/440px-Rash_of_amoxicillin_use_during_EBV_infection.jpg 2x" data-file-width="1530" data-file-height="1883" /></a><figcaption>Maculopapular rash from amoxicillin use during EBV infection</figcaption></figure> The <a href="/wiki/Medical_sign" class="mw-redirect" title="Medical sign">signs</a> and <a href="/wiki/Symptoms" class="mw-redirect" title="Symptoms">symptoms</a> of infectious mononucleosis vary with age. <div class="mw-heading mw-heading3"><h3 id="Children">Children</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=2" title="Edit section: Children">edit</a>]</div> Before puberty, the disease typically only produces <a href="/wiki/Flu" class="mw-redirect" title="Flu">flu</a>-like symptoms, if any at all.<a href="#cite_note-17">[17]</a> When found, symptoms tend to be similar to those of common <a href="/wiki/Sore_throat" title="Sore throat">throat infections</a> (mild <a href="/wiki/Pharyngitis" title="Pharyngitis">pharyngitis</a>, with or without <a href="/wiki/Tonsillitis" title="Tonsillitis">tonsillitis</a>).<a href="#cite_note-Harrison-16">[16]</a> Denis Burkitt reckoned that 18 per 100,000 children every year are infected with Burkitts’s lymphoma (Epstein-Barr virus). This usually causes a violent tumor in children. <a href="#cite_note-18">[18]</a> <div class="mw-heading mw-heading3"><h3 id="Adolescents_and_young_adults">Adolescents and young adults</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=3" title="Edit section: Adolescents and young adults">edit</a>]</div> In <a href="/wiki/Adolescence" title="Adolescence">adolescence</a> and young adulthood, the disease presents with a characteristic triad:<a href="#cite_note-Cohen2005-19">[19]</a> <ul><li><a href="/wiki/Fever" title="Fever">Fever</a> – usually lasting 14 days;<a href="#cite_note-20">[20]</a> often mild.<a href="#cite_note-Harrison-16">[16]</a></li> <li><a href="/wiki/Acute_pharyngitis" class="mw-redirect" title="Acute pharyngitis">Sore throat</a> – usually severe for 3–5 days, before resolving in the next 7–10 days.<a href="#cite_note-21">[21]</a></li> <li><a href="/wiki/Lymphadenopathy" title="Lymphadenopathy">Swollen glands</a> –  mobile; usually located around the back of the neck (posterior <a href="/wiki/Cervical_lymph_nodes" title="Cervical lymph nodes">cervical lymph nodes</a>) and sometimes throughout the body.<a href="#cite_note-JAMA2016-9">[9]</a><a href="#cite_note-Harrison-16">[16]</a><a href="#cite_note-Benign_lymphadenopathy-22">[22]</a></li></ul> Another major symptom is <a href="/wiki/Fatigue_(medical)" class="mw-redirect" title="Fatigue (medical)">feeling tired</a>.<a href="#cite_note-CDC2014Eb-2">[2]</a> <a href="/wiki/Headache" title="Headache">Headaches</a> are common, and <a href="/wiki/Abdominal_pain" title="Abdominal pain">abdominal pains</a> with <a href="/wiki/Nausea" title="Nausea">nausea</a> or <a href="/wiki/Vomiting" title="Vomiting">vomiting</a> sometimes also occur.<a href="#cite_note-Cohen2005-19">[19]</a> Symptoms most often disappear after about 2–4 weeks.<a href="#cite_note-CDC2014Eb-2">[2]</a><a href="#cite_note-Johannsen2009-23">[23]</a> However, fatigue and a general feeling of being unwell (<a href="/wiki/Malaise" title="Malaise">malaise</a>) may sometimes last for months.<a href="#cite_note-Harrison-16">[16]</a> Fatigue lasts more than one month in an estimated 28% of cases.<a href="#cite_note-24">[24]</a> Mild fever, swollen neck glands and <a href="/wiki/Myalgia" title="Myalgia">body aches</a> may also persist beyond 4 weeks.<a href="#cite_note-Harrison-16">[16]</a><a href="#cite_note-Luzuriaga2010-25">[25]</a><a href="#cite_note-Ebell2004-26">[26]</a> Most people are able to resume their usual activities within 2–3 months.<a href="#cite_note-Luzuriaga2010-25">[25]</a> The most prominent sign of the disease is often <a href="/wiki/Pharyngitis" title="Pharyngitis">pharyngitis</a>, which is frequently accompanied by <a href="/wiki/Tonsillitis" title="Tonsillitis">enlarged tonsils</a> with <a href="/wiki/Pus" title="Pus">pus</a>—an <a href="/wiki/Exudate" title="Exudate">exudate</a> similar to that seen in cases of <a href="/wiki/Strep_throat" class="mw-redirect" title="Strep throat">strep throat</a>.<a href="#cite_note-Harrison-16">[16]</a> In about 50% of cases, small reddish-purple spots called <a href="/wiki/Petechia" title="Petechia">petechiae</a> can be seen on the <a href="/wiki/Roof_of_the_mouth" class="mw-redirect" title="Roof of the mouth">roof of the mouth</a>.<a href="#cite_note-Ebell2004-26">[26]</a> Palatal <a href="/wiki/Enanthem" title="Enanthem">enanthem</a> can also occur, but is relatively uncommon.<a href="#cite_note-Harrison-16">[16]</a> A small minority of people spontaneously present a <a href="/wiki/Rash" title="Rash">rash</a>, usually on the arms or trunk, which can be <a href="/wiki/Macular" class="mw-redirect" title="Macular">macular</a> (<a href="/wiki/Morbilliform" title="Morbilliform">morbilliform</a>) or <a href="/wiki/Papule" title="Papule">papular</a>.<a href="#cite_note-Harrison-16">[16]</a> Almost all people given <a href="/wiki/Amoxicillin" title="Amoxicillin">amoxicillin</a> or <a href="/wiki/Ampicillin" title="Ampicillin">ampicillin</a> eventually develop a generalized, itchy maculopapular rash, which however does not imply that the person will have <a href="/wiki/Adverse_reaction" class="mw-redirect" title="Adverse reaction">adverse reactions</a> to <a href="/wiki/Penicillin" title="Penicillin">penicillins</a> again in the future.<a href="#cite_note-Harrison-16">[16]</a><a href="#cite_note-Johannsen2009-23">[23]</a> Occasional cases of <a href="/wiki/Erythema_nodosum" title="Erythema nodosum">erythema nodosum</a> and <a href="/wiki/Erythema_multiforme" title="Erythema multiforme">erythema multiforme</a> have been reported.<a href="#cite_note-Harrison-16">[16]</a> Seizures may also occasionally occur.<a href="#cite_note-27">[27]</a> <div class="mw-heading mw-heading3"><h3 id="Complications">Complications</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=4" title="Edit section: Complications">edit</a>]</div> <a href="/wiki/Splenomegaly" title="Splenomegaly">Spleen enlargement</a> is common in the second and third weeks, although this may not be apparent on <a href="/wiki/Physical_examination" title="Physical examination">physical examination</a>. Rarely the spleen may rupture.<a href="#cite_note-28">[28]</a> There may also be some <a href="/wiki/Hepatomegaly" title="Hepatomegaly">enlargement of the liver</a>.<a href="#cite_note-Ebell2004-26">[26]</a> <a href="/wiki/Jaundice" title="Jaundice">Jaundice</a> occurs only occasionally.<a href="#cite_note-Harrison-16">[16]</a><a href="#cite_note-29">[29]</a> It generally gets better on its own in people who are otherwise healthy.<a href="#cite_note-pmid29885408-30">[30]</a> When caused by EBV, infectious mononucleosis is classified as one of the <a href="/wiki/Epstein%E2%80%93Barr_virus%E2%80%93associated_lymphoproliferative_diseases" title="Epstein–Barr virus–associated lymphoproliferative diseases">Epstein–Barr virus–associated lymphoproliferative diseases</a>. Occasionally the disease may persist and result in a chronic infection. This may develop into systemic EBV-positive T cell <a href="/wiki/Lymphoma" title="Lymphoma">lymphoma</a>.