4collegewomen.org - mononucleosis

Introduction

The disease mononucleosis is most common in people 10 to 35 years old, with its peak incidence in those 15 to 17 years old. Only 50 people out of 100,000 in the general population get mono, but it strikes as many as 2 out of 1,000 teens and twenty-somethings, especially those in high school, college, and the military. While mono is not usually considered a serious illness, it may have serious complications and can sometimes be life-threatening. Without a doubt your lifestyle will change for several months.^[1]

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Who is At Risk?

While there are many illnesses that teens and young adults don't get, unfortunately, mono is most common among 15-35 year olds. The reason that not everyone comes down with mono during these years is that most of the population has already exposed to the virus that causes mono (usually the Epstein-Barr virus) before we reach the age of 18. Exposure at a young age usually is asymptomatic, meaning that no symptoms result, or instead may seem like a cold. This type of exposure usually makes us immune to re-infection later on in life. However if exposure has not occurred by the age of 18 then encountering EBV often results in mono.

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What Causes Mono?

Two viruses can cause mono: Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Both viruses are in the herpes family, whose other members include viruses responsible for cold sores and chickenpox. The EBV is responsible for approximately 85% of mono cases. Both of these viruses, like other Herpes viruses, have no cure and will stay in your body for life.^[2] [ To Top ]

How is it Spread?

Many people think of mono as the "kissing disease", and with good reason. It is found in moist exhaled air, nasal and oral secretions like saliva and mucus, and is not as easy to transmit as many other viruses such as colds. It generally requires direct contact, like kissing, though it can be spread by other means as well, such as coughing. A person with mono is most contagious just before they feel sick and while they ARE sick because this is the time when the most viral particles are produced. Even after you have completely recovered, you can still spread the virus that causes mono. Every so often you can produce the virus in your saliva and spread it to another person, even if you feel fine.

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What are the Symptoms?

Symptoms of mononucleosis generally resemble those of the flu and include fever, sore throat, and swollen lymph glands. Sometimes, a swollen spleen or liver involvement may develop. These symptoms usually last for more than two days and may appear slowly. Heart problems or involvement of the central nervous system occurs only rarely, and mono is almost never fatal.

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What are the Long-Term Effects?

Mono can make a person feel miserable for a while, but when taken care of, the disease goes away within a couple of months. There are some instances when complications can arise. One such complication may include enlargement and rupture of the spleen. define This is a serious concern because it can lead to death. Some of the signs and symptoms of this complication include pain in your upper left abdomen, difficulty breathing, lightheadedness, excessive bleeding, and feeling like your heart is beating harder and faster than normal. A very common complication is dehydration. A sore throat can make you hesitant to drink enough fluids so that you become dehydrated. There are also several other rare complications that include:

Complication	What it is
Thrombocytopenia	a low number of platelets define in the blood
Granulocytosis	a low number of white blood cells in the blood
Hemolytic anemia	a low number of red blood cells in the blood
Myocarditis	inflammation of the heart muscle
Encephalitis or aseptic meningitis	inflammation of the brain and membranes around it
Guillain-Barre syndrome	paralyzing disorder

** The illness Chronic Fatigue Syndrome has not been shown to be related to the viruses that cause mono. For more information on this disease visit: http://www.niaid.nih.gov/factsheets/cfs.htm

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How is Mono Diagnosed?

The clinical diagnosis of mononucleosis is suggested on the basis of the symptoms of fever, sore throat, swollen lymph glands, and the age of the patient. Usually, laboratory tests are needed for confirmation. Blood test results for people with mono include a high white blood cell count, an increased percentage of certain atypical white blood cells, and a positive reaction to a "mono spot" test.^[4] This test is designed to look to see if your blood platelet count is too low and if your white blood cells are abnormal. A blood chemistry panel can be done to see if the enzymes in your liver are abnormal, which can be a sign that you have mono.

Mono tests may not show positive results until you have been sick for a few days. This is because it may take about five days or so for your body to produce enough antibodies to show up on the test. If your mono test is negative and you are still feeling sick after a couple of days, you may want to consider a follow-up visit with your doctor. It is sometimes necessary to be tested more than once; after a week or two of being sick the tests are approximately 85% accurate.

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How is Mono Treated?

There is no specific treatment for mononucleosis, other than treating the symptoms. No antiviral drugs or vaccines are available. Some physicians have prescribed a 5-day course of steroids to control the swelling of the throat and tonsils. The use of steroids has also been reported to decrease the overall length and severity of illness, but these reports have not been published. Therefore, the best course of action is to rest and let you body fight the virus. You can feel more comfortable when you are sick by taking some over-the-counter medications to alleviate symptoms.

Acetaminophen for fever (no aspirin)
Ibuprofen for pain (consult your doctor if you want to take aspirin)
Rest (plan to take lots of naps)
Drink more fluids (at least 2 quarts a day)
Throat lozenges, salt water gargle, and ice cream for your sore throat
No vigorous exercise, contact sports, or heavy lifting
Antibiotics if strep throat or another bacterial infection is present (this is determined by your doctor)
Good nutrition and NO alcohol
It can take anywhere from one week to three months to fully recover, so take care of your body and continue to rest until your doctor says it's ok to get back to your normal routine.

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How Long Will I be Sick?

There are generally four stages of mono. The first is the incubation period (you've been exposed to the virus, but you feel normal) that can last as long as 2-6 weeks. The prodromal period is next (the time just before you get sick, but you feel like you're "coming down with something") and lasts from 3-5 days. Generally symptoms at this point include fatigue, lack of appetite, and an overall "blah" feeling. The third stage is called the acute stage (you ARE sick), which usually lasts from 7-20 days. Now you have the symptoms of mono like sore throat, fever, swollen glands, etc. The final stage, the convalescent period, can last from 2-6 weeks to up to 3 months. During this time you'll feel much better, but are still weak and tired.

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Will it Come Back?

Most people get mono only once during their lifetime and then become immune to it. However, it is possible to get it more than once, just not very likely.

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How Can I Prevent Mono?

Mono is a difficult disease to prevent. It can take up to two months to develop symptoms and you can be contagious for as long as a year afterward and at different points in your lifetime. By the time you realize that you have mono, it's usually too late to find out where you got it from and prevent other people from getting it too. The best way to protect yourself is to get plenty of rest and keep yourself healthy (no all-nighters, or at least not too many in a row). Try to maintain a healthy, nutritious diet, practice good personal hygiene, and don't share plates and silverware.

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Resources

[1] http://www.fda.gov/fdac/features/1998/398_mono.html

[2] http://www.fda.gov/fdac/features/1998/398_mono.html

[3] http://www.cdc.gov/ncidod/diseases/ebv.htm

[4] http://www.cdc.gov/ncidod/diseases/ebv.htm

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