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“Glee” Episode: Mono

by Sue Hubbard, M.D.

I have received several questions via our iPhone App regarding mononucleosis, which is commonly called, “the kissing disease”, as the virus is passed in saliva.   I think it’s because many were watching the recent “Glee” espisode where Finn and Quinn have mono.

Mono is most frequently caused by the Epstein Barr virus, but there are other viruses which may mimic the symptoms of mono.Many of us have been exposed to Epstein Barr virus (EBV) and may not even realized it, while others will develop a viral illness which typically causes sore throat, fever, congestion, swollen lymph nodes, and fatigue. As you can see, these symptoms mimic many illnesses.

In my experience, the most classic cases are in the teenage age group, who are often found to be kissing one another,  as well as sharing glasses, sports bottles, food and even lipsticks which may also transmit the virus via contamination with saliva.  In most cases a person has no idea where they contracted the virus and it takes from 4 – 10 weeks after exposure to develop the symptoms of mono.

A teen will often come in to the office complaining of a really bad sore throat with or without fever and swollen lymph nodes in their neck.  They usually think they have strep throat. But, their throat culture comes back negative for strep, so they are assumed to have a viral pharyngitis. A typical  viral sore throat usually improves over a few days, but with mono the patient usually feels worse rather than better after 4-7 days.  Their throat actually becomes more painful, with more swelling of the tonsils and the tonsils are often covered with white patches (called exudate) larger cervical lymph nodes, headache and fatigue.

In some cases there may be swelling of the upper eye lids (periorbital edema) and a skin rash may be seen (especially if the patient had previously been put on a penicillin related antibiotic for presumed strep).  It is interesting that younger children who acquire mono often do not have as many of the symptoms as a teen, and indeed they have a shorter illness, so many youngsters with mono are never “officially” diagnosed with the EBV virus, but are now immune to the virus too.

The easiest way to diagnose mono is with a blood test called a monospot, that picks up the EBV antibodies in the bloodstream. It usually takes about a week after symptoms begin to have a positive monospot.  There are also other antibody tests that may be run to determine if a patient currently has mono, or  has ever had mono, but these are more expensive and take a longer period of time to get results.

The acute symptoms of mono last anywhere from 7 – 14 days but the fatigue may last longer.  Because mono is a VIRAL illness, it is not treated with antibiotics  Treatment like so many other illnesses is simply symptomatic.  Fluids, rest, pain relievers like acetaminophen or ibuprofen (do not use aspirin products in children), and tincture of time. I also recommend that patients take several weeks off of sports due to the possibility of their spleen (which is lymph tissue too) becoming swollen.  The issue with splenic swelling is the risk of rupture if the spleen is hit, bumped or fallen on during an activity.

Once the patient is feeling better and has been examined again and their spleen has returned to normal, they may return to their sports.   It is also wise to limit a teens activity so that they may get sufficient rest.  This basically means that once they are feeling well enough they return to school, but other activities are put on hold until they are back in school and their energy is returning.  As one teenage patient aptly put it, “it is like I was grounded, but I didn’t even get into trouble.”  The reason for slow return to full activity with extra rest is to ensure that within 3-4 weeks of diagnosis the patient is fully recovered and back to all activities.

I have found if you don’t tell teens specifics about activities, once their acute symptoms are better they do not rest,  and the fatigue lasts longer. Good rest and nutrition are essential to recovery.  The good news, you only get EBV once!

By the way, we are all fans of “Glee”!

That’s your daily dose for today.  We’ll chat again tomorrow.

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