Mononucleosis: The Constant Companion

By on January 30, 2008

She looked horrible and felt worse. Her face was puffy, her tonsils enormous, she had a fever and all she wanted to do was sleep, but she couldn’t because she was so achy. “Welcome to Monoland,” I wanted to say but didn’t because she felt bad enough already. I sent some of her blood to the lab and the next day it was official: she had mononucleosis.

Mononucelosis is a frequent viral illness caused by Epstein-Barr virus (EBV), with 95% of the population being infected by the age of 40. It is the scourge of high school and college students because it can cause weeks of misery and inability to carry on as usual in more than a few cases.

[I have frequently fantasized Epstein’s mother chiding him for it. “So this is what we get for sending you to medical school? Instead of a miracle treatment you invent a debilitating disease with no cure? Go invent a curable disease!”]

Mono peaks in the winter months but is around all year. Each year I diagnose about 50 cases in college students. I am on track this year with about 15 cases so far.

Mono has no cure except time, and often causes extreme fatigue, fever, sore throat and aches. It is an inconvenient disease because it sometimes leaves the victim in a state of limbo: Too sick to function normally, not sick enough to stay home. Even worse, the duration of the disease is unpredictable, anywhere from a week to a month or more, which makes me useless in terms of advising the person to hang in there, drop out for a semester, etc.

The good news is that most cases are moderate, lasting a week or two, and the student can continue their usual routine although strenuous activity must be avoided for about a month. Because the spleen is enlarged and fragile in about half of cases, contact sports must be avoided and many sports doctors require a sonogram of the spleen before clearing contact sport athletes to play after recovering from mono.

The Epstein Barr virus is transmitted in saliva by kissing, sneezing, or sharing eating utensils and drink containers. (Sharing of water bottles caused three members of a sports team to come down with mono at the same time a few years ago, knocking them out for the season. Team members are now taught to be generous with assists and stingy with their water.)

Transmission of the virus does occur through casual contact but clusters of illness in roommates are common. I often find sharing of drinking glasses or bottles a factor in spreading the disease.

There is no vaccine for EBV, therefore wise students protect themselves by never sharing eating and drinking objects, never kissing anyone who has a sore throat or fever, I will not say never kissing anyone because that would just be useless advice, and trying to get enough rest to allow their immune system to fight off new infections.

If you get sick with mono-like symptoms, we will do our best to ease the pain, but there is only so much we can do. If going home for a weekend or more is an option we encourage that choice because, let’s face it, you can rest a lot better at home in your old room than in a dorm with two or three roommates.

Even though we can’t cure the disease, we can limit the symptoms and get you back on your feet with the least amount of disruption possible to your academic and social life.


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