Mono (Infectious Mononucleosis)
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What is mono?
Mono (infectious mononucleosis) is a contagious viral illness most
commonly caused by the Epstein-Barr virus (EBV). It affects the
respiratory tract, liver, and spleen. Mono most commonly occurs in
persons15-35 year old. The virus may be in the body for 4-10 weeks
before symptoms develop. Initially the person may feel rundown, have a
slight headache, and experience a loss of appetite. After 3-5 days,
acute symptoms may appear, including sore throat; fatigue; swollen
glands in the neck, armpits, and groin; fever; muscle aches; and
occasionally a rash. The spleen in the upper left abdomen may be
enlarged and tender and liver enzyme levels may increase. There may be
difficulty breathing due to enlarged tonsils and other tissue. Not
everyone with mono experiences every symptom and the level of severity
will vary from person to person.
How do I know if it's mono?
The same symptoms can be caused by other illnesses so it is advisable to
visit your health care provider to have them evaluated and possibly have
a mono test done. It may be 5 to 7 days into the illness before mono
antibodies develop to a detectable level in the blood. If you test
negative initially but your symptoms persist, you may want to have the
test repeated. Other more specific tests can also be ordered.
How is mono spread?
Infectious mononucleosis is known as the “kissing disease” because it is
spread through saliva by intimate contact (coughing, kissing, sharing of
food). Do not share drinking glasses, eating utensils, or cigarettes.
The illness is most contagious when there is fever. It may be impossible
to know who passed the infection to you because not everyone who is
infected with EBV will develop classic mono. However, the infected
person is still able to unknowingly spread the illness to others.
Quarantine of people who have mono is not necessary because it is not
highly contagious. People with mono rarely spread the disease to
roommates or friends with whom they have only casual contact. The risk
of contracting mono does increase with stress, fatigue or exhaustion, or
recent illness. If you have mono, you should also avoid contact with
persons with immune deficiencies (anyone with AIDS, cancer, on
chemotherapy, or anti-rejection drugs) because they are more susceptible
to catching the illness. Washing your hands thoroughly and often with
soap and water or an alcohol-based hand rub remains one of the best ways
to prevent the spread of infection.
How long does mono last?
The length of the illness will differ from person to person. About a
third of those with mono never even need to stay in bed because their
illness is so mild. Most people who have mono are up and around again
within two weeks or less. Occasionally, however, more bed rest is required
and complications may develop. Contact sports and strenuous exercise may
be discouraged for one to two months after getting mono but other
activities can be resumed earlier. People who are infected with EBV virus
are usually immune from ever getting the virus again.
What is the treatment for mono?
Treatment usually includes rest. It is not always necessary to stay in
bed, but adequate rest is essential. A pain reliever such as acetaminophen
(e.g., Tylenol) may be taken for sore throat discomfort, fever, and muscle
aching. Aspirin should be avoided because there is a slight risk of a rare
complication (Reye’s Syndrome) associated with inflammation of the brain
and liver when aspirin is used to treat symptoms of a viral illness.
Aspirin and ibuprofen (e.g., Advil) both could potentially aggravate a
gastrointestinal bleeding problem.
Gargling with warm salt water (1/2 tsp. salt to an 8 ounce glass of
water), an antacid solution, or sucking on hard candy may help soothe a
sore throat. Avoid scratchy or hard, crunchy foods.
The EBV virus may cause some mild liver abnormalities but your liver
function should return to normal as you recover. However, you are advised
not to drink alcohol while you are ill and to avoid it for a month or so
after you recover. People who become jaundiced (yellow skin, eyes, dark
urine) need to avoid alcohol for as long as a year after having mono
because of the possible damage to the liver cells.
If your spleen is enlarged, your health care provider may recommend a
stool softener to prevent constipation. This lessens the chance of the
spleen rupturing as a result of straining to have a bowel movement. Eating
a balanced diet, high in fruits and vegetables is also advised. Increasing
your fluid intake is important to help prevent dehydration.
If you develop excessive swelling of the throat or rupture of the spleen
is impending, steroids may be prescribed. Steroids are not a routine
treatment for infectious mononucleosis.
Antibiotics are not effective in treating viral illnesses, including
infectious mononucleosis. Your own immune system should be able to fight
the infection if you take good care of yourself while you are ill. The
antibiotics ampicillin and amoxicillin should especially be avoided due to
a high incidence of rash with mono.
What complications can occur with mono?
Mono hepatitis (inflammation of the liver and jaundice) occasionally
develops. Persons with mono hepatitis are often sicker and may require
hospitalization, especially if nausea, vomiting, and dehydration occur.
Women who are taking oral contraceptives may be taken off the birth
control pills until the mono hepatitis resolves.
Rupture of the spleen is a rare but serious complication of mono.
Indications of a ruptured spleen include pain that starts in the left
upper abdomen, radiates to the top of the left shoulder, is worse with
inhaling, and then spreads across the whole abdomen. Immediate medical
attention is required. Half of the ruptured spleens that occur in mono
patients are the result of direct blows to the spleen or physical
exertion.
Strep infections (Group A streptococcal) of the throat and tonsils occur
in about eight percent of mono patients. Antibiotics can treat the strep
infection, but they are not effective against EBV.
What should I expect in recovering from mono?
You will need to protect your immune system’s functioning by getting
adequate rest, eating well, and taking good care of yourself in general.
Even though the acute phase of the illness is over in two weeks or so, it
can take longer to get back to your normal energy level. In fact, fatigue
may last three to six weeks or longer beyond the acute phase of the
illness.
Because there does not seem to be a link between the severity of the mono
and the rupturing of the spleen, contact sports and rigorous exercise
should be avoided for at least 4 weeks or until your health care
provider advises that it is safe to resume normal activities.
Contact your health care provider if you have difficulty swallowing
or sleeping, if your symptoms are getting worse, if your fever is still
present after 10 days, if you are not well enough to return to classes
after 14 days, or if you still have symptoms after 4 weeks.
Seek medical care immediately if you have difficulty breathing,
severe abdominal pain, left shoulder pain, pale or clammy skin, bleeding
into the skin or elsewhere, fast or pounding heartbeat or if you feel
lightheaded or weak.
Disclaimer: This material is provided for informational purposes
only. It does not constitute medical advice and is not intended to replace
professional care. Please consult your health care provider with any
questions or concerns you may have regarding your condition.
For additional information, contact CMU Health Services, 989-774-3944 or
e-mail:
healthservices@cmich.edu.
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