On the Teen Scene:
When Mono Takes You Out of the Action

Missed parties. Postponed exams. Sitting out a season of team sports. And loneliness. These are a few of the ways that scourge of high school and college students known as "mono" can affect your life.

The disease whose medical name is infectious mononucleosis is most common in people 10 to 35 years old, with its peak incidence in those 15 to 17 years old. Only 50 people out of 100,000 in the general population get mono, but it strikes as many as 2 out of 1,000 teens and twenty-somethings, especially those in high school, college, and the military. While mono is not usually considered a serious illness, it may have serious complications. Without a doubt your lifestyle will change for a few months.

You've probably heard people call mono the "kissing disease." But if your social life is in a slump, you may wonder, "How did I get this 'kissing disease' when I haven't kissed anyone romantically recently?"

Here's how. Mono is usually transmitted though saliva and mucus--which is where the "kissing disease" nickname comes from. But the kissing or close contact that transmits the disease doesn't happen right before you get sick. The virus that causes mono has a long incubation period: 30 to 50 days from the time you're exposed to it to the time you get sick. In addition, the virus can be transmitted in other ways, such as sipping from the same straw or glass as an infected person--or even being close when the person coughs or sneezes. Also, some people can have the virus in their systems without ever having symptoms and you can still catch it from them.

Two viruses can cause mono: Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Both viruses are in the herpes family, whose other members include viruses responsible for cold sores and chickenpox.

EBV causes 85 percent of mono cases. About half of all children are infected with EBV before they're 5, but at that young age, it usually doesn't cause any symptoms. If you don't become infected with EBV until you're a teen or older, you're more likely to develop mono symptoms. After you're infected, the virus stays with you for life, but usually doesn't cause any additional symptoms. Still, every now and then you may produce viral particles in your saliva that can transmit the virus to other people, even though you feel perfectly fine. By age 40, 85 to 90 percent of Americans have EBV antibodies, indicating they have the virus in their systems and are immune to further EBV infection.

CMV is also a very common virus. About 85 percent of the U.S. population is infected with it by the time they reach adulthood. As with EBV, CMV is frequently symptomless, and mono most often results when infection occurs in the teens and 20s. Sore throat is less common in people who have CMV mono than in those infected with EBV.

As another one of its nicknames--glandular fever--implies, perhaps the most distinguishing mono symptom is enlarged glands or lymph nodes, especially in the neck, but also in the armpit and groin.

Another common mono symptom is fever. A temperature as high as 39.5 degrees Celsius (103 degrees Fahrenheit) is not uncommon. Other symptoms include a tired achy feeling, appetite loss, white patches on the back of the throat, and tonsillitis.

"My tonsils got so swollen they were touching each other in back," says Heidi Palombo of Annandale, Va., who had mono when she was a senior in college. She recalls her throat being "so hot and swollen that the only thing that felt good was ice water."

Cold drinks and frozen desserts are both ways to relieve sore throat symptoms. Doctors also recommend gargling with saltwater (about half a teaspoon salt to 8 ounces of warm water) and sucking on throat lozenges available over the counter in pharmacies and other stores. If throat or tonsils are infected, a throat culture should be taken so the doctor can prescribe an appropriate antibiotic. Ampicillin is usually not recommended because it sometimes causes a rash that can be confused with the pink, measles-like rash that 1 out of 5 mono patients develops.

For fever and achiness, you can take acetaminophen (marketed as Tylenol, Datril and others) or ibuprofen (marketed as Advil, Motrin, Nuprin, and others). If you're under 20, don't take aspirin unless your doctor approves it. In children and teens, aspirin taken for viral illnesses has been associated with the potentially fatal disease Reye syndrome. Sometimes a person with mono may have trouble breathing because of swelling in the throat, and doctors have to use other medications and treatment. A person who has mono--or those caring for the person--should contact a doctor immediately if the person starts having breathing problems.

Some people with mono become overly sensitive to light and about half develop enlargement of the spleen, usually two to three weeks after they first become sick. Mild enlargement of the liver may also occur.

Whether or not the spleen is enlarged, people who have mono should not lift heavy objects or exercise vigorously--including participating in contact sports--for two months after they get sick, because these activities increase the risk of rupturing the spleen, which can be life-threatening. If you have mono and get a severe sharp, sudden pain on the left side of your upper abdomen, go to an emergency room or call 911 immediately.

Because its symptoms can be very similar to those of other illnesses, doctors often recommend tests to find out exactly what the problem is.

"I was misdiagnosed at first and told I was bit by a spider," writes John L. Gipson, of Kansas City, Mo., in a note he posted to a Website (see "Help from the World Wide Web"). "That's what I thought because I had killed a spider in my room. I figured I'd been bitten by a spider in my sleep. A few days after ... I had no energy, a fever ... and those pea-sized bumps on the back of my neck." Gipson returned to his doctor, who did blood tests and diagnosed mononucleosis.

Other diagnostic problems can result because enlarged lymphocytes, a type of white cell, are common with mono, but can also be a symptom of leukemia. Blood tests can distinguish between the type of white cell seen in leukemia and that with mono.

If your throat is sore, having a throat culture is usually a good idea for several reasons. First, the symptoms of mono and strep infection (including that caused by Strep-A, a particularly serious form of strep) are very similar. Second, strep throat or other throat infections can develop anytime during or shortly after in the disease. In any case, it's important that throat infections be diagnosed as soon as possible and treated with antibiotics that can kill the organism responsible for the infection.

The test most commonly used to tell whether you have mono or some other ailment is the mononucleosis spot test. This blood test detects the antibodies (proteins) that the body makes to fight EBV or CMV. Because it takes a while for antibodies to develop after infection, your doctor may need to order or repeat the test one to two weeks after you develop symptoms. At that time the test is about 85 percent accurate.

Other tests your doctor might order include a complete blood count (CBC) to see if your blood platelet count is lower than normal and if lymphocytes are abnormal, and a chemistry panel to see if liver enzymes are abnormal.

Bed rest is the most important treatment for uncomplicated mono. It's also important to drink plenty of fluids. Mono is not usually a reason to quarantine students. Many people are already immune to the viruses that cause it. But if you have mono you'll want to stay in bed and out of classes for several days, until the fever goes down and other symptoms abate. Even when you've started to get better, you can expect to have to curtail your activities for several weeks, and it can take two to three months or more until you feel your old self again.

The author of this article had mono herself when she was 16. Though she didn't mind getting out of all that homework (or at least putting it off), having to delay finals only added to her anxiety about college applications that many high school juniors experience. And then there was that guy who never called again.

When you add the time spent recuperating to the fact that most people are not exactly anxious to get close to a person with mono, you can understand why some students find themselves combating loneliness on top of their other troubles.

Getting through mono may be both challenging and depressing--and seem to take forever. But if you rest when your body tells you to, you can lessen the chances of complications and get back your life.

Judith Levine Willis is a member of FDA's public affairs staff.

Help from the World Wide Web

HealthAnswers
www.healthanswers.com
Medical info for the general public.

The Merck Manual
www.merck.com/pubs/mmanual/
Info in doctor language.

National Institute of Allergy and Infectious Diseases
www.niaid.nih.gov
Info about CMV, EBV, and related diseases.

FDA Consumer magazine (May-June 1998)