Also known as infectitious mononucelosis or glandular disease, ‘kissing disease’ is quite a common occurrence.
Increased frequency is especially observed in university student because of its peculiar mode of transmission – by way of intimate kissing!
Occurrence of Kissing Disease
Kissing disease occurs in late teenage years or early adulthood – almost 90% of humans are affected during this age. During childhood, maternal antibodies protect against the virus causing the condition. However, during late teen years, these antibodies begin to wane - thus making a person susceptible to the virus
What causes it?
Kissing disease is a viral illness – caused by infection with Epstein-Barr virus (EBV).
Transmission occurs by ‘intimate contact’. Exchange of oropharyngeal secretions – saliva – during kissing is what causes it!
Most cases are asymptomatic. However, when symptoms do occur, a characteristic clinical triad is observed. The components of this triad are:
Additionally, fatigue, loss of appetite and vomiting will help you identify the condition and differentiate it from normal sore throat. Petechial rash over the pharynx and an enlarged spleen can help a clinician make the diagnosis.
There is a very real risk of the condition being misdiagnosed and therefore mistreated by a physician.
Part of the reason is that similar symptoms can be caused by a plethora of other viruses like Cytomegalovirus (CMV), Herpes Simplex virus (HSV), Adenovirus and parasites like Toxoplamsa gondii. Some of the signs and symptoms are also similar to those caused by viral hepatitis A, B and C.
Due to the high frequency of upper respiratory tract infection in general population, this condition may be diagnosed as streptococcal pharyngitis. The misdiagnosed condition, when treated with penicillin causes the appearance of a rash which is then diagnosed as allergy to penicillin- making the clinician then institute anti-allergic treatment. That kind of complicates things, doesn’t it?! – thus the immense importance of the condition being diagnosed properly.
Being a viral disease, definitive therapeutic treatment is not available. The good news is that the condition is self-limiting meaning it will take of itself.
However, doctors prescribe drugs like paracetamol for fever and pain management and corticoids like prednisolone for enlarged tonsils making swallowing difficult and painful.
Penicillin antibiotics like Ampicillin are contraindicated because of their ability to cause a rash. Fatigue (as you would expect with a viral infection) makes bed rest of paramount importance.
Also, if you are a college athlete, you are better off not playing any contact sports for a few weeks since it increases the chances of rupturing your enlarged spleen – and a ruptured spleen because of the amount of blood loss it causes is a surgical emergency – don’t we all know that?! Well, if you didn’t, now you do!!
Importance of Kissing Disease
What increases the importance of this seemingly innocuous condition is the fact that EBV infection can lead to some life threatening conditions in later life.
EBV has a liking for pharyngeal cells – after gaining entry into the body, it lodges into the lining epithelial cells of the pharynx - here it replicates and remains dormant for a very long.
Depending on the immune status of the individual, the virus can continue to remain dormant throughout the life of an individual or can cause some serious conditions; some of these are:
Take Home Message
So, if you have been kissing someone passionately over the last few weeks, and happen to suffer from sore throat, the diagnosis of ‘kissing disease’ should be foremost in your mind, especially since your doctor has a very realistic chance of missing the diagnosis.
A little input form you during ‘history taking’ can help the ‘unsuspecting’ doctor to reach a proper diagnosis!