<a href="#cite_note-pmid29885408-30">[30]</a> <div class="mw-heading mw-heading3"><h3 id="Older_adults">Older adults</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=5" title="Edit section: Older adults">edit</a>]</div> Infectious mononucleosis mainly affects younger adults.<a href="#cite_note-Harrison-16">[16]</a> When older adults do catch the disease, they less often have characteristic signs and symptoms such as the sore throat and lymphadenopathy.<a href="#cite_note-Harrison-16">[16]</a><a href="#cite_note-Ebell2004-26">[26]</a> Instead, they may primarily experience prolonged fever, fatigue, malaise and body pains.<a href="#cite_note-Harrison-16">[16]</a> They are more likely to have liver enlargement and <a href="/wiki/Jaundice" title="Jaundice">jaundice</a>.<a href="#cite_note-Ebell2004-26">[26]</a> People over 40 years of age are more likely to develop serious illness.<a href="#cite_note-Odumade2011-31">[31]</a> <div class="mw-heading mw-heading3"><h3 id="Incubation_period">Incubation period</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=6" title="Edit section: Incubation period">edit</a>]</div> The exact length of <a href="/wiki/Incubation_period" title="Incubation period">time between infection and symptoms</a> is unclear. A review of the literature made an estimate of 33–49 days.<a href="#cite_note-Richardson2001-32">[32]</a> In adolescents and young adults, symptoms are thought to appear around 4–6 weeks after initial infection.<a href="#cite_note-Harrison-16">[16]</a> Onset is often gradual, though it can be abrupt.<a href="#cite_note-Odumade2011-31">[31]</a> The main symptoms may be <a href="/wiki/Prodrome" title="Prodrome">preceded</a> by 1–2 weeks of fatigue, feeling unwell and body aches.<a href="#cite_note-Harrison-16">[16]</a> <div class="mw-heading mw-heading2"><h2 id="Cause">Cause</h2>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=7" title="Edit section: Cause">edit</a>]</div> <div class="mw-heading mw-heading3"><h3 id="Epstein–Barr_virus">Epstein–Barr virus</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=8" title="Edit section: Epstein–Barr virus">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Epstein%E2%80%93Barr_virus" title="Epstein–Barr virus">Epstein–Barr virus</a></div> About 90% of cases of infectious mononucleosis are caused by the <a href="/wiki/Epstein%E2%80%93Barr_virus" title="Epstein–Barr virus">Epstein–Barr virus</a>, a member of the <a href="/wiki/Herpesviridae" title="Herpesviridae">Herpesviridae</a> family of <a href="/wiki/DNA_viruses" class="mw-redirect" title="DNA viruses">DNA viruses</a>. It is one of the most commonly found <a href="/wiki/Viruses" class="mw-redirect" title="Viruses">viruses</a> throughout the world. Contrary to common belief, the Epstein–Barr virus is not highly contagious. It can only be contracted through direct contact with an infected person's <a href="/wiki/Saliva" title="Saliva">saliva</a>, such as through kissing or sharing toothbrushes.<a href="#cite_note-33">[33]</a> About 95% of the population has been exposed to this virus by the age of 40, but only 15–20% of teenagers and about 40% of exposed adults actually develop infectious mononucleosis.<a href="#cite_note-34">[34]</a> <div class="mw-heading mw-heading3"><h3 id="Cytomegalovirus">Cytomegalovirus</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=9" title="Edit section: Cytomegalovirus">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Human_betaherpesvirus_5" class="mw-redirect" title="Human betaherpesvirus 5">Human betaherpesvirus 5</a></div> About 5–7% of cases of infectious mononucleosis is caused by <a href="/wiki/Human_cytomegalovirus" title="Human cytomegalovirus">human cytomegalovirus</a> (CMV), another type of <a href="/wiki/Herpesviridae" title="Herpesviridae">herpes virus</a>.<a href="#cite_note-pmid27933614-35">[35]</a> This virus is found in body fluids including <a href="/wiki/Saliva" title="Saliva">saliva</a>, <a href="/wiki/Urine" title="Urine">urine</a>, <a href="/wiki/Blood" title="Blood">blood</a>, <a href="/wiki/Tears" title="Tears">tears</a>,<a href="#cite_note-STD_Sourcebook-36">[36]</a> <a href="/wiki/Breast_milk" title="Breast milk">breast milk</a> and genital secretions.<a href="#cite_note-frontiersCMV2006-37">[37]</a> A person becomes infected with this <a href="/wiki/Virus" title="Virus">virus</a> by direct contact with infected body fluids. Cytomegalovirus is most commonly transmitted through kissing and sexual intercourse. It can also be transferred from an infected mother to her unborn child. This virus is often "silent" because the signs and symptoms cannot be felt by the person infected.<a href="#cite_note-STD_Sourcebook-36">[36]</a> However, it can cause life-threatening illness in infants, people with <a href="/wiki/HIV" title="HIV">HIV</a>, <a href="/wiki/Organ_transplant" class="mw-redirect" title="Organ transplant">transplant</a> recipients, and those with weak <a href="/wiki/Immune_systems" class="mw-redirect" title="Immune systems">immune systems</a>. For those with weak immune systems, cytomegalovirus can cause more serious illnesses such as <a href="/wiki/Pneumonia" title="Pneumonia">pneumonia</a> and inflammations of the <a href="/wiki/Retina" title="Retina">retina</a>, <a href="/wiki/Esophagus" title="Esophagus">esophagus</a>, <a href="/wiki/Liver" title="Liver">liver</a>, <a href="/wiki/Large_intestine" title="Large intestine">large intestine</a>, and <a href="/wiki/Brain" title="Brain">brain</a>. Approximately 90% of the human population has been infected with cytomegalovirus by the time they reach adulthood, but most are unaware of the infection.<a href="#cite_note-38">[38]</a> Once a person becomes infected with cytomegalovirus, the virus stays in their body throughout the person's lifetime. During this latent phase, the virus can be detected only in <a href="/wiki/Monocytes" class="mw-redirect" title="Monocytes">monocytes</a>.<a href="#cite_note-frontiersCMV2006-37">[37]</a> <div class="mw-heading mw-heading3"><h3 id="Other_causes">Other causes</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=10" title="Edit section: Other causes">edit</a>]</div> <a href="/wiki/Toxoplasma_gondii" title="Toxoplasma gondii">Toxoplasma gondii</a>, a parasitic <a href="/wiki/Protozoon" class="mw-redirect" title="Protozoon">protozoon</a>, is responsible for less than 1% of the infectious mononucleosis cases. <a href="/wiki/Viral_hepatitis" title="Viral hepatitis">Viral hepatitis</a>, <a href="/wiki/Adenovirus" class="mw-redirect" title="Adenovirus">adenovirus</a>, <a href="/wiki/Rubella" title="Rubella">rubella</a>, and <a href="/wiki/Herpes_simplex" class="mw-redirect" title="Herpes simplex">herpes simplex</a> viruses have also been reported as rare causes of infectious mononucleosis.<a href="#cite_note-jms1978-7">[7]</a> <div class="mw-heading mw-heading3"><h3 id="Transmission">Transmission</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=11" title="Edit section: Transmission">edit</a>]</div> <a href="/wiki/Epstein%E2%80%93Barr_virus" title="Epstein–Barr virus">Epstein–Barr virus</a> infection is spread via <a href="/wiki/Saliva" title="Saliva">saliva</a>, and has an <a href="/wiki/Incubation_period" title="Incubation period">incubation period</a> of four to seven weeks.