Dear Dr. Lanny:
My 7-year-old had mononucleosis a few months back, and I had to keep her home for over a week. It took her a few weeks beyond that to recover her normal boundless energy levels. What can you tell me about mono? How does a little kid get what’s known as “the kissing disease”?
A: Whenever the possibility of mono is brought up, the very first thing that comes to anyone’s mind is “the kissing disease.” So, before any discussion of the illness, I’d like to address that myth.
You don’t have to kiss someone with mono to get it, although this is certainly an efficient way to spread the disease.
Mono, which is short for infectious mononucleosis, is a viral illness that is usually spread through contact with infected saliva. Coughing, sneezing, spitting all can infect others. Contagion by way of infected objects, such as utensils or toothbrushes, is much less likely.
Mono is caused by the Epstein-Barr virus (EBV), which was named after Sir Michael Anthony Epstein and Yvonne Barr, British virologists who discovered the cause in the early 1960s. (Why Michael was given a knighthood and Yvonne moved to Australia is beyond the scope of this article.)
The virus is found throughout the world and it is estimated that 90 percent to 95 percent of adults have been infected. Infants are initially protected by maternal immunity, but this rapidly fades and young children become susceptible. In young children the illness tends to be similar to other mild viral infections and resolves without treatment or even recognition that the problem was mono.
Symptoms include fever, sore throat, swollen glands and frequently fatigue. A swollen and tender spleen, just below the ribs on the left side of the abdomen, may be noted as well. Strep throat tends to come on more suddenly, and it frequently includes nausea. If you have seen your doctor, testing for strep was negative and the sore throat is dragging on beyond a week, mono becomes a consideration. Significant fatigue would increase the likelihood of mono even more.
Although mono can occur in young children, it tends to be much more significant in adolescents. Mono is virtually never a dangerous disease, although injury to a swollen spleen is possible. Mono can, however, be quite long lasting and debilitating with an occasional adolescent losing as much as a semester of school to persistent fatigue.
Because mono is a viral illness, there is no place for antibiotics, which only help with bacterial disease. Mono and strep can also coexist, confusing the picture. If a patient has strep and mono, and is treated with amoxicillin, a rash frequently occurs. This rash can easily be mistaken for an allergic reaction to amoxicillin. Some physicians will prescribe a brief course of steroids (e.g. prednisone) if the tonsils or spleen are quite enlarged. The benefit of this treatment has always been controversial.
Diagnosis of mono is by blood and may include several tests. A complete blood count (CBC), or mono spot test may be sufficient, and together cost about $50. More comprehensive Epstein-Barr virus titers cost approximately $130. Frequently all three tests will be ordered. Rapid testing in the doctor’s office is available but the accuracy remains questionable. The Epstein-Barr virus testing is often confusing as results are frequently reported as “consistent with a present or past infection.”
Patients, fearing the needle, may ask why testing is necessary if there is no treatment for mono. This seems to me a pretty reasonable question, but knowing why you feel such malaise, and knowing that it is ultimately not a serious illness, is worth a small poke in the arm.
Patients with mono need not be excluded from school, although common sense precautions, particularly keeping one’s lips to oneself, are obvious. Many healthy people can carry the virus in their saliva and intermittently spread the disease throughout their life. Patients may return to school when they feel strong enough to navigate the rigors of a busy school day. In some cases attending only part of the day may be all the student can manage.
When I tell a child your daughter’s age that she can go back to school … but no kissing, the looks I get are priceless. Kissing? Oh gross. A few years later? Well, you’ll be there before you can say mononucleosis.
Dr. Alan Freshman, father of two grown sons, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at email@example.com.