Wednesday, March 10, 2010

On Call with Dr. Kolsky

“My teenager has been unusually tired lately and is now experiencing and a very sore throat. Could my child have mono?”

Dr. Kolsky answers the most frequently asked questions on this topic

"Infectious Mononucleosis or “Mono” as it is called by most people is a viral infection characterized by the triad of fever, tonsillitis or pharyngitis and swollen glands.. It is an extremely common cause of “sore throat” and is usually caused by the virus specifically known as Epstein-Barr virus (EBV).

Many, if not most children, have a sub-clinical infection (i.e. they either don’t know that they are ill or they have a very mild sore throat). By age 18 years, it is estimated that about 80% of the world’s population has had EBV infection, and that by age 40 years, 90-95% of adults have had it.”

How is Mono Diagnosed?

EBV infection during early childhood is often sub-clinical (i.e. no apparent symptoms). During adolescence thru adult years, the incidence of symptomatic infection rises, with the peak incidence in the 15-24 year age group. The typical features in this age group include the above mentioned fever, sore throat, swollen glands, and also fatigue.

Blood work reveals elevation of a certain type of white blood cell called atypical lymphocytes. Other lab data that support the diagnosis include the “Mono spot test” and measurement of specific EBV antibodies. Sometimes, especially during the 1st week of the illness, the Mono spot test can be negative, and needs to be repeated in week 2 or 3 if symptoms of Mono persist.

Rarely Mono is caused by a different agent other than EBV. This includes cytomegalovirus, toxoplasmosis, and human herpes virus.

How is Mono spread?

After developing infectious mono, the virus can be transmitted from the saliva for many weeks.

Although the virus spreads primarily through saliva, it is NOT a very contagious illness. The virus can persist in the mouths of patients for as long as 18 months following recovery from the illness. This may explain why only a small number of patients with Mono recall any previous contact with an infected individual. Also spread within a family is UNCOMMON, again demonstrating that it is NOT a particularly contagious illness.

What is the treatment of Mono?

The most important part of treatment is supportive care and there are NO specific medications to cure Mono.

Acetaminophen or Ibuprofen is recommended for the treatment of fever, sore throat, and general malaise. Giving plenty of fluids and proper nutrition are also important. Plenty of rest helps the symptoms, BUT absolute bed rest is NOT necessary.

There are times when steroids are used, especially if the patient is having great difficulty swallowing fluids and is at risk of becoming dehydrated. Steroids are also used if the patient is experiencing breathing problems from the enlarged tonsils.

Does Mono Have Complications?

Most patients have an unremarkable recovery and are back to regular activities within a few weeks after the illness. Sports are often delayed for a period of time (usually 4 weeks) and for contact sports a bit longer (4-8 weeks).

Possible complications from Mono include:

Anemia which is a low red blood cell count

Low platelet count (thrombocytopenia)

Airway obstruction from markedly swollen tonsils

Rupture of spleen, especially in those athletes who return to contact sports too soon after the illness