<a href="#cite_note-pmid8710247-39">[39]</a> The length of time that an individual remains <a href="/wiki/Contagious_disease" title="Contagious disease">contagious</a> is unclear, but the chances of passing the illness to someone else may be the highest during the first six weeks following infection. Some studies indicate that a person can spread the infection for many months, possibly up to a year and a half.<a href="#cite_note-40">[40]</a> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=12" title="Edit section: Pathophysiology">edit</a>]</div> The virus replicates first within <a href="/wiki/Epithelium" title="Epithelium">epithelial cells</a> in the <a href="/wiki/Human_pharynx" class="mw-redirect" title="Human pharynx">pharynx</a> (which causes <a href="/wiki/Pharyngitis" title="Pharyngitis">pharyngitis</a>, or sore throat), and later primarily within <a href="/wiki/B_cell" title="B cell">B cells</a> (which are invaded via their <a href="/wiki/Complement_receptor_2" title="Complement receptor 2">CD21</a>). The host immune response involves cytotoxic (CD8-positive) <a href="/wiki/T_cell" title="T cell">T cells</a> against infected B lymphocytes, resulting in enlarged, reactive lymphocytes (<a href="/wiki/Reactive_lymphocyte" title="Reactive lymphocyte">Downey cells</a>).<a href="#cite_note-eMedicine-41">[41]</a> When the infection is acute (recent onset, instead of <a href="/wiki/Chronic_(medicine)" class="mw-redirect" title="Chronic (medicine)">chronic</a>), <a href="/wiki/Heterophile" class="mw-redirect" title="Heterophile">heterophile</a> <a href="/wiki/Antibodies" class="mw-redirect" title="Antibodies">antibodies</a> are produced.<a href="#cite_note-Ebell2004-26">[26]</a> <a href="/wiki/Human_cytomegalovirus" title="Human cytomegalovirus">Cytomegalovirus</a>, <a href="/wiki/Adenovirus_infection" title="Adenovirus infection">adenovirus</a> and <a href="/wiki/Toxoplasma_gondii" title="Toxoplasma gondii">Toxoplasma gondii</a> (<a href="/wiki/Toxoplasmosis" title="Toxoplasmosis">toxoplasmosis</a>) infections can cause symptoms similar to infectious mononucleosis, but a <a href="/wiki/Heterophile_antibody_test" title="Heterophile antibody test">heterophile antibody test</a> will test negative and differentiate those infections from infectious mononucleosis.<a href="#cite_note-CDC2014Eb-2">[2]</a><a href="#cite_note-42">[42]</a> Mononucleosis is sometimes accompanied by secondary <a href="/wiki/Cold_agglutinin_disease" title="Cold agglutinin disease">cold agglutinin disease</a>, an <a href="/wiki/Autoimmune_disease" title="Autoimmune disease">autoimmune disease</a> in which abnormal circulating antibodies directed against <a href="/wiki/Red_blood_cell" title="Red blood cell">red blood cells</a> can lead to a form of <a href="/wiki/Autoimmune_hemolytic_anemia" title="Autoimmune hemolytic anemia">autoimmune hemolytic anemia</a>. The cold agglutinin detected is of <a href="/wiki/Ii_antigen_system" title="Ii antigen system">anti-i</a> specificity.<a href="#cite_note-Mayo_Textbook-43">[43]</a><a href="#cite_note-44">[44]</a> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=13" title="Edit section: Diagnosis">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Infectious_Mononucleosis_3.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/eb/Infectious_Mononucleosis_3.jpg/290px-Infectious_Mononucleosis_3.jpg" decoding="async" width="290" height="218" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/eb/Infectious_Mononucleosis_3.jpg/435px-Infectious_Mononucleosis_3.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/eb/Infectious_Mononucleosis_3.jpg/580px-Infectious_Mononucleosis_3.jpg 2x" data-file-width="1024" data-file-height="768" /></a><figcaption>Infectious mononucleosis, peripheral smear, high power showing reactive lymphocytes</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:SplenomegalyandsubcaphematomaCorMark.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/73/SplenomegalyandsubcaphematomaCorMark.png/290px-SplenomegalyandsubcaphematomaCorMark.png" decoding="async" width="290" height="281" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/73/SplenomegalyandsubcaphematomaCorMark.png/435px-SplenomegalyandsubcaphematomaCorMark.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/73/SplenomegalyandsubcaphematomaCorMark.png/580px-SplenomegalyandsubcaphematomaCorMark.png 2x" data-file-width="798" data-file-height="772" /></a><figcaption>Splenomegaly due to mononucleosis resulting in a subcapsular hematoma</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:SplenomegalyandsubcaphematomaMarked.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/33/SplenomegalyandsubcaphematomaMarked.png/290px-SplenomegalyandsubcaphematomaMarked.png" decoding="async" width="290" height="228" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/33/SplenomegalyandsubcaphematomaMarked.png/435px-SplenomegalyandsubcaphematomaMarked.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/33/SplenomegalyandsubcaphematomaMarked.png/580px-SplenomegalyandsubcaphematomaMarked.png 2x" data-file-width="953" data-file-height="750" /></a><figcaption>Splenomegaly due to mononucleosis resulting in a subcapsular hematoma</figcaption></figure> The disease is diagnosed based on: <div class="mw-heading mw-heading3"><h3 id="Physical_examination">Physical examination</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=14" title="Edit section: Physical examination">edit</a>]</div> The presence of an <a href="/wiki/Splenomegaly" title="Splenomegaly">enlarged spleen</a>, and swollen posterior <a href="/wiki/Cervical_lymph_nodes" title="Cervical lymph nodes">cervical</a>, <a href="/wiki/Axillary_lymph_nodes" title="Axillary lymph nodes">axillary</a>, and <a href="/wiki/Inguinal_lymph_node" class="mw-redirect" title="Inguinal lymph node">inguinal lymph nodes</a> are the most useful to suspect a diagnosis of infectious mononucleosis. On the other hand, the absence of swollen cervical lymph nodes and fatigue are the most useful to dismiss the idea of infectious mononucleosis as the correct diagnosis. The insensitivity of the physical examination in detecting an enlarged spleen means it should not be used as evidence against infectious mononucleosis.<a href="#cite_note-Ebell2004-26">[26]</a> A physical examination may also show <a href="/wiki/Petechiae" class="mw-redirect" title="Petechiae">petechiae</a> in the <a href="/wiki/Palate" title="Palate">palate</a>.<a href="#cite_note-Ebell2004-26">[26]</a> <div class="mw-heading mw-heading3"><h3 id="Heterophile_antibody_test">Heterophile antibody test</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=15" title="Edit section: Heterophile antibody test">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Heterophile_antibody_test" title="Heterophile antibody test">Heterophile antibody test</a></div> The heterophile antibody test, or monospot test, works by agglutination of red blood cells from guinea pigs, sheep and horses. This test is specific but not particularly <a href="/wiki/Sensitivity_and_specificity" title="Sensitivity and specificity">sensitive</a> (with a <a href="/wiki/False-negative" class="mw-redirect" title="False-negative">false-negative</a> rate of as high as 25% in the first week, 5–10% in the second, and 5% in the third).<a href="#cite_note-Ebell2004-26">[26]</a> About 90% of diagnosed people have heterophile antibodies by week 3, disappearing in under a year. The <a href="/wiki/Antibody" title="Antibody">antibodies</a> involved in the test do not interact with the Epstein–Barr virus or any of its <a href="/wiki/Antigen" title="Antigen">antigens</a>.