Mononucleosis, also known as infectious mononucleosis, mono or the kissing disease, is an infection caused by the Epstein-Barr virus. This virus is easily transmissible in the saliva and by close contact to infected people. The virus can cause different symptoms, including liver inflammation or hepatitis, which can be detected as a persistent elevation of the liver enzymes.
Symptoms
The symptoms of infectious mononucleosis start slowly. Symptoms include fever, fatigue, headache, sore throat and a general feeling of achiness. As the symptoms progress, the person may experience swelling of the tonsils and the lymph nodes around the neck, making it extremely difficult and painful to swallow. Occasionally, people with mononucleosis may develop a measles-like pink rash, especially if given penicillin antibiotics.
Hepatitis
When liver cells become inflamed, as in hepatitis, they release enzymes into the bloodstream. This elevation of liver enzymes can be detected with blood tests to measure the degree of liver damage. According to the Merck Manual, about 95 percent of patients with infectious mononucleosis have an elevation of their liver enzymes. This elevation may last up to four weeks. After that, if liver enzymes continue to be elevated, other causes of hepatitis should be considered. Hepatitis due to the Epstein-Barr virus can cause jaundice, a yellowish discoloration of the skin; abdominal pain, particularly in the right upper side of the abdomen where the liver is located; and swelling of the liver. Other symptoms include nausea and vomiting, weight loss, decreased appetite and dark discoloration of the urine.
Liver Enzymes
Two liver enzymes -- alanine aminotransferase, or ALT, and aspartate aminotransferase, or AST -- become elevated in cases of hepatitis. Together, these two enzymes are called transaminases. ALT is mostly found in the liver, so it is the best test for detecting hepatitis. AST is found in other tissues in the body, including the heart and other muscles.
Treatment
The treatment for infectious mononucleosis is mostly symptomatic. People with severe swelling of the tonsils and lymph nodes of the neck who cannot swallow fluids effectively may become dehydrated and need intravenous fluids. Warm salt-water gargles may help alleviate throat pain. Elevation of liver enzymes usually resolves without any therapy.
