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Mono: Not Just For Kissing Teenagers

Everyone has heard of mono, short for mononucleosis, but there is a lot that is misunderstood about it. I have seen 4 kids in the last couple of weeks with mono, so it seems to be making a little bit of local resurgence.

What is mono?

Mono is short for mononucleosis. It is caused by the Epstein-Barr virus (EBV) which is in the Herpes virus family. Like other herpes viruses once you get it, you have it for life. It isn’t always active though, it stays in the body latent (just hanging out doing nothing) and can be reactivated. So yes, it is possible to get mono more than once.  It can happen at any age, but is most common in people between the ages of 15-30. Most adults have been exposed to the test at some point in their life (they just may not have known it).

How do you get mono?

Everyone thinks of mono as the “kissing disease” since it can be passed that way. However, you can get mono anytime spit is swapped. Saliva can be passed by sharing drinks, toothbrushes, and eating utensils. The virus has even been detected in mucous and tears (although those aren’t classic methods of spread). It can also be spread through semen (sexual contact). Humans are the only known carriers to EBV (meaning, you can’t get it from your dog or cat).

Common mono signs and symptoms:

  1. Sore throat
  2. Fever (+/- chills)
  3. Swollen lymph nodes (a.k.a. lymphadenopathy)
  4. Fatigue
  5. Headache
  6. Puffy eyelids
  7. Enlarged liver and spleen (the doctor should check for this)

How is mono diagnosed?

Whenever a doctor suspects mono, he/she will do a physical exam. Certain findings (red throat, swollen glands, enlarged liver and/or spleen) are highly suggestive of mono. However, the definitive diagnosis is made by a specific blood test. There is quick test called a “mono spot,” but it isn’t completely reliable (there are a fair number of false results) and doesn’t distinguish between active and past infection. The most accurate testing is from a complete blood draw (it enables a doctor to determine if a patient has a current, active infection or a past/latent infection).

Tricky tests, how mono is misdiagnosed:

So mono is tricky, because a patient will come in with a sore throat, fever, some swollen lymph nodes, and not feel very good. The doc will look in the patient’s throat, discover that it looks red and may even have little pus pockets (in medicine we call those “exudates”). Naturally, the doctor will think that the patient has strep throat (after all, it’s far more common) and do a rapid strep. So here’s the crazy thing, the rapid test can be positive (even though the kid doesn’t have strep). It’s a fault of the test, a true false positive. The doc will believe it (because the picture fits) and write a script for penicillin (commonly amoxicillin). The patient will take the medicine and within a few doses, break out in a horrible red rash.  The virus reacts with the medicine and creates the rash. The rash should clue the doctor (and now you), to look for mono. The good news is that once the patient stops the medicine, the rash will gradually resolve and not cause any long term problems.

This risk of missing mono is the reason that I always examine a patient’s abdomen when they come in with complaints of sore throat. Strep throat doesn’t cause enlarged livers and spleens, where mono does. Taking the extra one minute to feel a patients belly is a good insurance policy to not missing the diagnosis.

The rare, but crazy complications:

The vast majority of the time, when a person gets mono, they recover without complications. However, it the spirit of full disclosure, there are rare complications that can happen. They include:

  1. Anemia
  2. Meningitis
  3. Cancer
  4. Encephalitis (inflammation of the brain)
  5. Guillain-Barré syndrome (a paralyzing disorder)
  6. Thrombocytopenia (low platelets)
  7. Myocarditis (inflammation of the heart)

How is mono treated?

Unfortunately, there isn’t a cure for mono/EBV. An antibiotic won’t do any good since it’s a virus. There also isn’t a vaccine to prevent it. All the treatment is aimed at what we call “supportive measures.” For example, if there is a fever or sore throat, you may use some Tylenol or Motrin. Treat the fatigue with lots of rest. There is one important element to the treatment that is often overlooked. Kids with active mono shouldn’t engage in any contact sports. With mono, the spleen can get enlarged. When the spleen is enlarged, it is at risk of rupture if it gets hit/injured. If you rupture your spleen, you will have serious internal bleeding and can bleed to death.

Now if the patient has any of the serious complications, then treatment may be aimed at addressing those complications. All of those circumstances should be addressed by a medical doctor (as many are life threatening).

How long does mono last?

Again, this is an unfortunate virus. While most viruses last 7-10 days, this one can last weeks to months (in terms of active symptoms). The other thing that is a little tricky about this virus is its long incubation period (meaning the time it takes between being exposed to the virus and showing symptoms of it). The incubation period can be up to 6 weeks. That sort of delay, can make it hard to determine if other kids in the family have it or where someone got it in the first place.