<a href="#cite_note-Longmore2007-45">[45]</a> The monospot test is not recommended for general use by the <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">CDC</a> due to its poor accuracy.<a href="#cite_note-CDC2014Diag-10">[10]</a> <div class="mw-heading mw-heading3"><h3 id="Serology">Serology</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=16" title="Edit section: Serology">edit</a>]</div> Serologic tests detect <a href="/wiki/Antibody" title="Antibody">antibodies</a> directed against the Epstein–Barr virus. <a href="/wiki/Immunoglobulin_G" title="Immunoglobulin G">Immunoglobulin G</a> (IgG), when positive, mainly reflects a past infection, whereas <a href="/wiki/Immunoglobulin_M" title="Immunoglobulin M">immunoglobulin M</a> (IgM) mainly reflects a current infection. EBV-targeting antibodies can also be classified according to which part of the virus they bind to: <ul><li>Viral capsid antigen (VCA):</li></ul> <dl><dd><ul><li>Anti-VCA IgM appear early after infection, and usually, disappear within 4 to 6 weeks.<a href="#cite_note-CDC2014Diag-10">[10]</a></li> <li>Anti-VCA IgG appears in the acute phase of EBV infection, reaches a maximum at 2 to 4 weeks after onset of symptoms and thereafter declines slightly and persists for the rest of a person’s life.<a href="#cite_note-CDC2014Diag-10">[10]</a></li></ul></dd></dl> <ul><li>Early antigen (EA)</li></ul> <dl><dd><ul><li>Anti-EA IgG appears in the acute phase of illness and disappears after 3 to 6 months. It is associated with having an active infection. Yet, 20% of people may have antibodies against EA for years despite having no other sign of infection.<a href="#cite_note-CDC2014Diag-10">[10]</a></li></ul></dd></dl> <ul><li>EBV nuclear antigen (EBNA)</li></ul> <dl><dd><ul><li>Antibody to EBNA slowly appears 2 to 4 months after the onset of symptoms and persists for the rest of a person’s life.<a href="#cite_note-CDC2014Diag-10">[10]</a></li></ul></dd></dl> When negative, these tests are more accurate than the heterophile antibody test in ruling out infectious mononucleosis. When positive, they feature similar specificity to the heterophile antibody test. Therefore, these tests are useful for diagnosing infectious mononucleosis in people with highly suggestive symptoms and a negative heterophile antibody test.<a href="#cite_note-46">[46]</a> <div class="mw-heading mw-heading3"><h3 id="Other_tests">Other tests</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=17" title="Edit section: Other tests">edit</a>]</div> <ul><li>Elevated hepatic <a href="/wiki/Transaminase" title="Transaminase">transaminase</a> levels are highly suggestive of infectious mononucleosis, occurring in up to 50% of people.<a href="#cite_note-Ebell2004-26">[26]</a></li> <li>By <a href="/wiki/Blood_film" class="mw-redirect" title="Blood film">blood film</a>, one diagnostic criterion for infectious mononucleosis is the presence of 50% <a href="/wiki/Lymphocyte" title="Lymphocyte">lymphocytes</a> with at least 10% <a href="/wiki/Reactive_lymphocyte" title="Reactive lymphocyte">reactive lymphocytes</a> (large, irregular <a href="/wiki/Cell_nucleus" title="Cell nucleus">nuclei</a>),<a href="#cite_note-Longmore2007-45">[45]</a> while the person also has fever, pharyngitis, and <a href="/wiki/Lymphadenopathy" title="Lymphadenopathy">swollen lymph nodes</a>. The reactive lymphocytes resembled <a href="/wiki/Monocyte" title="Monocyte">monocytes</a> when they were first discovered, thus the term "mononucleosis" was coined.</li> <li>A <a href="/wiki/Fibrin_ring_granuloma" title="Fibrin ring granuloma">fibrin ring granuloma</a> may be present in the liver or bone marrow.<a href="#cite_note-47">[47]</a><a href="#cite_note-48">[48]</a></li></ul> <div class="mw-heading mw-heading3"><h3 id="Differential_diagnosis">Differential diagnosis</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=18" title="Edit section: Differential diagnosis">edit</a>]</div> About 10% of people who present a clinical picture of infectious mononucleosis do not have an acute Epstein–Barr-virus infection.<a href="#cite_note-Bravender2010-49">[49]</a> A differential diagnosis of acute infectious mononucleosis needs to take into consideration <a href="/wiki/Human_cytomegalovirus" title="Human cytomegalovirus">acute cytomegalovirus infection</a> and <a href="/wiki/Toxoplasma_gondii" title="Toxoplasma gondii">Toxoplasma gondii</a> infections. Because their management is much the same, it is not always helpful–or possible–to distinguish between Epstein–Barr-virus mononucleosis and cytomegalovirus infection. However, in pregnant women, differentiation of mononucleosis from <a href="/wiki/Toxoplasmosis" title="Toxoplasmosis">toxoplasmosis</a> is important, since it is associated with significant consequences for the <a href="/wiki/Fetus" title="Fetus">fetus</a>.<a href="#cite_note-Ebell2004-26">[26]</a> Acute <a href="/wiki/HIV_infection" class="mw-redirect" title="HIV infection">HIV infection</a> can mimic signs similar to those of infectious mononucleosis, and tests should be performed for pregnant women for the same reason as toxoplasmosis.<a href="#cite_note-Ebell2004-26">[26]</a> People with infectious mononucleosis are sometimes misdiagnosed with a <a href="/wiki/Streptococcal_pharyngitis" title="Streptococcal pharyngitis">streptococcal pharyngitis</a> (because of the symptoms of fever, <a href="/wiki/Pharyngitis" title="Pharyngitis">pharyngitis</a> and <a href="/wiki/Lymphadenopathy" title="Lymphadenopathy">adenopathy</a>) and are given antibiotics such as <a href="/wiki/Ampicillin" title="Ampicillin">ampicillin</a> or <a href="/wiki/Amoxicillin" title="Amoxicillin">amoxicillin</a> as treatment.<a href="#cite_note-50">[50]</a> Other conditions from which to distinguish infectious mononucleosis include <a href="/wiki/Leukemia" title="Leukemia">leukemia</a>, <a href="/wiki/Tonsillitis" title="Tonsillitis">tonsillitis</a>, <a href="/wiki/Diphtheria" title="Diphtheria">diphtheria</a>, <a href="/wiki/Common_cold" title="Common cold">common cold</a> and <a href="/wiki/Influenza" title="Influenza">influenza</a> (flu).<a href="#cite_note-Longmore2007-45">[45]</a> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=19" title="Edit section: Treatment">edit</a>]</div> Infectious mononucleosis is generally <a href="/wiki/Self-limiting_(biology)" title="Self-limiting (biology)">self-limiting</a>, so only symptomatic or supportive treatments are used.<a href="#cite_note-Merck18-51">[51]</a> The need for rest and return to usual activities after the acute phase of the infection may reasonably be based on the person's general energy levels.<a href="#cite_note-Ebell2004-26">[26]</a> Nevertheless, in an effort to decrease the risk of <a href="/wiki/Splenic_rupture" class="mw-redirect" title="Splenic rupture">splenic rupture</a>, experts advise avoidance of <a href="/wiki/Contact_sports" class="mw-redirect" title="Contact sports">contact sports</a> and other heavy physical activity, especially when involving increased abdominal pressure or the <a href="/wiki/Valsalva_maneuver" title="Valsalva maneuver">Valsalva maneuver</a> (as in <a href="/wiki/Rowing_(sport)" title="Rowing (sport)">rowing</a> or <a href="/wiki/Weight_training" class="mw-redirect" title="Weight training">weight training</a>), for at least the first 3–4 weeks of illness or until enlargement of the spleen has resolved, as determined by a treating physician.