Thursday, November 26, 2015

Mono: just one 'kiss'− that's all it takes

One of my patients drove home from college to see me because she was "just not feeling well." About a month earlier she had a sore throat, which got better, and then came back again. And she needed to sleep a lot− 16 hours a day and she was still exhausted! When I examined her, I found her "Monospot" test was positive.

Mono: just one 'kiss'− that’s all it takes


By Rima Himelstein

One of my patients drove home from college to see me because she was “just not feeling well.” About a month earlier she had a sore throat, which got better, and then came back again. And she needed to sleep a lot− 16 hours a day and she was still exhausted! When I examined her, I found her to have swollen glands behind her neck. Her “Monospot,” a test used to diagnose infectious mononucleosis, was positive.

Infectious mononucleosis, unaffectionately known as “mono,” is a contagious illness that causes sore throat and other symptoms. A person of almost any age can get mono but it is more common and often more severe in high-school and college-age people. About 85% of mono is caused by the Epstein-Barr virus (EBV) and the other 15% by other viruses such as cytomegalovirus (CMV). 

Mono is spread through contact with saliva from a person with the infection. That’s why many people have heard it called the “kissing disease.” But it can also be spread when a person with mono sneezes or shares food, drinks or utensils. One of my patients said that half her dorm had mono—turns out they all shared the same sponges to wash their dishes!

People can spread the virus that causes mono without knowing it. EBV is a common but complicated infection− as many as 95% of adults in the United States have been infected by the time they are 40 years old. Not everyone who has the virus has mono symptoms, so they may be spreading it unknowingly.  The virus is “shed” or released into the saliva during the illness and for many months after the infection. What’s more, EBV stays in the body for life− usually without causing further illness− but from time to time it may be shed again.

Headache, sore throat, and fever a.k.a. feeling just plain awful. It takes four to six weeks for symptoms to appear after contact with infected saliva. 

  • Early symptoms: one to five days of fatigue, headache, and mild fever
  • Acute illness:
  • More fatigue and worse headache
  • Fever: as high as 104 degrees F, which may persist for several weeks
  • Sore throat: often severe with swollen tonsils and pharynx
  • Swollen glands: especially in the back of the neck
  • Enlarged spleen (the blood-filtering organ), in up to half of patients
  • Enlarged liver (a digestive organ), in up to a quarter of patients

Diagnosing mono is usually as simple as a blood test. If your child has these symptoms, ask for a mono test: a Monospot is a blood test for antibodies made by the immune system when the body is fighting mono. Sometimes the Monospot is negative but mono is still suspected; other tests can be done to detect EBV infection.

Doctor’s orders: rest and then rest some more...

  • Ibuprofen or acetaminophen can help with fever and pain.
  • Antibiotics may be prescribed if the patient is unlucky and has strep throat too (about a third of mono patients do). But hopefully not amoxicillin because amox and mono don’t mix− a rash may develop!
  • Prednisone may be prescribed if the patient’s tonsils are dangerously swollen and may block breathing; or if a patient has other complications, like a severely enlarged spleen.

With mono, patients need patience. Teens usually start feeling like themselves again in a few weeks, but in some it can take months, or longer. Here’s what is usually recommended:

  • Light activities can usually be started after three weeks− if the patient feels ready
  • Slowly increase to regular activities− if  the patient feels ready
  • No contact sports for four to six weeks − or until the teen’s doctor says “game on.” An elbow jab to the belly of a patient with mono can cause the spleen to rupture −a serious event that can occur even if the spleen was not felt to be enlarged.

Finally, it’s never too late for parents to share with their teens some loving advice “avoid unnecessary ‘saliva swapping!’” And if you send them off to college, give them extra sponges to wash their own dishes!

Adolescent Medicine Specialist at Crozer-Keystone Health System
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Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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