Mono — not just a “teen disease”

When she was 16 years old, Stephanie Williams started feeling unusually tired and achy. A couple of weeks later, she developed a very sore throat. Because her mother knew that mononucleosis was making the rounds at the high school, she decided it was time for Stephanie to see the doctor.

Stephanie was indeed diagnosed with mono, and because of the illness, she missed a month of school, slept a lot and did whatever she could to relieve her discomfort. She wasn't able to return to full physical activity for another two months.


When is it Mono?

Stephanie's experience with the mononucleosis virus is quite typical. It generally starts slowly, like a cold or the flu, but goes on to involve the throat and tonsils far more than any routine illness. Lymph nodes, or ‘glands’, in the neck become visibly enlarged and a high fever is common, as is extreme fatigue.

Teens and young adults are at highest risk for contracting this disease. "Mono is passed through close personal contact," explains Andrea McCoy, M.D., director of Primary Care at Temple University Children's Medical Center in Philadelphia. The virus is carried in oral secretions, so it can be passed on by sharing drinks or eating utensils as well as through intimate contact, hence its nickname, "the kissing disease”. Mono can also be spread through airborne transmissions, such as sneezing. According to Dr. McCoy, it can take up to two months from the time of exposure for a case of mono to fully develop.

It often surprises parents to learn that young children can contract mono too. According to Paula Elbirt, M.D., assistant clinical professor of pediatrics at both Mt. Sinai/NYU Medical Center and Lenox Hill Hospital in New York City, symptoms in younger children differ from those of older patients. "Symptoms are often more severe in young children," says Dr. Elbirt. "They can be prolonged with listlessness, high fever (104-105 degrees), swollen glands."


Diagnosis and Treatment The only way to verify the mono diagnosis of mononucleosis is through a blood test although in the early stages of the illness, the most blood test often yields a high number of false positives. Blood tests are most reliable if they are performed a week to 10 days after the onset of symptoms.

Since mononucleosis is a virus, it cannot be treated with antibiotics. Mono has to run its course, but patients can comfort themselves by treating symptoms — gargling with warm salt water for the sore throat, and taking Tylenol to relieve body aches.

Rest is the best medicine for mono. And convincing patients to take it easy during the initial period of illness is not difficult. Likely, they will want to do little other than sleep. Once they begin to feel better, parents need to find creative ways to keep their kids still, lest they overdo it too soon and prolong their recovery. Movies, books and music are good distractions, says Dr. McCoy, and once they are feeling well enough, friends can come over and hang out with them too, as long as they do not share any close personal contact. Since mono patients usually miss a good bit of school, having schoolwork brought to them will help pass the time, as well as keep them from getting too behind in their class work.


Complications The most common complications of mono involve enlargement of the spleen and/or liver. "The Epstein-Barr virus [the virus responsible for mono] loves the spleen and liver and it settles there," explains Dr. Elbirt. "The spleen is a blood-rich organ, and it gets congested, which puts it at risk for rupturing." Because of this risk, mono patients are restricted from taking part in any type of contact sports for the duration of their illness until a doctor gives the "all clear."

Alcohol consumption can worsen the condition of these organs. This is a definite risk for teens who do not take the warnings seriously. According to Dr. Elbirt, alcohol can cause permanent liver damage in a person whose liver is already weakened by mono.

Another complication of mono involves the throat. The lymph nodes and tonsils can swell to severely inhibit the ability to swallow, and can impede breathing as well. In these instances, patients might be treated with a one-time dose of steroids to decrease the swelling.


Keys to Recovery If your child should be diagnosed with mono, here are some keys to helping them recover:


— Rest, rest and more rest. Allow your child to sleep as much as she needs to, and as she recovers, encourage her to rest often and not overdo it.


— Drink fluids. Especially if there is a high fever, fluids need to be replaced. If a swollen throat is keeping a child from eating, make every sip count by providing electrolyte replacements, such as Gatorade, or even better, Pedialyte.


— Keep germs to yourself. Do not share cups, washrags and towels, eating utensils. Avoid close personal contact such as kissing or sexual contact. Discard all soiled tissues safely and immediately. According to Dr. McCoy, the best defense against mono and other illnesses is practicing good hygiene.


On the up side of mono, it is rare to get it more than once. Likewise, it is rare for two people from the same household to be hit with mono at the same time. With the proper precautions, you can limit the spread of this and other viruses, helping your family to stay happy and healthy.