<a href="#cite_note-Ebell2004-26">[26]</a><a href="#cite_note-Putukian2008-52">[52]</a> <div class="mw-heading mw-heading3"><h3 id="Medications">Medications</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=20" title="Edit section: Medications">edit</a>]</div> <a href="/wiki/Paracetamol" title="Paracetamol">Paracetamol</a> (acetaminophen) and <a href="/wiki/Non-steroidal_anti-inflammatory_drug" class="mw-redirect" title="Non-steroidal anti-inflammatory drug">NSAIDs</a>, such as <a href="/wiki/Ibuprofen" title="Ibuprofen">ibuprofen</a>, may be used to reduce fever and pain. <a href="/wiki/Prednisone" title="Prednisone">Prednisone</a>, a <a href="/wiki/Corticosteroid" title="Corticosteroid">corticosteroid</a>, while used to try to reduce throat pain or enlarged <a href="/wiki/Tonsils" class="mw-redirect" title="Tonsils">tonsils</a>, remains controversial due to the lack of evidence that it is effective and the potential for side effects.<a href="#cite_note-53">[53]</a><a href="#cite_note-54">[54]</a> Intravenous <a href="/wiki/Corticosteroid" title="Corticosteroid">corticosteroids</a>, usually <a href="/wiki/Hydrocortisone" title="Hydrocortisone">hydrocortisone</a> or <a href="/wiki/Dexamethasone" title="Dexamethasone">dexamethasone</a>, are not recommended for routine use but may be useful if there is a risk of airway obstruction, a <a href="/wiki/Thrombocytopenia" title="Thrombocytopenia">very low platelet count</a>, or <a href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">hemolytic anemia</a>.<a href="#cite_note-WebMD-55">[55]</a><a href="#cite_note-TGAntibiotic13-56">[56]</a> Antiviral agents act by inhibiting viral DNA replication.<a href="#cite_note-pmid27933614-35">[35]</a> There is little evidence to support the use of antivirals such as <a href="/wiki/Aciclovir" title="Aciclovir">aciclovir</a> and <a href="/wiki/Valacyclovir" class="mw-redirect" title="Valacyclovir">valacyclovir</a> although they may reduce initial viral shedding.<a href="#cite_note-Torre1999-57">[57]</a><a href="#cite_note-58">[58]</a> Antivirals are expensive, risk causing resistance to antiviral agents, and (in 1% to 10% of cases) can cause unpleasant <a href="/wiki/Side_effect" title="Side effect">side effects</a>.<a href="#cite_note-pmid27933614-35">[35]</a> Although antivirals are not recommended for people with simple infectious mononucleosis, they may be useful (in conjunction with steroids) in the management of severe EBV manifestations, such as EBV meningitis, peripheral neuritis, hepatitis, or hematologic complications.<a href="#cite_note-pmid20739216-59">[59]</a> Although antibiotics exert no antiviral action they may be indicated to treat bacterial <a href="/wiki/Secondary_infection" class="mw-redirect" title="Secondary infection">secondary infections</a> of the throat,<a href="#cite_note-Glandular_fever-60">[60]</a> such as with <a href="/wiki/Streptococcus" title="Streptococcus">streptococcus</a> (<a href="/wiki/Strep_throat" class="mw-redirect" title="Strep throat">strep throat</a>). However, <a href="/wiki/Ampicillin" title="Ampicillin">ampicillin</a> and <a href="/wiki/Amoxicillin" title="Amoxicillin">amoxicillin</a> are not recommended during acute <a href="/wiki/Epstein%E2%80%93Barr_virus" title="Epstein–Barr virus">Epstein–Barr virus</a> infection as a diffuse rash may develop.<a href="#cite_note-61">[61]</a> <div class="mw-heading mw-heading3"><h3 id="Observation">Observation</h3>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=21" title="Edit section: Observation">edit</a>]</div> <a href="/wiki/Splenomegaly" title="Splenomegaly">Splenomegaly</a> is a common symptom of infectious mononucleosis and health care providers may consider using <a href="/wiki/Abdominal_ultrasonography" title="Abdominal ultrasonography">abdominal ultrasonography</a> to get insight into the enlargement of a person's spleen.<a href="#cite_note-AMSSMfive-62">[62]</a> However, because spleen size varies greatly, ultrasonography is not a valid technique for assessing spleen enlargement and should not be used in typical circumstances or to make routine decisions about fitness for playing sports.<a href="#cite_note-AMSSMfive-62">[62]</a> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=22" title="Edit section: Prognosis">edit</a>]</div> Serious <a href="/wiki/Complication_(medicine)" title="Complication (medicine)">complications</a> are uncommon, occurring in less than 5% of cases:<a href="#cite_note-63">[63]</a><a href="#cite_note-64">[64]</a> <ul><li><a href="/wiki/Central_nervous_system" title="Central nervous system">CNS</a> complications include <a href="/wiki/Meningitis" title="Meningitis">meningitis</a>, <a href="/wiki/Encephalitis" title="Encephalitis">encephalitis</a>, <a href="/wiki/Hemiplegia" class="mw-redirect" title="Hemiplegia">hemiplegia</a>, <a href="/wiki/Guillain%E2%80%93Barr%C3%A9_syndrome" title="Guillain–Barré syndrome">Guillain–Barré syndrome</a>, and <a href="/wiki/Transverse_myelitis" title="Transverse myelitis">transverse myelitis</a>. Prior infectious mononucleosis has been linked to the development of <a href="/wiki/Multiple_sclerosis" title="Multiple sclerosis">multiple sclerosis</a>.<a href="#cite_note-pmid20824132-65">[65]</a></li> <li><a href="/wiki/Hematology" title="Hematology">Hematologic</a>: <a href="/wiki/Autoimmune_hemolytic_anemia" title="Autoimmune hemolytic anemia">Hemolytic anemia</a> (direct <a href="/wiki/Coombs_test" title="Coombs test">Coombs test</a> is positive) and various <a href="/wiki/Cytopenia" title="Cytopenia">cytopenias</a>, and bleeding (caused by <a href="/wiki/Thrombocytopenia" title="Thrombocytopenia">thrombocytopenia</a>) can occur.<a href="#cite_note-Mayo_Textbook-43">[43]</a></li> <li>Mild <a href="/wiki/Jaundice" title="Jaundice">jaundice</a></li> <li><a href="/wiki/Hepatitis" title="Hepatitis">Hepatitis</a> with the Epstein–Barr virus is rare.</li> <li>Upper airway obstruction from <a href="/wiki/Palatine_tonsil#Tonsillar_hypertrophy" title="Palatine tonsil">tonsillar hypertrophy</a> is rare.</li> <li><a href="/wiki/Fulminant" title="Fulminant">Fulminant</a> disease course of <a href="/wiki/Immunodeficiency" title="Immunodeficiency">immunocompromised</a> people are rare.</li> <li><a href="/wiki/Splenic_rupture" class="mw-redirect" title="Splenic rupture">Splenic rupture</a> is rare.</li> <li><a href="/wiki/Myocarditis" title="Myocarditis">Myocarditis</a> and <a href="/wiki/Pericarditis" title="Pericarditis">pericarditis</a> are rare.</li> <li><a href="/wiki/Postural_orthostatic_tachycardia_syndrome" title="Postural orthostatic tachycardia syndrome">Postural orthostatic tachycardia syndrome</a></li> <li><a href="/wiki/Myalgic_encephalomyelitis/chronic_fatigue_syndrome" title="Myalgic encephalomyelitis/chronic fatigue syndrome">Myalgic encephalomyelitis/chronic fatigue syndrome</a></li> <li><a href="/wiki/Cancers" class="mw-redirect" title="Cancers">Cancers</a> associated with the Epstein–Barr virus include <a href="/wiki/Burkitt%27s_lymphoma" class="mw-redirect" title="Burkitt's lymphoma">Burkitt's lymphoma</a>, <a href="/wiki/Hodgkin%27s_lymphoma" class="mw-redirect" title="Hodgkin's lymphoma">Hodgkin's lymphoma</a> and <a href="/wiki/Lymphomas" class="mw-redirect" title="Lymphomas">lymphomas</a> in general as well as <a href="/wiki/Nasopharyngeal_carcinoma" title="Nasopharyngeal carcinoma">nasopharyngeal</a> and <a href="/wiki/Gastric_carcinoma" class="mw-redirect" title="Gastric carcinoma">gastric carcinoma</a>.