Infectious mononucleosis, or "mono," is caused by the
Epstein-Barr virus, which is transmitted in infected saliva by coughing,
sneezing, and kissing. Although mononucleosis can occur at any age, it
is most common in 15- to 25-year-olds, possibly because of their more
intimate contacts with others. Contrary to popular belief, mononucleosis
is not very contagious. Household contacts of the sick person rarely
come down with it. Diagnostic findings include:
- severe sore throat
- enlarged red tonsils covered with pus
- swollen lymph nodes in the neck, armpits, and groin
- fever for seven to 14 days
- enlarged spleen (in 50% of patients)
- blood smear showing many unusual white blood cells
- positive blood test for mononucleosis.
Most youngsters have only mild symptoms for about one week. Even
those with severe symptoms usually feel completely well in two to four
weeks. Complications are rare and require hospitalization when they
occur. The most common complication is dehydration from not drinking
enough fluids. Also, enlarged tonsils, adenoids, and other lymph tissue
in the back of the throat may obstruct breathing. On rare occasions, the
enlarged spleen will rupture if the abdomen is hit or strained. Because
over 90% of mononucleosis patients develop a severe rash if they take
ampicillin or amoxicillin, these medications should be avoided.
In general, mononucleosis is neither lingering nor progressive. All
symptoms are gone by four weeks after they first appear. Persistent
laboratory findings of the Epstein-Barr virus in saliva and antibodies
to the virus in the blood have caused some confusion on this point. At
any given time, 10% to 20% of healthy adults who have had mononucleosis
in the past have the virus in their saliva because it reappears
periodically without any symptoms. Also, the number of mononucleosis
antibodies in the blood increases in response to new infections by other
viruses. Neither of these findings means that mononucleosis has
recurred.
There is no good scientific evidence to support mononucleosis as a
cause of chronic fatigue syndrome. The symptoms of this syndrome include
fatigue, weakness, recurrent pains, and the need for more sleep. They
must be present for at least six months. Recent evidence points to a
retrovirus as the cause of some cases of chronic fatigue syndrome.
HOME TREATMENT
Give medicine to relieve fever and pain. No specific medicine
will cure mononucleosis. Appropriate doses of acetaminophen or
ibuprofen, however, can usually relieve fever over 102° F and the pain
of swollen lymph nodes and sore throat.
Take measures to soothe the sore throat. Children over 6 years
of age can gargle four times a day with warm water containing one
teaspoon of an antacid solution per glass. Sucking on hard candies, for
children over 4 years of age, also relieves soreness (butterscotch seems
to be a soothing flavor).
Provide a soft diet. Since swollen tonsils can make some foods
hard to swallow, give your child soft foods to eat for as long as
necessary. To prevent dehydration, make sure that she drinks a lot of
fluids. Milk shakes and other cold drinks are especially good. Avoid
citrus fruits, which are acidic. Give a daily multiple vitamin pill
until the appetite returns to normal.
Allow your child to set his own pace. Your child does not need
to stay in bed. Bed rest will not shorten the course of the illness or
reduce symptoms. Your child can decide how much rest he needs. Usually
children voluntarily slow down until the fever has resolved. They can
return to school when the fever is gone and they can swallow normally.
Most children will want to be back to full activity by two to four
weeks.
Protect your child's enlarged spleen. A blow to the abdomen
can rupture an enlarged spleen and cause bleeding. This is a surgical
emergency. All children with mononucleosis should avoid contact sports
for at least four weeks. Athletes especially must restrict their
activity until the spleen returns to normal size as determined by a
physical exam. Constipation and heavy lifting should also be avoided
because of the sudden pressures they can put on the spleen. We will
check your child weekly until spleen size returns to normal.
Take precautions to keep the disease from spreading. Infectious
mononucleosis is most contagious while your child has a fever. After the
fever is gone, the virus is carried in the saliva for up to six months
but in small amounts. Overall, mononucleosis is only slightly contagious
from contacts. Boyfriends, girlfriends, roommates, and relatives rarely
get it. (The incubation period is four to ten weeks after contact.) The
person with mononucleosis does not need to be isolated. She should
definitely use separate glasses and utensils, however, and avoid kissing
until the fever has been gone for several days.
Call our office immediately if:
- Your child develops difficulty breathing.
- Your child becomes dehydrated (does not pass urine for over 12
hours).
- Your child complains of abdominal pain (especially high on the
left) or left shoulder pain.
- Bleeding into the skin (purple spots or dots) occurs.
- Your child starts acting very sick.
Call within 24 hours if:
- Your child develops noisy breathing.
- Your child can't drink enough fluids.
- Sinus or ear pain occurs.
Call during office hours if:
- The fever isn't gone within 10 days.
- Your child isn't back to school in two weeks.
- Any symptoms remain after four weeks.
- You have other questions or concerns.