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What Is Mononucleosis?
Q: What is mononucleosis? How is it transmitted?
A: A germ from the Herpes family called Epstein-Barr Virus causes Infectious Mononucleosis. Although many of us have been infected with this virus at some time or another and then carry it for life, not everyone has obvious clinical disease. Epstein-Barr Virus also has been associated with some rarer types of cancer. It originally was thought to be the cause of Chronic Fatigue Syndrome, but some studies have not supported this association.
Cases of mono in the United States are most often recognized in teenagers and young adults. This virus is spread from one person to the next through saliva (hence, the term "kissing disease"); only occasionally by contact with blood.
The virus is not likely to spread through the air or by touching objects. It can take as much as 7 weeks from first exposure before a person has symptoms.
Older children start out with non-specific symptoms of tiredness and lack of appetite before developing classic mono -- fever, sore throat, swollen glands, sluggishness, and headache. Children may first be checked for a strep throat. When the symptoms persist and do not seem to be responding in the same way, then mono is considered. Lab tests can be done to try to make the diagnosis. The reliability of blood tests depends upon which test is being done, the age of the patient, and when in the course of the illness the blood is being collected.
Treatment for mono is generally supportive. No antibiotics or other medicines are used routinely to treat this specific virus. Rest is strongly suggested, along with something for the throat pain and fever. Fluids are indicated to keep the patient well hydrated. A patient's spleen (an organ usually under the rib cage on the left side) is often enlarged with mono, so avoidance of contact sports for about 4 to 6 weeks is recommended. Patients tend to get better slowly, but most recover without complications.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.