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The Truth About Mononucleosis

Learn Facts and Myths About Mononucleosis

Sarah Cook is always a little tired after a soccer game, but after one game a couple of years ago, she was so exhausted she couldn't even keep up with her friends at the mall. By the time she got home, she had a high fever and a terrible headache. Her mom, Marcia, assumed she just had a bug and kept her home from school the next day. After a couple of days with no improvement, Marcia, a registered nurse and hospital administrator, suspected mononucleosis and took Sarah for blood tests. Her suspicions were confirmed when the tests came back positive for the virus.

Mononucleosis, commonly referred to as "mono," is a well-known scourge among teenage athletes like Cook, 15, of West Deer, Pa. It's a condition that affects mostly teenagers, since they're at the prime age for exposure, and can bring a busy teen's life to a screeching halt for up to six weeks.

"Because my spleen was swollen, I wasn't allowed to play soccer," says Cook. "I wanted to just play anyway, but one day when I decided to go to my game just to watch, I was so exhausted that I fell asleep leaning against the fence. I realized that I wasn't really in any shape to be on the field."

How Do Teens Really Get Mononucleosis?

Infectious mononucleosis is one of the many viruses in the herpes simplex family. This particular condition is caused by the Epstein-Barr virus (EBV) or the cytomegalovirus. It is estimated that 95 percent of adults in the United States between the ages of 35 and 40 have been exposed to the Epstein-Barr virus.

When children are infected, they don't usually experience any noticeable symptoms. In underdeveloped countries, children are usually exposed to the virus at a young age. In the United States, exposure occurs later, usually during the adolescent and young adult years, which is why it is so closely associated in our culture with teenagers. Generally, it is thought that this group develops mononucleosis in half of exposures.

Although Cook thinks that she developed mononucleosis from drinking out of a teammate's water bottle who had the condition, Dr. Ellen Wald, chief of the division of allergy, immunology and infectious diseases at Children's Hospital of Pittsburgh, is skeptical. Unlike viruses like those that cause influenza or the common cold, the virus that causes mononucleosis is not airborne. Rather, it is contracted by very close contact over time. This is what has led to its other nickname – The Kissing Disease. However, as Dr. Wald points out, that doesn't necessarily mean that it's only contracted via kissing.

"When we're friends with someone, we tend to be much closer physically than we realize," says Dr. Wald. "We study together and hug each other and have rather intimate contact, even though we may not think of it that way."

What Are the Symptoms of Mono?

While Cook may not have any idea how she contracted mononucleosis, her symptoms were classic: extreme fatigue, sore throat, fever and swollen glands. These are also symptoms of strep, often a secondary infection when mononucleosis is present, but what distinguishes mononucleosis from strep is the duration of the illness. Strep usually goes away in three or four days, while mononucleosis lasts for several weeks.

Occasionally, usually early in the course of the illness, a rash is present. Also, in about 30 percent of all cases, the spleen or liver can become enlarged. In those cases, the affected person needs to avoid possible injury to the abdominal area. This means giving up sports for several weeks, which can be a real hardship for some of today's dedicated athletes.

Bouncing Back

According to Dr. Wald, other than practicing caution in cases where the spleen or liver is swollen, a teenager with mononucleosis can go about their normal activities.

"Casual contact doesn't result in transmission, so from a standpoint of infection, there's no reason to keep them home from school," says Dr. Wald. "What they participate in should be a function of how attentive they can be. If they're extremely tired and have a high fever, they should probably stay home; if the symptoms are more mild, there's no reason they can't go to school."

Mono Myths

  • Mononucleosis is not a "kissing disease," although it can be contracted that way.
  • There is no way to avoid contracting mononucleosis, because even symptom-free people can carry the virus in their saliva.
  • There is no treatment for mononucleosis per se, but the symptoms can be treated. Rest is very important, acetaminophen for fever and ibuprophen for pain. If these over-the-counter medicines don't work, you can consult a doctor about prescription symptom relievers.
  • Mononucleosis can only be diagnosed with a blood test. There is no way to definitively identify mononucleosis without one.
  • Generally, people who have had mononucleosis once will not get it again. Dr. Wald speculates that the reason many people think they can relapse is that they perhaps weren't tested one of the two times they had mono-like symptoms.
  • The good news is that recovery from mononucleosis, while it can be long, is always complete.

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