Doctors' Answers to "Frequently Asked Questions" - Mononucleosis

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Mononucleosis [posted 1/13/99]
Question: I have recently been diagnosed with mononucleosis at the age of 21. Although you indicated that this cannot happen, it is the second time blood tests have shown a positive test for mononucleosis. I also had it at age 14. I know of one other person who has had recurrent mono. What might have caused this second positive result? How rare is it and why is their virtually no information available on the subject?

Answer: Once you have had the disease, your blood test will remain positive for a long period - possibly lifelong. Hence, checking the blood test after you have had a documented case at 14 was a complete waste of money. It does not indicate recurrent mono. There are some more specific tests that could be done, but difficult to do and must be timed correctly.

Contagious Mononucleosis
Question: How long is mononucleosis contagious for?

Answer: Hard to know, appears to be the first week or so-but, only mildly contagious then.

Mononucleosis
Question: I'm 18 years old and have been suffering from fatigue over the past couple of years. I have been tested for thyroid diseases and have been on antidepressants for over a year and a half, but it seems like I have gotten even more tired over the past several months. Also, over the past several months to a year, I have been getting the flu a lot. I probably get it close to once every month or two. Recently when I went to the doctor and found out I had mononucleosis, I was told that it wasn't possible to get the flu that often and that it must have been something else. I know that the Epstien-Barr virus can stay in the body for several months, but mono itself only lasts for about a month. Two questions: I know that mono causes fatigue, but could the EBV also cause fatigue before it actually gives you mono? My other question is, does the flu (or whatever it was that I had -- it was too severe to be just a cold) have anything to do with fatigue or with mono? Does fatigue cause the flu? My stomach is really swollen (I'm assuming from mono) -- How long will it take for it to go down after I get well? Oh, and by the way -- I don't really FEEL like I have mono. I feel fine other than my stomach hurts a little sometimes and my head hurts. But my lymph nodes in my neck aren't swollen and my lymph counts (on the monospot) were twice as many as they should be for mono. Is there anything I could have that could be mistaken for mono?

Answer: Have you been tested for mono before and been negative? If so, that is, this test is now positive which was previously negative. Mono can give you all these symptoms. If you had mono previously, you will not contract it again. So, first determine if this is new mono. If so, your symptoms are probably mono. The swollen stomach is an issue for two reasons. First, if the spleen is enlarged with mono this usually requires steroid treatment in order to shrink it. Also, you should avoid any contact since rupture of the spleen is about the only way to die from mono. If you are not having just mono, some tests need to be run - adrenal gland function, etc. Also, your white cell counts should be normal by now from mono.

Symptoms
Question:My childcare provider has an illness that appears to be mono. Symptoms include sore throat, fever, congestion, extremely swollen glands in the neck area, an enlarged spleen and tenderness in the liver area. However, she continually tests negative for mono and strep. After taking Keflex for more than a week she still is ill and running a low-grade fever. What do you think?

Answer: There are many viral illnesses that look like mononucleosis. Infection with Ebstein-Barr virus(the virus responsible for mononucleosis) can be similar to infection with cytomegalovirus, herpes simplex, and other infectious agents. Also, occasionally the mono spot test will be negative in the early stages of the disease. Antibody titers to Ehstcin-Barr virus can be arranged in that instance or rechecking four to six weeks later will usually give a positive mono spot test. For practicable purposes, if the spleen shrinks and the symptoms go away diagnosis is an academic exercise. Being able to treat the patient during the infection is what separates useful from merely interesting tests. If your child still has an enlarged spleen this needs to be followed very carefully until a diagnosis is obtained. Most physicians would reccomend no contact sports while the spleen is enlarged to avoid accidental rupture of the spleen.

Mono & Fatigue
Question: Since we met 15 years ago my wife has always needed a lot of sleep and tires easily. She claims this is because she had mono when she was young (she's 40 now and had mono when she was in grade-school) and hasn't been the same since. She's not very overweight, is otherwise healthy and at times has plenty of energy. Her now 26 year-old neice is the same in all the above respects and was recently diagnosed with Epstein-Barr. My question: My 4-year-old son and I have always had good energy and have been very healthy. How is mono really transmitted, how do we avoid it? Is my wife really tired because of having had mono or is she being a hypochondriac (she has a slight tendancy toward this and she's also very prone to hormonal mood swings)? Her low energy does not seem to corelate much with her menstrual cycle and she takes iron. Any light you could shed or resources you could point me to would be helpful.

Answer: At one time "chronic mono" was thought to be an answer to people with the Chronic Fatigue Syndrome. This is no longer the case and it is recognized that this syndrome probably doesn't exist. It would not be expected to cause chronic fatigue or need for extra sleep. Several medical conditions can cause this including hypothyroidism and sleep apnea I would query her physician if these conditions have been explored.


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