Mononucleosis and Guillain-Barre Syndrome: Causes, Symptoms, Diagnosis and Treatment

What is Mononucleosis?

Mononucleosis, also known as mono or the kissing disease, is an infectious disease caused by the Epstein-Barr virus (EBV). It is most commonly spread through contact with saliva, which is why it is often associated with kissing. However, mono can also be spread through coughing, sneezing, or sharing food and drinks with someone who is infected.

The most common symptoms of mono include fatigue, fever, sore throat, swollen lymph nodes in the neck, headaches, and muscle aches. Some people may also experience a skin rash. Symptoms usually appear 4-6 weeks after exposure to the virus and often last 1-2 months, but fatigue can linger for weeks or even months afterward.

Mono is most common among teens and young adults, but anyone can get infected. It is estimated that up to 95% of American adults have been infected with EBV at some point in their lives, often during childhood when symptoms are mild or nonexistent. Mono is diagnosed through a blood test that looks for antibodies to EBV.

There is no specific treatment for mono - simply managing symptoms with rest, fluids, and over-the-counter pain relievers is recommended. Avoiding contact sports or strenuous activity is also advised until fatigue and symptoms fully resolve, as a swollen spleen is common with mono and is at risk of rupture.

Risk Factors for Mononucleosis

Certain factors can increase risk of mono infection and severity of symptoms:

• Being an adolescent or young adult
• Living in crowded conditions or dormitories
• Participating in close contact sports
• Having an immune system weakened by other health conditions or medications
• Being male - males tend to have more severe symptoms than females

Complications of Mononucleosis

For the majority of healthy people under age 35, mono resolves without issue. However, potential complications can include:

• Rupture of an enlarged spleen
• Low platelet count (thrombocytopenia)
• Liver inflammation (hepatitis)
• Neurological complications like meningitis, encephalitis, Guillain-Barre syndrome, or temporary Bell's palsy facial paralysis
• Chronic fatigue persisting longer than 6 months after initial infection

What is Guillain-Barre Syndrome?

Guillain-Barre syndrome (GBS) is a rare autoimmune disorder in which the immune system mistakenly attacks the body's peripheral nervous system. This leads to nerve inflammation and muscle weakness or paralysis.

GBS affects about 1 in 100,000 people each year. While anyone can develop GBS, it is more common among adults over 50 and males. It often follows a bacterial or viral infection, with about 1/3 of cases occurring after a respiratory illness or diarrhea and a small percentage after mono or cytomegalovirus.

Guillain-Barre Syndrome Symptoms

The main symptom of GBS is progressive muscle weakness and paralysis, which typically starts in the legs and spreads upward. Other key symptoms include:

• Prickling or tingling sensations in the fingers and toes
• Difficulty walking, facial movements, chewing, swallowing, or speaking
• Double vision
• Difficulty breathing if chest muscles are affected
• Rapid heart rate and blood pressure changes

Symptoms come on relatively quickly, progressing over hours, days or weeks. Most people reach peak weakness within 2-4 weeks before plateauing and eventually improving.

Causes and Risk Factors

Its not fully understood why GBS occurs, but suspected triggers include:

• Bacterial infections like campylobacter jejuni
• Viral infections including flu, CMV, EBV, Zika, or hepatitis E
• Surgery
• Pregnancy
• Vaccinations
• Hodgkins lymphoma
• Autoimmune diseases like lupus

GBS is thought to be caused by molecular mimicry - when foreign antigens resemble and trigger an immune attack against the bodys own nerves. Risk factors include:

• Being male
• Older age
• Compromised immunity
• Lung or sinus infection in preceding 6 weeks
• Diarrheal illness in preceding 6 weeks
• History of surgery or vaccinations in preceding 6 weeks

Diagnosing Guillain-Barre Syndrome

There is no definitive single test for GBS. Doctors make the diagnosis based on characteristic symptoms, exam findings confirming muscle weakness and loss of reflexes, and test results that rule out other causes. Diagnostic tests and exams may include:

• Blood tests checking electrolyte, liver function, kidney function
• Lumbar puncture to analyze spinal fluid
• Nerve conduction velocity test to measure how fast electric signals travel through a nerve
• Electromyography to assess muscle and nerve abnormalities
• MRI scan of the spine to look for nerve inflammation or compression

Doctors may also test for preceding infections like EBV or CMV that are associated with GBS.

Guillain-Barre Syndrome Classification

There are a few main subtypes and variants of GBS that doctors may reference based on clinical presentation, test findings, and course of illness:

• Acute inflammatory demyelinating polyneuropathy (AIDP): The most common form, involves immune damage to myelin nerve coatings and some axons. Weakness is relatively symmetrical and loss of reflexes occurs early.
• Acute motor axonal neuropathy (AMAN): Immune attack targets the axons of motor nerves. Reflexes are preserved early on.
• Acute motor and sensory axonal neuropathy (AMSAN): Sensory nerves are also affected.
• Miller Fisher syndrome: Rare variant involving eye muscle weakness, loss of balance/coordination, and abnormal reflexes.
• Bickerstaffs brainstem encephalitis: Impacts brainstem function.

Treatment for Guillain-Barre Syndrome

Although most people recover from GBS, supportive hospital care is crucial early on. Treatment focuses on calming inflammation and preventing complications. Options may include:

• Plasmapheresis (plasma exchange): Blood is filtered to remove harmful antibodies, then returned to the body.
• IVIg: High dose immunoglobulin injections to modulate immunity.
• Physical therapy: Stretches and exercises to maintain joint motion and prevent contractures.
• Pain medications: For neuropathy, muscle aches, headache.
• Blood thinners: Prevent blood clots from immobility.
• Breathing support: Ventilator if necessary until lungs/chest strength improves.

These treatments curb progression of paralysis, shorten recovery time, and reduce risk of complications. Supportive care like physical/occupational therapy, pain management, and nutritional support continue through the recovery process.

Recovery and Prognosis

With treatment, 60-80% of GBS patients are able to walk unaided after 6-12 months. However, recovery takes time and is gradual, with lingering fatigue common.

Mortality rates range from 3-7%. Death typically results from complications like pneumonia, sepsis, pulmonary embolism, or cardiac arrest.

<p

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.