<a href="#cite_note-66">[66]</a></li> <li><a href="/wiki/Hemophagocytic_lymphohistiocytosis" title="Hemophagocytic lymphohistiocytosis">Hemophagocytic lymphohistiocytosis</a><a href="#cite_note-pmid29358936-67">[67]</a></li></ul> Once the acute symptoms of an initial infection disappear, they often do not return. But once infected, the person carries the virus for the rest of their life. The virus typically lives dormant in B lymphocytes. Independent infections of mononucleosis may be contracted multiple times, regardless of whether the person is already carrying the virus dormant. Periodically, the virus can reactivate, during which time the person is again infectious, but usually without any symptoms of illness.<a href="#cite_note-CDC2014Eb-2">[2]</a> Usually, a person with IM has few, if any, further symptoms or problems from the latent B lymphocyte infection. However, in susceptible hosts under the appropriate environmental stressors, the virus can reactivate and cause vague physical symptoms (or may be subclinical), and during this phase, the virus can spread to others.<a href="#cite_note-CDC2014Eb-2">[2]</a><a href="#cite_note-68">[68]</a><a href="#cite_note-69">[69]</a> <div class="mw-heading mw-heading2"><h2 id="History">History</h2>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=23" title="Edit section: History">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Epstein%E2%80%93Barr_virus#History" title="Epstein–Barr virus">Epstein–Barr virus § History</a></div> The characteristic symptomatology of infectious mononucleosis does not appear to have been reported until the late nineteenth century.<a href="#cite_note-Altschuler1999-70">[70]</a> In 1885, the renowned Russian pediatrician <a href="/wiki/Nil_Filatov" title="Nil Filatov">Nil Filatov</a> reported an infectious process he called "idiopathic adenitis" exhibiting symptoms that correspond to infectious mononucleosis, and in 1889 a German <a href="/wiki/Balneologist" class="mw-redirect" title="Balneologist">balneologist</a> and pediatrician, <a href="/wiki/Emil_Pfeiffer" title="Emil Pfeiffer">Emil Pfeiffer</a>, independently reported similar cases (some of lesser severity) that tended to cluster in families, for which he coined the term Drüsenfieber ("glandular fever").<a href="#cite_note-Evans1974-71">[71]</a><a href="#cite_note-72">[72]</a><a href="#cite_note-73">[73]</a> The word mononucleosis has several <a href="/wiki/Word_sense" title="Word sense">senses</a>,<a href="#cite_note-Dorlands-74">[74]</a> but today it usually is used in the sense of infectious mononucleosis, which is caused by EBV. Around the 1920’s , infectious mononucleosis was not known and there were not many things to test whether people were infected or not. Before this there weren't many cases disclosed besides a few and one of these would take place in 1896. This outbreak infected an Ohio community which ended leaving them devastated. Epidemics seemed to keep reappearing here and there including an outbreak that happened in which 87 people were infected in the Falcon Islands. Some other outbreaks that occurred around this time would include some nurseries and boarding schools and also the U.S. Naval Base, Coronado, Calif,  where hundreds were infected by this virus. <a href="#cite_note-75">[75]</a> The term "infectious mononucleosis" was coined in 1920 by Thomas Peck Sprunt and Frank Alexander Evans in a classic clinical description of the disease published in the <a href="/wiki/Bulletin_of_the_Johns_Hopkins_Hospital" class="mw-redirect" title="Bulletin of the Johns Hopkins Hospital">Bulletin of the Johns Hopkins Hospital</a>, entitled "Mononuclear leukocytosis in reaction to acute infection (infectious mononucleosis)".<a href="#cite_note-Evans1974-71">[71]</a><a href="#cite_note-76">[76]</a> A lab test for infectious mononucleosis was developed in 1931 by Yale School of Public Health Professor John Rodman Paul and Walls Willard Bunnell based on their discovery of heterophile antibodies in the sera of persons with the disease.<a href="#cite_note-77">[77]</a> The Paul-Bunnell Test or PBT was later replaced by the <a href="/wiki/Heterophile_antibody_test" title="Heterophile antibody test">heterophile antibody test</a>. The Epstein–Barr virus was first identified in <a href="/wiki/Burkitt%27s_lymphoma" class="mw-redirect" title="Burkitt's lymphoma">Burkitt's lymphoma</a> cells by <a href="/wiki/Anthony_Epstein" title="Anthony Epstein">Michael Anthony Epstein</a> and <a href="/wiki/Yvonne_Barr" title="Yvonne Barr">Yvonne Barr</a> at the <a href="/wiki/University_of_Bristol" title="University of Bristol">University of Bristol</a> in 1964.<a href="#cite_note-78">[78]</a> The link with infectious mononucleosis was uncovered in 1967 by Werner and Gertrude Henle at the <a href="/wiki/Children%27s_Hospital_of_Philadelphia" title="Children's Hospital of Philadelphia">Children's Hospital of Philadelphia</a>, after a laboratory technician handling the virus contracted the disease: comparison of serum samples collected from the technician before and after the onset revealed development of <a href="/wiki/Antibody" title="Antibody">antibodies</a> to the virus.<a href="#cite_note-Miller2006-79">[79]</a><a href="#cite_note-Henle1968-80">[80]</a> Yale School of Public Health epidemiologist Alfred E. Evans confirmed through testing that mononucleosis was transmitted mainly through kissing, leading to it being referred to colloquially as "the kissing disease".<a href="#cite_note-81">[81]</a> <div class="mw-heading mw-heading2"><h2 id="References">References</h2>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=24" title="Edit section: References">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-wni1811-1"><a href="#cite_ref-wni1811_1-0">^</a> <a rel="nofollow" class="external text" href="http://www.whonamedit.com/synd.cfm/1811.html">Filatov's disease</a> at <a href="/wiki/Whonamedit%3F" title="Whonamedit?">Whonamedit?</a> </li> <li id="cite_note-CDC2014Eb-2">^ <a href="#cite_ref-CDC2014Eb_2-0">a</a> <a href="#cite_ref-CDC2014Eb_2-1">b</a> <a href="#cite_ref-CDC2014Eb_2-2">c</a> <a href="#cite_ref-CDC2014Eb_2-3">d</a> <a href="#cite_ref-CDC2014Eb_2-4">e</a> <a href="#cite_ref-CDC2014Eb_2-5">f</a> <a href="#cite_ref-CDC2014Eb_2-6">g</a> <a href="#cite_ref-CDC2014Eb_2-7">h</a> <a href="#cite_ref-CDC2014Eb_2-8">i</a> <a href="#cite_ref-CDC2014Eb_2-9">j</a> <a href="#cite_ref-CDC2014Eb_2-10">k</a> <a href="#cite_ref-CDC2014Eb_2-11">l</a> <a href="#cite_ref-CDC2014Eb_2-12">m</a> <a href="#cite_ref-CDC2014Eb_2-13">n</a> <a href="#cite_ref-CDC2014Eb_2-14">o</a> <a href="#cite_ref-CDC2014Eb_2-15">p</a> <a href="#cite_ref-CDC2014Eb_2-16">q</a> <a href="#cite_ref-CDC2014Eb_2-17">r</a> <a href="#cite_ref-CDC2014Eb_2-18">s</a> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cdc.gov/epstein-barr/about-ebv.html">"About Epstein-Barr Virus (EBV)"</a>. 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Pediatrics. 75 (6): 1003–1010. