Infectious mononucleosis is so common that by the
age of 40 over 85% of Americans have already had the illness! This may seem hard to
believe, especially to those who cannot ever recall having had a mono-like illness.
Because most people who contract mono have such a mild case, they never realized that a
past scratchy sore throat or an unusual bout of fatigue was actually "mono."
While anyone can contract the illness, the disease is most commonly seen by physicians in
young adults between the ages of 15 and 30, especially those living in close contact at
schools, colleges, and military bases. "Mono" can occur year round, but most
cases develop in the fall and early spring.
Infectious mononucleosis is caused by the
Epstein-Barr virus, and is spread by close personal contact. Since kissing allows the
virus to pass from one person to another, the illness has been nicknamed "the kissing
disease." However, most younger children contract the disease by putting their hands,
contaminated with the virus from other children, into their mouths, or by playing with a
toy, previously touched by another child with mono.
The incubation period (the time between exposure
to the virus and the outbreak of symptoms) is 1-2 months, averaging six weeks. The
symptoms unfold slowly and the illness may takes days to even weeks to develop, making the
diagnosis difficult. After feeling "out of sorts" for a few days, the child with
mono might experience headaches, fever, muscle aches, abdominal pain and tonsillitis, with
the characteristic extreme fatigue coming not far behind. The lymph glands in the neck and
armpits swell and become tender, and loss of appetite usually develops. In about 50% of
children with mono, the spleen-an internal abdominal organ located below the left
diaphragm, becomes enlarged, causing soreness in the upper abdomen.The virus can also
affect the liver, producing a mild case of hepatitis and yellow jaundice.
Because these same symptoms occur in many other
diseases, the diagnosis can be tricky. Mono is frequently confused with strep throat, the
"flu", hepatitis, and even German measles. The illness is confirmed by having
the typical symptoms and a positive blood test showing antibodies against the Epstein-Barr
virus. These studies may have to be repeated, because the test frequently is frequently
negative in its early stages of the illness and only converts to being positive later. In
addition, a blood count shows a large number of unusually shaped white blood cells with
one nucleus (mononuclear), thus the term mononucleosis.
Unfortunately, there is no treatment for
mononucleosis. Antibiotics, used to treat bacterial infections, have no effect on this
viral disorder. The illness takes about one to four weeks to run its course, though
fatigue may persist for two months or more in some children. Severe complications from
infectious mononucleosis are fortunately rare. The sore throat can be intense at times and
many children have trouble eating and drinking. To help soothe the throat, children should
drink plenty of cold liquids and use throat spray. Since swollen tonsils can make foods
hard to swallow, a soft diet is best for a while. Acetaminophen may also help ease the
throat pain and any headache. While antibiotics have no effect on infectious
mononucleosis, they are sometimes used to treat secondary bacterial infections that can
develop with the mononucleosis. Hospitalization is rarely necessary unless the child is
having trouble breathing or is unable to take adequate amounts of fluids and becomes
Bed rest is usually not required and forcing the
child to stay in bed does not speed recovery. Most children are so tired that they
voluntarily reduce their activity to a level they are comfortable with, taking it easy for
as long as the weakness and tiredness persist. However, contact sports and other strenuous
activities should be avoided for at least six to eight weeks or until the spleen returns
to normal size.
Despite its reputation, infectious mononucleosis
is not highly contagious, and there is no need to isolate the affected child or
adolescent. Family members and roommates do not readily contract the illness , but
that’s because they are already immune. Children with mono can have visitors and eat
with the family, but separation of drinking and eating utensils ( for example, avoid
drinking from the same glass) is usually all that is necessary. Common sense would
indicate people with infectious mononucleosis should avoid kissing until recovery is
complete. A child with infectious mononucleosis is most contagious when they have the
upper respiratory symptoms (during the first 7-10 days) , but it is not known for sure
exactly how long they can spread the virus. Once a child or adult has been infected they
become immune to further infections from the Epstein-Barr virus. While no vaccine is
available to prevent mono, researchers are optimistic that one can soon be developed.
Most parents equate infectious mononucleosis with the prolonged
illness seen primarily in adolescents and college students. What they do not realize is
that the Epstein-Barr virus is commonly acquired at an early age in nursery schools, day
care centers, or from friends and relatives. Therefore, one of their children’s many
past colds could have been infectious mononucleosis, and they are probably already immune
to the "kissing disease."
Mononucleosis: Information for Parents
Mononucleosis: Information for Teenagers
As a reminder, this information should not be relied on as
medical advice and is not intended to replace the advice of your childs pediatrician.
Please read our full disclaimer.