Mononucleosis is a viral illness that is common among young adults but can affect people of almost any age. Severe sore throat, swollen lymph nodes, fever and extreme fatigue are the recognizable hallmarks of this condition. Why the disease is more common in teens remains unclear. It may have something to do with the lifestyle, poor diet, not enough rest and stress, all of which lowers the resistance of the immune system. The underlying culprit is the Epstein-Barr virus (EBV). This virus, a member of the herpes virus family, is so common that 95% of all adults test positive for exposure to it. The EBV has been implicated as playing a role in some uncommon malignancies later in life or another condition chronic fatigue syndrome. However, keep in mind that the virus is very common. Even though exposed some time in their life by adulthood, most people do not manifest any clinical symptoms of mononucleosis. Viral transmission occurs through intimate contact with saliva or blood of the infected person. Hence, the antiquated name of the “kissing disease”. The virus is not airborne. The risk to others in the family or friends is very low unless there is intimate contact.
Severe sore throat, extreme fatigue, swollen glands and lymph nodes characterize the typical symptoms. The inflammatory process usually affects the liver and spleen resulting in some enlargement. In a small number of severe cases, abdominal pain or difficulty swallowing may be an issue. Twenty percent of people with mono develop a fine red rash resembling measles. Some medications in particular amoxicillin based antibiotics can also trigger the rash. The incubation period from time of exposure to onset ranges from 14 to 45 days. The average illness lasts 4 weeks. The first two weeks are most difficult because of the intensity of the symptoms including a severe sore throat that makes it awkward to maintain an adequate diet. The fatigue makes people want to sleep a lot. People usually miss two weeks of school or work during this time. The second two weeks are usually quite a bit better but energy levels are still waning. Getting up in the morning feeling good and somewhat energetic, but running out of gas after a few hours is characteristic. Some modification of activities with a limited schedule during the second two weeks is to be expected. A specific blood test can confirm the diagnosis in the doctor’s office. An exam to rule out other similar conditions is prudent.
Since it is a viral illness it will run its own course, there is no specific treatment. The majority of cases improve with rest and a balanced diet. In the rare severe case, other medications such as a steroid or an anti-viral drug may be used. There are a few instances when a second bacterial infection such as strep throat may occur at the same time. Appropriate tests can easily determine whether an antibiotic is necessary to treat a secondary infection. Symptomatic treatment is helpful just like treating the flu. Ibuprofen or acetaminophen for fever or muscle aches, plenty of clear liquids and trying to maintain a healthy balanced diet are nonetheless important. Avoiding alcohol for six weeks is suggested while the liver inflammation subsides spontaneously. The biggest frustration for people is simply the lack of energy and fatigue. It can usually take 4 to 6 weeks or more before normal stamina returns.