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The Facts About Mono

by Sue Hubbard, M.D.

The chatter with moms at a recent school function revolved around a case of mono at school. The mothers were all concerned that their own child had been exposed to the girl with mono and when they were “all going to get mono”. They were also concerned that the “index” case of mono was still attending school. “How could this be?”

So here is some accurate information about mono. Mononucleosis is a viral infection that is caused by the Epstein-Barr virus (EBV). Mono, also known as the kissing disease, is commonly thought of as a teenage illness. But, many younger children may be exposed to the virus and have very few symptoms, several days of fever and feeing badly, and develop life long antibodies to EBV. Older children and adolescents usually exhibit fairly classic symptoms including a horrible sore throat, fever, headache, puffy eyes, fatigue and just feel dreadful during the acute phase of the illness. The fever and sore throat are persistent and when you see the child’s throat the tonsils are very large and covered in white (exudate is the medical term), and their cervical lymph nodes are huge and tender. In some cases the spleen enlarges, as do lymph nodes in the groin and under the arm. Occasionally there is a rash.

Mono is diagnosed with a blood test, not a throat culture. The rapid mono test detects antibodies to EBV, so it takes several days of being symptomatic before the test is positive.

Most people with mono never know when or where they were exposed to the virus. The virus is shed in saliva (hence, “the kissing disease”), and body fluids, and may be transmitted by drinking or eating after someone else. It is often four to seven weeks after exposure before you develop symptoms, so the girl in the class is not going to make you sick to tomorrow or the next day, and you can not get mono from her by sharing her books or sitting next to her at the movies. Good reason not to share drinks!

The treatment for mono is entirely symptomatic as it is due to a virus. Rest is paramount as the fatigue from mono may last for several weeks. I give patients medication to control their fever, pain relievers for the sore throat and general aches, and good nutrition and rest as they feel better. The initial symptoms usually last for five to 10 days but the fatigue may last for several weeks. I limit physical activity and after school activity until the fatigue has improved and they have returned to normal school days etc. This is the hardest part, as your teen wants to go back full steam ahead, but slow and steady wins this race and within a month they are back to normal.

That’s your daily dose, we’ll chat again soon.

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