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1542%2Fpeds.75.6.1003">10.1542/peds.75.6.1003</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0031-4005">0031-4005</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/2987784">2987784</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatrics&rft.atitle=Epstein-Barr+virus+infectious+mononucleosis+in+children.+I.+Clinical+and+general+laboratory+findings&rft.volume=75&rft.issue=6&rft.pages=%3Cspan+class%3D%22nowrap%22%3E1003-%3C%2Fspan%3E1010&rft.date=1985-06&rft.issn=0031-4005&rft_id=info%3Apmid%2F2987784&rft_id=info%3Adoi%2F10.1542%2Fpeds.75.6.1003&rft.aulast=Sumaya&rft.aufirst=C.+V.&rft.au=Ench%2C+Y.&rft_id=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F2987784%2F%23%3A~%3Atext%3DChildren%2520with%2520infectious%2520mononucleosis%2C%2520in%2Cbeen%2520reported%2520in%2520adult%2520patients.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AInfectious+mononucleosis" class="Z3988"> </li> <li id="cite_note-18"><a href="#cite_ref-18">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFSoldanLieberman2020" class="citation journal cs1">Soldan SS, Lieberman PM (2020). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059607">"Epstein-Barr Virus Infection in the Development of Neurological Disorders"</a>. Drug Discovery Today: Disease Models. 32 (Pt A): 35–52. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.ddmod.2020.01.001">10.1016/j.ddmod.2020.01.001</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1740-6757">1740-6757</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059607">8059607</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/33897799">33897799</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Drug+Discovery+Today%3A+Disease+Models&rft.atitle=Epstein-Barr+Virus+Infection+in+the+Development+of+Neurological+Disorders&rft.volume=32&rft.issue=Pt+A&rft.pages=%3Cspan+class%3D%22nowrap%22%3E35-%3C%2Fspan%3E52&rft.date=2020&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC8059607%23id-name%3DPMC&rft.issn=1740-6757&rft_id=info%3Apmid%2F33897799&rft_id=info%3Adoi%2F10.1016%2Fj.ddmod.2020.01.001&rft.aulast=Soldan&rft.aufirst=Samantha+S.&rft.au=Lieberman%2C+Paul+M.&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC8059607&rfr_id=info%3Asid%2Fen.wikipedia.org%3AInfectious+mononucleosis" class="Z3988"> </li> <li id="cite_note-Cohen2005-19">^ <a href="#cite_ref-Cohen2005_19-0">a</a> <a href="#cite_ref-Cohen2005_19-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFCohen2005" class="citation book cs1">Cohen JI (2005). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=TRO-wXto8hcC&q=epstein-barr+jeffrey+I.+cohen+abstract">"Clinical Aspects of Epstein-Barr Infection"</a>. In Robertson, Erle S. (ed.). Epstein-Barr Virus. Horizon Scientific Press. pp. 35–42. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-904455-03-5" title="Special:BookSources/978-1-904455-03-5"><bdi>978-1-904455-03-5</bdi></a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20140224131627/http://books.google.com/books?id=TRO-wXto8hcC&printsec=frontcover#v=onepage&q=epstein-barr%20jeffrey%20I.%20cohen%20abstract&f=false">Archived</a> from the original on 24 February 2014. 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Elsevier Health Sciences. p. 79. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7020-6338-1" title="Special:BookSources/978-0-7020-6338-1"><bdi>978-0-7020-6338-1</bdi></a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20170911003200/https://books.google.com/books?id=Dhq3DAAAQBAJ&pg=PA79">Archived</a> from the original on 2017-09-11.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Infectious+Diseases&rft.pages=79&rft.pub=Elsevier+Health+Sciences&rft.date=2016&rft.isbn=978-0-7020-6338-1&rft.aulast=Cohen&rft.aufirst=Jonathan&rft.au=Powderly%2C+William+G.&rft.au=Opal%2C+Steven+M.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DDhq3DAAAQBAJ%26pg%3DPA79&rfr_id=info%3Asid%2Fen.wikipedia.org%3AInfectious+mononucleosis" class="Z3988"> </li> <li id="cite_note-21"><a href="#cite_ref-21">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFBennettDolinBlaser2014" class="citation book cs1">Bennett JE, Dolin R, Blaser MJ (2014). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=BseNCgAAQBAJ&pg=PA1760">Principles and Practice of Infectious Diseases</a>. Elsevier Health Sciences. p. 1760. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4557-4801-3" title="Special:BookSources/978-1-4557-4801-3"><bdi>978-1-4557-4801-3</bdi></a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20170911003200/https://books.google.com/books?id=BseNCgAAQBAJ&pg=PA1760">Archived</a> from the original on 2017-09-11.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Principles+and+Practice+of+Infectious+Diseases&rft.pages=1760&rft.pub=Elsevier+Health+Sciences&rft.date=2014&rft.isbn=978-1-4557-4801-3&rft.aulast=Bennett&rft.aufirst=John+E.&rft.au=Dolin%2C+Raphael&rft.au=Blaser%2C+Martin+J.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DBseNCgAAQBAJ%26pg%3DPA1760&rfr_id=info%3Asid%2Fen.wikipedia.org%3AInfectious+mononucleosis" class="Z3988"> </li> <li id="cite_note-Benign_lymphadenopathy-22"><a href="#cite_ref-Benign_lymphadenopathy_22-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFWeissO'Malley2013" class="citation journal cs1">Weiss LM, O'Malley D (2013). <a rel="nofollow" class="external text" href="https://doi.org/10.1038%2Fmodpathol.2012.176">"Benign lymphadenopathies"</a>. 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U.S.A. 59 (1): 94–101. <a href="/wiki/Bibcode_(identifier)" class="mw-redirect" title="Bibcode (identifier)">Bibcode</a>:<a rel="nofollow" class="external text" href="https://ui.adsabs.harvard.edu/abs/1968PNAS...59...94H">1968PNAS...59...94H</a>. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1073%2Fpnas.59.1.94">10.1073/pnas.59.1.94</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC286007">286007</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/5242134">5242134</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proc.+Natl.+Acad.+Sci.+U.S.A.&rft.atitle=Relation+of+Burkitt%27s+tumor-associated+herpes-ytpe+virus+to+infectious+mononucleosis&rft.volume=59&rft.issue=1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E94-%3C%2Fspan%3E101&rft.date=1968-01&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC286007%23id-name%3DPMC&rft_id=info%3Apmid%2F5242134&rft_id=info%3Adoi%2F10.1073%2Fpnas.59.1.94&rft_id=info%3Abibcode%2F1968PNAS...59...94H&rft.aulast=Henle&rft.aufirst=G&rft.au=Henle%2C+W&rft.au=Diehl%2C+V&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC286007&rfr_id=info%3Asid%2Fen.wikipedia.org%3AInfectious+mononucleosis" class="Z3988"> </li> <li id="cite_note-81"><a href="#cite_ref-81">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFFountain1996" class="citation news cs1">Fountain H (1996-01-25). <a rel="nofollow" class="external text" href="https://www.nytimes.com/1996/01/25/us/alfred-s-evans-78-expert-on-origins-of-mononucleosis.html">"Alfred S. Evans, 78, Expert On Origins of Mononucleosis"</a>. The New York Times. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0362-4331">0362-4331</a>. Retrieved 2019-01-04.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Alfred+S.+Evans%2C+78%2C+Expert+On+Origins+of+Mononucleosis&rft.date=1996-01-25&rft.issn=0362-4331&rft.aulast=Fountain&rft.aufirst=Henry&rft_id=https%3A%2F%2Fwww.nytimes.com%2F1996%2F01%2F25%2Fus%2Falfred-s-evans-78-expert-on-origins-of-mononucleosis.