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Family Health Magazine
ADOLESCENT HEALTH

Mononucleosis
The facts about this 'kissing disease'

Often just referred to as 'mono,' Infectious Mononucleosis (IM) is a common illness in adolescence. The Epstein-Barr virus causes infectious mononucleosis. It is spread by contact with saliva from a person who has or is recovering from the disease. (This method of spread is how it earned its nickname “the kissing disease.”) Mononucleosis can also be spread from a person who had IM months previously. The incubation period (time from contact to development of symptoms) is usually between 30 and 50 days.

Course of the Illness

The early symptoms of mono are sore throat and fever. There is often headache, muscle aches and a general feeling of being unwell. Usually there is a loss of appetite. After a few days of these symptoms, swelling of the neck glands occurs. A small number of people develop swollen eyelids and a skin rash.

If your teen has these symptoms, it is wise to consult your family doctor. Strep throat and a variety of viruses can cause similar symptoms. Your family doctor may need to take a throat swab to test for Group A Streptococcus, the bacteria that causes Strep throat. A person may suffer from infectious mononucleosis and Strep throat at the same time. Although a Strep infection is usually treated with penicillin,

Ampicillin™ or Amoxicillin™ (types of penicillin) are best avoided when there is the possibility of IM because they can cause an uncomfortable skin rash in these patients.

While complications of IM can, on rare occasions, affect nearly every body organ, only a few sites are typical of the disease. One common complication is a mild hepatitis, causing nausea and sometimes jaundice. Liver function studies may be carried out early in the illness to test for hepatitis which may be present before other symptoms occur.

An enlarged spleen is another common complication. The spleen is an organ that sits in the upper left side of the abdomen. A large spleen can be difficult to feel during examination. For this reason, especially in athletic adolescents, ultrasound of the abdomen may be done to assess the size of the spleen and judge recovery. A swollen spleen is at risk of rupture which can be a serious complication requiring surgery.

Sometimes there is trouble swallowing or obstruction of the upper airway by enlarged tonsils, pus and the pressure of neck glands. When breathing problems arise, the patient usually requires a stay in hospital.

Laboratory testing can support the diagnosis of infectious mononucleosis. Early in the illness, the white cell numbers can fall. Platelet numbers will decrease in nearly half of patients. A test called a Monospot will usually become positive in the second week of illness. This indicates the body has begun making antibodies which it needs to fight the infection. A blood test two to three weeks into the infection will show an increased number of white blood cells called lymphocytes. Those lymphocytes, characteristic of IM, can be seen through the microscope.

There are a number of very detailed and expensive tests which can be done to confirm the diagnosis. While these tests are far more accurate than the monospot, they are rarely needed.

Treatment and Recovery

Treatment includes rest, fluids and pain relief. Acetaminophen (Tylenol™, Tempra™, Panadol™) is often given for sore throat, fever and the muscle aches. Drinking fluids is important to keep the body well hydrated and allow it to fight the infection. Your family doctor will usually advise avoiding physical activities for three to four weeks after the illness has started.

The symptoms of fever, sore throat and gland swelling will last about two weeks. This is followed by another two weeks of fatigue. The fatigue sometimes lasts for months. Once your teen begins to feel better (which is generally within two weeks of onset of symptoms) gradual return to normal activities, including school, is encouraged. Contact sports and very strenuous activities must be avoided while the spleen is enlarged. This can be so dangerous for athletes that ultrasound examination of the spleen is often needed to confirm the spleen is back to normal. Only then can participation be permitted.

Infectious mononucleosis is particularly common in adolescents. The fatigue and low energy can persist for several weeks. Most teenagers enjoy being active and this unusual lack of energy and reduced involvement in activities can be a frustrating time for all concerned. For a teenager keen to get back to sporting activities, it is especially important to follow advice about rest and activity to prevent the serious complication of rupture of the spleen.