Infectious Mononucleosis

When I was seventeen, one day I found a lump on the left side of my neck.  It was in a funny place, lower down on my neck than it would be if I had a cold.  It didn’t hurt, so I shrugged and thought I’d show it to my mom or dad that evening.

Turned out a few hours later I had a fever and a horrible sore throat, like someone had used razor blades in there.  It hurt even to sip water.  Eating was out of the question.  My lump developed a bunch of friends all around my neck.  My mom called the doctor and the next day took me in.

The doctor took one look at me falling asleep in the exam room, checked my throat, admired my collection of swollen glands and the lovely jaundiced yellow of my skin, and informed my parents that I had infectious mononucleosis.

I don’t remember much of the next few weeks.  I had hepatitis, tonsillitis and hugely swollen glands in my neck, my armpits and other places too.  (Who knew there even WERE glands in some of these places!).  I slept nonstop unless my mom woke me up and made me eat macaroni and cheese or pudding and drink some water.

Infectious mononucleosis is a contagious illness usually caused by the Epstein-Barr virus (EBV).  This virus is a member of the herpes virus family, like chickenpox and the cold sore virus.  The illness can be very mild, sometimes with no symptoms at all, or it can be serious enough that a person has to be hospitalized.

The virus is transmitted from person to person in saliva, through kissing or by sharing eating utensils and beverages.  This is one reason why teenagers are the ones who usually come down with infectious mononucleosis.  Dating!  Studies have shown that more than 50% of people have antibodies to EBV when they graduate high school.

Typical symptoms of infectious mononucleosis include fever, swollen glands, severe fatigue, and swollen, painful tonsils.  Almost all patients have hepatitis (inflammation of the liver).  Some patients, like me, actually get jaundiced.  Lab testing shows a high percentage of atypical lymphocytes and monocytes in the blood, which gives the illness its name.  Steroids like prednisone are used to relieve the symptoms.

One concerning problem in teens with mono is that the spleen can get swollen.  If a patient has trauma to the abdomen (like getting tackled in football or kicked in martial arts) the spleen can rupture and the patient can bleed to death.  If a teen plays contact sports they should be screened with an ultrasound of the spleen before returning to play after a bout of infectious mononucleosis.

When I had mono as a high school senior, I missed several weeks of school and work and it took me a long while to get back to normal.  Luckily it didn’t have any long-term impact on my academics and my part-time job at a fast-food restaurant was happy to wait until I was ready to come back.

For most patients infectious mononucleosis is an inconvenience, an annoyance that causes some significant short-term misery but no long-lasting consequences.  The illness can cause life-threatening complications but thankfully this is rare.

QUESTION: Have you had mono?  What was your experience like?

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3 thoughts on “Infectious Mononucleosis

  1. Dr. Wurst my friends son is in college at Ohio state he has had mono at least 4 times he’s very lethargic doesn’t want to do anything. He just came home for Christmas break and I told them to take him to the doctor here because I thought once you had it you normally don’t get it again. I’m really worried about him, is this normal?

    • Hi, Heather. EBV is a herpesvirus so the body doesn’t clear it completely. It can come back if the immune system is suppressed. The first thing for him to do is to make sure he is getting plenty of rest, drinking plenty of fluids and eating very healthy. Nutritional supplements can be very helpful in supporting the immune system and help him feel better. I’ve had good results with Shaklee in helping folks with chronic/recurrent EBV get better and stay better. If these don’t help quickly he should see a doctor, it is possible that he has something medical going on that is interfering with his immune system’s ability to control the virus. Your friend is welcome to reach out to me at drjen@jenniferwurstmd.com or on Facebook at Jennifer Wurst, MD (my business page) for nutritional supplement recommendations. Hope this helps!

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