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Forum Name: Viral Infections

Question: salivary gland problem and Mononucleosis


 stpwest - Mon Nov 23, 2009 8:25 pm

Starting in Jan 2009, I began to have sinus, ear, nose, and throat problems. I have been to both an ENT doctor and an Allergist. I have had 2 CT scans and 1 set of blood work performed. The allergist has me on Flonase and Allegra D 24hr. My sinus scans were clear and the flonase and allegra have relieved my issues with pain and breathing through my nose. My continuing problem is with a salivary gland on my left side of my jaw and also my left ear. The scans did not show any stones or tumors. The blood work was ok except for high levels of indicator for having had mononucleosis.
This pain with my gland, ear, and fatigue have been going on for months now. My ENT has referred me back to my primary for chronic mononucleosis. I believe the problem with the gland occurred first before the mononucleosis. Now I am left to wonder if a chronic infection of the salivary gland is hindering my recovery from the mononucleosis. Is removing the gland a good idea given the fact I don't know if that is the main problem? Should I ask to see an infectious disease specialist?
 Dr.M.Aroon kamath - Thu Dec 31, 2009 12:28 pm

User avatar Hi,
Infectious mononucleosis, which is caused by Epstein-Barr virus can present with swelling in the parotid region due to
- a parotitis
- an acute parotid lymph nose enlargement (acute lymphadenitis) or
- as certain parotid tumors.


Parotid lymph node enlargement in Infectious mononucleosis may occur in two ways..
- as part of generalised lymphadenopathy or
- secondary to 'membranous tonsillitis' which is known to occur in this condition.


Lymphomas of the parotid gland and undifferentiated carcinomas lof parotid gland are thought to be associated with Epstein-Barr viral infection. Clonal EBV genomes have been detected in undifferentiated carcinomas of the parotid gland exclusively in Alaskan natives and inuits. Both groups are also at the highest risk for nasopharyngeal carcinoma.

There is some evidence that the Epstine-Barr viral genome can persist in salivary glands and in saliva for many years following the initial infection.

Checking for the viral genome in saliva is not very useful as many normal healthy people can carry and spread the virus intermittently for life in their saliva.

Direct detection of EBV in blood or lymphoid tissues is a research tool and is not available for the clinical situations. Instead, serologic testing is the method of choice for diagnosing primary infection. An acute-phase sample should be tested for antibodies to several EBV-associated antigens(the early antigen, EBV nuclear antigen (EBNA) & the viral capsid antigen) simultaneously.This may provide evidence for re-activation of the infection.

However, i must warn you that finding an answer to your question is not that simple, and interpretation of laboratory results is highly complex and should be ideally performed by physicians who are familiar with EBV testing and who have access to a given patient's clinical condition.
I hope i have clarified some of your doubts. Best wishes!

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