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AInfectious+mononucleosis" class="Z3988"> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2>[<a href="/w/index.php?title=Infectious_mononucleosis&action=edit&section=25" title="Edit section: External links">edit</a>]</div> <ul><li><a href="/wiki/File:Commons-logo.svg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/12px-Commons-logo.svg.png" decoding="async" width="12" height="16" class="mw-file-element" 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ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /></div><div role="navigation" class="navbox" aria-label="Navbox32" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q207367" class="extiw" title="d:Q207367">D</a></div><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/B27">B27</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=075">075</a></li><li><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D007244">D007244</a></li><li><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb4387.htm">4387</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000591.htm">000591</a></li><li><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/emerg/319-overview">emerg/319</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/med/topic1499.htm#">med/1499</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/ped/topic705.htm#">ped/705</a></li><li><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/infectious-mononucleosis">Infectious mononucleosis</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235" /></div><div role="navigation" class="navbox" aria-labelledby="Infectious_diseases_–_viral_systemic_diseases519" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output 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style="width:100%;padding:0"><div style="padding:0 0.25em"> <dl><dt><a href="/wiki/DNA_virus" title="DNA virus">DNA virus</a></dt> <dd><a href="/wiki/Hepatitis_B_virus" title="Hepatitis B virus">HBV</a> <dl><dd><a href="/wiki/Hepatocellular_carcinoma" title="Hepatocellular carcinoma">Hepatocellular carcinoma</a></dd></dl></dd> <dd><a href="/wiki/Papillomaviridae" title="Papillomaviridae">HPV</a> <dl><dd><a href="/wiki/Cervical_cancer" title="Cervical cancer">Cervical cancer</a></dd> <dd><a href="/wiki/Anal_cancer" title="Anal cancer">Anal cancer</a></dd> <dd><a href="/wiki/Penile_cancer" title="Penile cancer">Penile cancer</a></dd> <dd><a href="/wiki/Vulvar_cancer" title="Vulvar cancer">Vulvar cancer</a></dd> <dd><a href="/wiki/Vaginal_cancer" title="Vaginal cancer">Vaginal cancer</a></dd> <dd><a href="/wiki/HPV-positive_oropharyngeal_cancer" title="HPV-positive oropharyngeal cancer">Oropharyngeal cancer</a></dd></dl></dd> <dd><a href="/wiki/Kaposi%27s_sarcoma-associated_herpesvirus" title="Kaposi's sarcoma-associated herpesvirus">KSHV</a> <dl><dd><a href="/wiki/Kaposi%27s_sarcoma" title="Kaposi's sarcoma">Kaposi's sarcoma</a></dd></dl></dd> <dd><a href="/wiki/Epstein%E2%80%93Barr_virus" title="Epstein–Barr virus">EBV</a> <dl><dd><a href="/wiki/Nasopharyngeal_carcinoma" title="Nasopharyngeal carcinoma">Nasopharyngeal carcinoma</a></dd> <dd><a href="/wiki/Burkitt%27s_lymphoma" class="mw-redirect" title="Burkitt's lymphoma">Burkitt's lymphoma</a></dd> <dd><a href="/wiki/Hodgkin_lymphoma" title="Hodgkin lymphoma">Hodgkin lymphoma</a></dd> <dd><a href="/wiki/Follicular_dendritic_cell_sarcoma" title="Follicular dendritic cell sarcoma">Follicular dendritic cell sarcoma</a></dd> <dd><a href="/wiki/Extranodal_NK/T-cell_lymphoma,_nasal_type" title="Extranodal NK/T-cell lymphoma, nasal type">Extranodal NK/T-cell lymphoma, nasal type</a></dd></dl></dd> <dd><a href="/wiki/Merkel_cell_polyomavirus" title="Merkel cell polyomavirus">MCPyV</a> <dl><dd><a 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style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HIV" title="HIV">HIV</a> <ul><li><a href="/wiki/HIV/AIDS" title="HIV/AIDS">AIDS</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Central_nervous_system_viral_disease" title="Central nervous system viral disease">Central nervous system</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Viral_encephalitis" title="Viral encephalitis">Encephalitis</a>/ <a href="/wiki/Viral_meningitis" title="Viral meningitis">meningitis</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <dl><dt><a href="/wiki/DNA_virus" title="DNA virus">DNA virus</a></dt> <dd><a href="/wiki/Human_polyomavirus_2" title="Human polyomavirus 2">Human polyomavirus 2</a> <dl><dd><a href="/wiki/Progressive_multifocal_leukoencephalopathy" title="Progressive multifocal leukoencephalopathy">Progressive multifocal leukoencephalopathy</a></dd></dl></dd></dl> <dl><dt><a href="/wiki/RNA_virus" title="RNA virus">RNA virus</a></dt> <dd><a href="/wiki/Measles_morbillivirus" class="mw-redirect" title="Measles morbillivirus">MeV</a> <dl><dd><a href="/wiki/Subacute_sclerosing_panencephalitis" title="Subacute sclerosing panencephalitis">Subacute sclerosing panencephalitis</a></dd></dl></dd> <dd><a href="/wiki/Lymphocytic_choriomeningitis" title="Lymphocytic choriomeningitis">LCV</a> <dl><dd><a href="/wiki/Lymphocytic_choriomeningitis" title="Lymphocytic choriomeningitis">Lymphocytic choriomeningitis</a></dd></dl></dd> <dd><a href="/wiki/Arbovirus_encephalitis" class="mw-redirect" title="Arbovirus encephalitis">Arbovirus encephalitis</a></dd> <dd><a 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respiratory syndrome">Middle East respiratory syndrome</a></li></ul></li> <li><a href="/wiki/Severe_acute_respiratory_syndrome_coronavirus" class="mw-redirect" title="Severe acute respiratory syndrome coronavirus">SARS coronavirus</a> <ul><li><a href="/wiki/Severe_acute_respiratory_syndrome" class="mw-redirect" title="Severe acute respiratory syndrome">Severe acute respiratory syndrome</a></li></ul></li> <li><a href="/wiki/SARS-CoV-2" title="SARS-CoV-2">SARS-CoV-2</a> <ul><li><a href="/wiki/COVID-19" title="COVID-19">COVID-19</a></li></ul></li></ul> <ul><li><a href="/wiki/RNA_virus#Group_V_–_negative-sense_ssRNA_viruses" title="RNA virus">V</a>, <a href="/wiki/Orthomyxoviridae" title="Orthomyxoviridae">Orthomyxoviridae</a>: <a href="/wiki/Influenza_A_virus" title="Influenza A virus">Influenza virus A</a>/<a href="/wiki/Influenza_B_virus" title="Influenza B virus">B</a>/<a href="/wiki/Influenza_C_virus" title="Influenza C virus">C</a>/<a href="/wiki/Influenza_D_virus" title="Influenza D virus">D</a> <ul><li><a href="/wiki/Influenza" title="Influenza">Influenza</a>/<a href="/wiki/Avian_influenza" title="Avian influenza">Avian influenza</a></li></ul></li></ul> <ul><li>V, <a href="/wiki/Paramyxoviridae" title="Paramyxoviridae">Paramyxoviridae</a>: <a href="/wiki/Human_parainfluenza_viruses" title="Human parainfluenza viruses">Human parainfluenza viruses</a> <ul><li><a href="/wiki/Human_parainfluenza_viruses" title="Human parainfluenza viruses">Parainfluenza</a></li></ul></li> <li><a href="/wiki/Human_orthopneumovirus" class="mw-redirect" title="Human orthopneumovirus">Human orthopneumovirus</a></li> <li><a href="/wiki/Human_metapneumovirus" title="Human metapneumovirus">hMPV</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_digestive_system" title="Human digestive system">Human digestive system</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" 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