Ask the Pharmacist

Q) My son has been diagnosed with mono. What do we need to know?

A) Mononucleosis, or mono as it is more commonly known as, is an infectious disease most frequently seen in teens and young adults. Mono is far more prevalent than the vast majority of us might suspect. In fact, it is estimated that by midlife, 90% of us have been infected by the virus (most infections in fact occur even before our adolescent years), developed antibodies to it, and subsequently gained immunity from it.

The reason most of us never realize we have been infected is that most infected individuals either are asymptomatic or have only a very mild illness that seems to pass within a few days and therefore never suspect they have been infected by the “mono” virus.

Mono is usually caused by the Epstein-Barr virus but a small percentage of patients may get the disease from other viruses such as cytomegalovirus and adenovirus. Those who do experience the “classic” symptoms tend to in the 15-17 year old age range or in their early 20’s.

The most common symptoms are shared by many other types of infections such as a fever, sore throat, and swollen lymph glands in the neck, under the arms and in the groin region. Other possible symptoms include fatigue (sometimes extreme), muscle aches or weakness, headaches, white patches in the throat, a pink rash all over the body that resembles measles, a loss of appetite, chills, a sore throat and an enlarged spleen.

Generally, in the first few days, a typical patient will have a fever with a headache and muscle aches and feel unusually fatigued before the rest of the symptoms start to be felt. Typically these symptoms last in the range of from 1 to 4 weeks but some take as long as 2 months before they feel well enough to resume their normal level of activity.

Like most viruses, mono has an extended incubation period. It can take from 4 to 6 weeks after becoming infected before symptoms start to appear. As for the chances of passing it on, mono is not incredibly contagious therefore there is no need to isolate the infected one from most others (although it would be prudent to stay away from the immune suppressed amongst us such as the very young or someone undergoing chemotherapy).

You are most contagious when the virus is in the acute stage (i.e. while you are still fevered) but many may continue to shed the virus for months or even years (the average is 6 months)meaning that they can still pass on the virus to others long after they feel well again. To make matters even more challenging in terms of not passing the infection along, occasionally the virus can become reactivated again long after the illness has passed which would once again make the individual infectious.

The virus is transmitted by body fluids (hence its nickname as the “kissing disease”) such as saliva (predominantly), blood or semen. One can decrease the risk of contracting the virus by not sharing drinks, food, utensils or toothbrushes, frequent hand-washing both by the sick person and their close contacts and refraining from kissing others while he or she is feeling ill.

Diagnosis is usually made by a physical examination by a physician and blood work can be used to help confirm the results. As far as treatment goes, there is no cure for mononucleosis. It typically goes away on its own. Recovery usually involves getting plenty of rest, drinking lots of fluids and treating symptoms such as a fever or sore throat with over the counter pain killers such as ibuprofen or acetaminophen.

Serious long term complications are rare but 0.5% of patients may experience a ruptured spleen which is a serious and potentially fatal event. For this reason, athletes should avoid contact sports for at least 3 to 4 weeks after getting mono.

Other less common complications can include jaundice (due to swelling of the liver), difficulty breathing, an irregular heart rhythm and anemia. Returning to normal activity levels completely depends upon how you are felling. It is important to make sure you give your body a chance to get the rest it needs but there is no set time frame forcing you to stay home from work/ school since you are not a threat to the health of the individuals around you.