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It's the "Kissing Disease"! - More About Mono

by Dr. Douglas Barton, M.D., Pediatrician 08/16/2011

Infectious mononucleosis (Mono) is a very common disease in all cultures.  In the United States, most cases of mono occur in teens and young adults, although it can occur at any age.  It is caused by a virus called Ebstein-Barr virus (EBV).  This virus is prevalent in all cultures and is present year-round.

It is actually a very complicated illness.  Most people who are exposed to mono never show any symptoms at all.  Even though their bodies have the virus in them, the body does not respond by having symptoms.  The most common illness symptoms are sore throat, swollen lymph nodes in the neck and fatigue.  Often, this sore throat is accompanied by stomach aches, rashes, sore muscles and headaches.  Other less common symptoms include jaundice from liver injury and encephalitis, a brain infection that causes confusion, disorientation, tremors, seizures and severe headache. Occasionally, patients will even hear and see things that aren't there.  Chronic infection has been associated with Burkett's lymphoma, a type of cancer.  There are some that argue that chronic infection can lead to chronic fatigue syndrome, though that has yet to be firmly established.

For most people, once they have had mono, their immune system is primed to fight it off in the future.  Fortunately, this means that very few people get mono twice.

EBV is a respiratory pathogen ("bug").  This means that it is passed in the usual way that colds are passed from one person to another.  Needless to say, this is where the term "kissing disease" comes from because, just like a cold, mono can be passed by kissing.  Any activity that spreads nasal, eye or mouth secretions can pass mono.  So, coughing or sneezing on someone, sharing a glass, kissing, touching something that has come in contact with the ill person's nose or mouth, even shaking someone's unwashed hands can all pass the illness.

Testing for mono is mostly straight-forward.  There is a blood test that gives results in about 15 minutes.  The problem with the test is that it is not 100% reliable.  There are some viral illnesses that will cause a positive test even though mono is not the cause of the illness.  Also, during the first week of illness, it is possible for the rapid mono test to be negative.  Finally, due to slight differences in children under eight years old, the rapid test is truly unreliable.  There is a much more reliable test called EBV titers that can test whether patients currently have the illness.  This test also reports whether a patient has ever had the illness and, possibly, if they have a reactivation of an old infection.  This test can take several days to come back.  

There is no specific treatment for mono.  Just like any other virus, antibiotics do not help at all.  Rest and hydration are generally recommended for most individuals with mono.  If the throat becomes very swollen and sore, steroids can help decrease some of the swelling and allow affected individuals to swallow more easily.  Very occasionally, individuals are hospitalized to receive IV fluids if they become unable to keep hydrated.  Importantly, individuals with mono can develop a very swollen spleen.  This becomes very dangerous in those who play contact sports.  Blunt trauma directly to the upper left abdomen, such as being tackled playing football, can cause an enlarged spleen to tear leading to pain and bleeding.  If there is spleen enlargement with mono, contact sports are strongly discouraged. 

Prevention of mono is identical to prevention of colds.  Good hygiene is critically important to preventing the spread of mono.  Excellent hand washing is vital.  Also, minimizing contact with an ill person's eyes, nose and mouth will help prevent the spread.



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