What about "MONO"?

This may be the harbinger of Infectious Mononucleosis.  The infection is caused by the Epstein-Barr virus, a member of the Herpes Family.  It belongs in the Herpes group because, like Chickenpox (Varicella to doctors) and Herpes Simplex viruses, you only get severely ill from them when you are first infected by the germ.  As a rule the patient completely recovers, but never clears the virus from his body.  It becomes dormant, hiding out in body tissue (usually nerve cells).  It can make a reappearance even years later (as shingles can after chickenpox), but almost always in a limited form.  I mention this early in my essay to clear away the MYTH of chronic mono.  Because of the theoretical possibility that the "E-B" virus could reactivate, some people who suffer with relentless fatigue of unknown cause are labeled sufferers of chronic Epstein Barr viral infection.  I've discussed this condition with many Infectious Disease specialists, and not a single one believes the theory is valid.  Close to 100% of these patients are proven to NOT have active E-B viral infection.

But what of acute mono?  The syndrome I described in the first paragraph usually strikes only a teenaged patient.  If a young child is infected by the virus, she may only suffer symptoms of a standard cold/sore throat.  In communities in the world where crowded living conditions are the rule, kids are frequently infected when they are young, even four years old.  But, unlike the bacteria that causes strep throat,  E-B virus requires very close, intimate contact to spread.  Hence, its nickname, "The Kissing Disease".  But it can also be spread during intense athletic sports where young people share each others' water bottles, or share food from the same plate.

The illness begins with signs of a cold and sore throat, but it becomes MORE severe with terrible tonsil pain as a week passes.  Marked swelling of the lymph nodes in the back of the neck occur along with fever.  Rarely, it can present with terrible fatigue alone.  Often, infection with Group A streptococcus is considered as the possible culprit causing the illness.  It is important to know that both infections can occur simultaneously.  In fact, an estimated 30%of patients with "mono" have Group A strep infection at the same time!

But this illness is not just a "tired sore throat":

Hepatitis occurs in the majority of patients.  The liver is injured by the infection so that some patients can become jaundiced with yellow/orange eyes and skin.  Blood tests will prove this damage with changes in blood chemicals.  Fortunately, the injury is almost always mild and brief.  The liver heals quickly when the body/immune system overcomes the infection.

Classic "Mono" also involves the spleen.  It becomes painful to pressure and large enough for a doctor to feel in one quarter of cases when the abdomen is examined.  The engorged spleen is in danger of hemorrhage if injured.  Contact sports, including bicycle riding, aren't permitted during the illness.

Riding in an automobile is discouraged since a seat belt could injure the spleen in an accident.  And, rarely, a spleen could begin bleeding even without a noted injury.  Patients are warned to beware of severe abdomen pain and to notify their doctor should it develop.

There is no medicine to treat "Mono".  In fact, taking the antibiotics amoxicillin, ampicillin and Augmentin are almost GUARANTEED to cause a severe body rash, confusing patients to believe they are allergic to the treatment.

Occasionally, however, a patient's throat and tonsils are so swollen that he can't swallow at all.  In that case, offering the child prednisone or decadron steroid medication for a few days can avoid the need for hospitalization.  The swelling shrinks in a remarkably short time, and the patient feels much better. (Because of the possible side effects, this treatment shouldn't be used routinely.)

Rarely, an alarming neurologic syndrome occurs with the patient "not feeling like themself".  They may also be confused with the size of objects, with things appearing much smaller or larger than reality, as in "Alice in Wonderland".

These complaints are thankfully only temporary, as a rule.

The blood tests that help us make the diagnosis include

The CBC.  This reveals "atypical lymphocytes" found almost exclusively in "Mono".  The platelet count is typically mildly lower than normal.

The "liver enzyme" test is ALMOST ALWAYS abnormal with elevated levels (usually only mildly so) even to the point that jaundice (yellowed eyes and skin) can occur.

The rapid "Mono spot" test gives a result in under ten minutes.  But the test is unreliable if the patient is a young child, or if the illness has been ongoing for less than a week.  More definitive is the viral capsid antibody (VCA) test for IgG and IgM.  If the IgM value is elevated, the patient almost CERTAINLY has EBV infection.  If only the IgG level is high, it means the patient is ALREADY immune to Mono and NOT currently ill with that infection.

It is important for the patient to eat lightly, drink plenty of fluids, and try to keep out of bed during the day.  MOST patients recover in two to three weeks.

Return to school and activities is best done gradually, so the patient regains endurance and doesn't become exhausted after weeks of inactivity.