Kentucky Ear, Nose & Throat

Infectious mononucleosis (commonly called mono) is an illness that can be caused by several agents. The Epstein - Barr virus (EBV) causes more than 95 percent of cases among adolescents and adults and is usually in the body 30-50 days before an infected person develops symptoms. Early symptoms can include feeling rundown, loss of appetite and slight headaches. After three to five days, acute symptoms usually become apparent and these may include sore throat, fatigue, swollen glands, fever, muscle aches and sometimes a skin rash. The spleen is often enlarged and some liver enzyme changes occur. Not all of these symptoms are present in every case, however.
 

 

If your symptoms resemble the ones described here, it doesn’t necessarily mean you have mono, but you should visit a health professional who will evaluate your symptoms and possibly test your blood for mono antibodies. It is often necessary to wait until you’ve been sick for five to seven days before mono tests can be run because it can take at least that long for mono antibodies in the blood to reach detectable levels.

Preliminary screening tests for mono can give results within a day or two. If you test negative for mono but your symptoms continue to suggest that you have the infection, your health professional may repeat the tests. Even with the most accurate tests, about 15 percent of adolescents and adults who have mono will test negative at first. This can happen when a person fails to produce antibodies for mono. Other, more specific blood tests may be given in these cases.
 

 

Infectious mononucleosis is spread through saliva, hence its nickname the ‘kissing disease.” Even though this means the disease is almost always spread through intimate contact, it can be hard to tell who passed the infection to you because only about a third of the people who become infected with EBV develop classic mono. An infected person who never gets ill can unknowingly give the virus to others. Also, people who have had mono can still have the virus in their saliva long after the illness is over. Typically the virus is present in the saliva for about 30-45 days, but in some people it can appear on and off in the saliva for up to 18 months. A majority of cases most likely are contracted through intimate contact between a susceptible person (someone who can catch mono because they have never formed antibodies to EBV), and a healthy person who has EBV in their saliva. In most cases, people who have been infected with EBV are immune from ever getting the virus again.
 

 

No – at least not through casual contact. In fact, studies have shown that roommates of people who have mono have no greater chance of getting mono than anyone else. And because mono is not highly contagious, there is no need to quarantine people who have it.
 

 

Antibiotics are not useful in treating viral diseases like mono. While there’s no shot or pill to cure mono, your body should be able to successfully fight the infection if you take proper care of yourself while sick.

Treatment usually includes adequate rest and a pain reliever such as acetaminophen (the active ingredient in Tylenol) for your fever, sore throat and other aches and pains. Be sure to increase your fluid intake to avoid dehydration.

If your spleen is quite a bit larger than normal, your health professional may recommend stool softeners to prevent constipation. This reduces the chance of a ruptured spleen caused by straining. Also, remember to eat a balanced diet, high in fruits and vegetables.

While the virus may cause some minor liver abnormalities, these probably won’t require special treatment and your liver function will return to normal as you recover. However, it is wise not to drink alcohol while you are ill, and your health professional may recommend that you avoid alcohol for about a month afterwards as well. People who develop jaundice usually need to avoid alcohol for as much as a year after the illness because of possible damage to the liver cells.

Steroids may be prescribed if you develop symptoms such as excessive swelling of the throat or impending rupture of the spleen. However, this potent medication is not a routine treatment for infectious mononucleosis.
 

 

Strep
In about eight percent of mono cases, the infection is complicated by Group A streptococcal infections in the throat (strep throat) and on the tonsils. Penicillin or another antibiotic can treat strep throat, but are not effective against EBV.

Inflammation of The Liver and Jaundice
One uncommon complication of mono is mono hepatitis (an inflammation of the liver) possibly resulting in jaundice. Jaundice, which occurs when bile enters the blood, can cause eyes, skin, and urine to become abnormally yellow. People with mono hepatitis tend to be sicker, and may require hospitalization, especially if they experience vomiting and dehydration. Occasionally, women taking birth control pills who have mono hepatitis are taken off the pill until their hepatitis subsides.

Rupture of the Spleen
Rupture of the spleen (a large organ in the upper left abdomen that stores and filters blood) is a rare, serious complication of mono. This occurs in only one or two people with mono per 1,000 and usually between the fourth and 21st day of illness. Direct blows to the area of the spleen or too much physical exertion account for about one-half of ruptured spleens among people with mono. Since no link has been found between the severity of mono and rupture of the spleen, people with mono should avoid contact sports and rigorous exercise until a health professional advises that it is safe to resume these activities.

A sign that a person’s spleen may be rupturing is pain starting in the upper left abdomen that radiates to the top of the left shoulder; gets worse when he or she inhales and then quickly spreads over the entire abdomen. If this occurs, the person should get immediate medical attention.

Return To Usual Activities
The most important things to do while recovering are to get proper rest, eat well and take good overall care of yourself. Although the illness is often gone in two weeks, it can take longer to get back to your normal energy level.

Fatigue can sometimes last for two or three months beyond the acute stage of mono. Make sure to get regular rest, including naps if you need them, but don’t let fatigue alone keep you bed-ridden. This will only allow your body to become weaker and make you feel more tired.

Be careful about resuming sports or exercise if your spleen is enlarged. Blows to the chest or abdomen could cause your spleen to rupture. If you are involved in strenuous physical activity or athletics, ask your health professional about when you can safely resume that activity. Unless advised otherwise, you should be able to resume mild physical activity - such as easy swimming - after your symptoms have subsided. In general, count on at least a month (and possibly two months) before you can resume strenuous exercise or contact sports.