Primary Care - About Mono

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Mono: Facts and Fiction

By Dr. Michelle Linkous

With the kids coming home from college for winter break, this is a good time to talk about a common infectious disease on college campuses – mononucleosis.

Mono is a viral infection that causes a sore throat, swollen glands and fever and leaves patients, especially college students, feeling so worn out they don’t want to move.

They used to call it the kissing disease, because it’s transmitted through saliva. But mono spreads easily on college campuses not so much because of kissing but because young people live in close quarters. They share water bottles, ice cream and pizza, drinking glasses and – yes – some of them are kissing.

Here’s something else I see in my teenage patients, those still at home in high school and those away at school. They’re stressed out and pushing themselves to do more of everything. They take heavy course loads. They want to make friends and stay out late. They want to play two sports and join clubs and work on the school newspaper and join a sorority. They don’t sleep enough and they don’t eat balanced meals. All of which lowers their resistance to infection – with mono topping the list.

But it’s hard to tell a high school student to go to bed early and eat his vegetables and harder still to expect that of a college freshman.

Symptoms of Mono

Symptoms for mono include swollen glands, a painful sore throat, fever and exhaustion. If your child is away at school and tells you about such symptoms and they don’t go away after a couple of days, encourage her to go to the student health office. The doctor will examine her throat and run a blood test that picks up the antibodies to a virus called Epstein-Barr, which causes mono.

Epstein-Barr is one of the most common viruses around and most of us have been infected, which can make the diagnosis a little tricky. According to the Centers for Disease Control and Prevention more than 95 percent of adults between 35 and 40 have been infected. In children, the virus rarely causes symptoms. But in teenagers and young adults, the virus causes mono about half the time.  Antibodies are often left over from a long ago infection, but when present with a sore throat, fever and swollen glands, we diagnose mono. Doctors will also take a throat swab to make sure the patient doesn’t have a strep infection, which, if left untreated, can have serious consequences such as rheumatic fever.

The trouble with mono is that once it’s diagnosed there’s not much to do except let it run its course. Doctors in student health will probably tell your child the same thing I tell my primary care patients at Wake Forest Baptist Health Pediatrics-Clemmons: Treat the sore throat with ibuprofen, acetaminophen or a combination. Your student should also drink plenty of fluids, even if it hurts to swallow. Some patients prefer cool drinks. Others find warm drinks soothing. I had a teen-age patient with mono recently who had to be hospitalized for dehydration because he wouldn’t drink anything.  So even if your child can only drink a sip every 15 minutes, that’s enough to prevent dehydration.

In some patients with mono the spleen becomes enlarged because it is working overtime fighting off the virus. That’s good. But a ruptured spleen can be fatal. So student health will tell your student not play any sports, especially contact sports, for a month to prevent any damage to the spleen. Beyond that, the best treatment for mono is rest.

Most patients get better in a week or two. But students often fall behind when they get mono. Here’s what I recommend: Do as much as you feel up to, but put your schoolwork first and put other activities, from parties to debate club, on hold.

Patients with mono rarely suffer complications. In that regard, mono is a far less serious disease than other contagious illnesses that spread around college campuses. The most serious is bacterial meningitis, which can be fatal. That’s why we recommend a vaccine against meningitis at age 11 and a booster again before a child goes away to school.

The parents I know are always looking for advice that will help their children stay healthy at school. Unfortunately, most college students won’t follow the best advice I know. Wash your hands. Don’t share your water bottle and get some rest.

So here’s some advice for parents of teenagers. Let them relax a little. There’s so much pressure these days to succeed academically and socially. And all that pressure leads to stress which lowers resistance to infection – including mono.

Learn more about primary care services at Wake Forest Baptist.

Linkous MichelleDr. Michelle Linkous is a pediatrician at Pediatrics Clemmons, an affiliate of Brenner Children’s Hospital of Wake Forest Baptist Medical Center. 

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