16 Mar·Apr 2014 | CMA Today

 quick clinic

B y L a r a J a c k s o n

Known commonly as “the kissing disease,” mononucleosis, or “mono” for short, is often spread by saliva and close contact. The disease occurs most often in those ages 15 to 17, but infection may develop at any age.1 “Mono is the syndrome [that] is caused by Epstein-Barr [virus],” explains Pritish Tosh, MD, infectious disease physician at the Mayo Clinic, Rochester, Minn. Mono can also be caused by other organisms.1

A member of the herpesvirus family, the Epstein-Barr virus (EBV) is one of the most common human viruses worldwide, and most people become infected with EBV at some point during their lives. As many as 95 percent of American adults between the ages of 35 and 40 have been infected.2

In the U.S. and other developed coun-tries, EBV does not affect many children; even those who become infected often present only mild symptoms. The danger increases as children age—between 35 and 50 percent of teenagers infected with EBV develop infectious mononucleosis.2

Too close for comfort“People become infected with mono through close personal contact or sharing personal items, such as utensils or tooth-brushes,” explains Stephen Calderwood,

MD, chief of the division of infectious

diseases at Massachusetts General Hospital

in Boston.

Mono can also arise from blood trans-

fusions with infected blood products.

“People may be infected with the disease

for a month before they start showing

any symptoms, so they could pass on the

virus during this time,” states Dr. Tosh.

Anyone with a suppressed immune

system also may be at risk for contracting

the disease.

LovesickFatigue is usually the first symptom of

mononucleosis. A headache, sore throat,

and general ill feeling eventually follow.

These symptoms worsen over time. “The

patient feels so fatigued that he [or she]

doesn’t feel like doing anything,” explains

Dr. Calderwood.

Typical symptoms include the fol-

lowing:

l Swollen tonsils with a whitish-yellow

coating

l Swollen and painful lymph nodes

l Fever

l Loss of appetite

l Muscle aches and stiffness

l Rash3,4

Some less frequently occurring symptoms include the following:

l Chest pain

l Headache

l Hives

l Nosebleed

l Rapid heart rate4

If further confirmation is needed to make a diagnosis, the physician may require a blood test. These are the two most com-mon tests:

l Antibody test (monospot test). This test checks for antibodies to EBV. Results are usually ready within a day, but the test may not detect infection during the first week of the disease. A different antibody test requires a longer result time, but can detect t he disease during the first week with symptoms.

l White blood cell count. A count may be ordered to check for an elevated number of white blood cell counts (lymphocytes) or abnormal-looking lymphocytes. These blood tests will not confirm mono, but they may suggest it as a possibility.4

When diagnosed, the best course of treat-ment for mono is to let the disease run its course, with plenty of rest and fluids. On

Mononucleosis

Sealed with

a kiss

CMA Today | Mar·Apr 2014 17

average, symptoms usually dissipate after

about two weeks. Those infected do not

have to worry about isolating themselves

because the disease does not usually spread

through the air.

Even though there is no cure for

mononucleosis, the patient’s health care

provider may prescribe the following

medications to treat symptoms:

l Pain relievers, such as acetamino-

phen (Tylenol) or ibuprofen (Advil)

for fever. Parents or guardians

should not give over-the-counter

pain relievers to children without

talking to the physician first.

l Corticosteroids, such as prednisone

(Deltasone), may be used to ease

swelling of tonsils.

l Antibiotics do not work against

mono, but the physician may pre-

scribe them to treat strep throat.5

Patients should avoid contact sports and

heavy lifting for at least two months after

a bout with mono. An enlargement of

the spleen is a potential side effect of

mononucleosis, and contact sports could

increase the chances of a spleen rupture.

The spleen is part of the lymph system,

It’s complicatedPossible minor complicationsNonlife-threatening complications of mononucleosis include the following:

l Red spots or rashes. These can develop when taking certain anti-biotics, and are not an allergic reaction.

l Mild anemia. This usually goes away after one to two months with treatment.

l Thrombocytopenia. This is an unusually low number of platelets in the blood. The condition usu-ally goes away without treatment.

l Low neutrophils. A low number of neutrophils (a type of white blood cell which helps fight infection) is another condition that usually goes away without treatment.

l Hepatitis. An inflammation of the liver can occur during the second to fourth weeks of mono.6

“If the patient is taking ampicillin or amoxicillin for mono, he or she may break out in a dramatic rash. This can happen to 70 to 90 percent of people taking the medication,” explains Stephen Calderwood, MD.

Possible serious complicationsBesides the enlargement of the spleen and chance of rupture, which requires immediate surgery, other serious complications of mono include the following:

l Airway obstruction and difficulty breathing caused by swollen tonsils. In severe cases it may be necessary to surgically remove the tonsils.

l Brain and spinal cord problems

l Cardiac problems, such as an irregular heartbeat, can occur during the first three weeks of infection, but these types of prob-lems usually resolve themselves on their own.6

Information at arm’s lengthAmerican Academy of Family Physicians www.familydoctor.org

The AAFP offers information on adult and child health conditions. Its website has topics on medicines, physician visits, physical and mental health issues, parenting, and more.

Centers for Disease Control and Prevention www.cdc.gov

The CDC, an agency of the U.S. Department of Health and Human Services, works with state and local

health officials and the public to achieve better health for all people. The CDC creates the expertise, informa-tion, and tools that people and commu-nities need to protect their health.

KidsHealth for Parents, Children, and Teenswww.kidshealth.org

Sponsored by the Nemours Foundation, the KidsHealth website has a wide range of information about children’s health, from allergies and diseases to normal growth and development (birth to adolescence).

which works as a drainage system defend-ing the body against infection. By taking these steps to heal properly, patients can rest assured that their troubles are behind them. “The vast majority of the population infected with EBV won’t get reinfected with mono once they’ve had it,” states Dr. Tosh.

References1. Mononucleosis. U.S. National Library of

Medicine. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001617/. Reviewed May 15, 2012. Accessed November 11, 2013.

2. X-plain Epstein-Barr virus/mono reference summary. The Patient Education Institute. http://www.nlm.nih.gov/medlineplus/tutorials/epsteinbarrvirusmono/id299104.pdf. Updated December 19, 2010. Accessed November 11, 2013.

3. Mononucleosis. MedlinePlus, National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000591.htm. Updated October 13, 2013. Accessed November 11, 2013.

4. Mononucleosis: tests and diagnosis. Mayo Clinic. http://www.mayoclinic.com/health/mononucleosis/DS00352/DSECTION=tests -and-diagnosis. Published December 19, 2012. Accessed November 11, 2013.

5. Mononucleosis. University of Maryland Medical Center. http://umm.edu/health/medical/altmed/condition/mononucleosis. Updated May 7, 2013. Accessed November 11, 2013.

6. Complications from mononucleosis. WebMD. http://www.webmd.com/a-to-z-guides/compli-cations-from-mononucleosis. Updated July 28, 2011. Accessed November 11, 2013.