FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[LIMITED EXCERCISE OK FOR DAUGHTER RECOVERING FROM MONO]

Question: My daughter is a freshman college student. She has been ill with mononucleosis for four weeks. She normally works out daily, but has been unable to do this for the first three weeks of this illness. She resumed mild workouts this week. When do you know you have fully recovered from mono? Is there any immune boosting she can do?

Answer: Mononucleosis - also called infectious mononucleosis or simply "mono" - is a very common infection caused by the Epstein-Barr virus (EBV). Sixty percent of U.S. children and ninety percent of adults over 40 years old have antibodies to this virus in their blood. An interesting part of this illness is that it is often so mild that less than half of us can recall ever having a "mono-like" illness. About one third of us, however, develop the classic mono symptoms.

Infection with the EBV occurs in the teen years in about 20 percent of the population. After exposure to the infection, symptoms develop in 30 to 50 days. There is usually a period of three to five days when the person feels like they are coming down with a cold followed by swelling and tenderness of the lymph nodes in the neck. There is usually a sore throat with a pus-like substance on the tonsils as well as accompanying fever, abdominal discomfort and muscle aching. The person also has bad breath that will "peel the paint off the wall at ten paces," or so it seems.

The Epstein-Barr virus is present in high concentrations in the saliva of individuals with an acute infection. In fact, the infection is only spread by saliva - through sharing eating utensils, through kissing or other means. On college campuses, where EBV can sometimes become epidemic, it is often known as the "kissing disease" because students are aware of this method of catching mononucleosis.

So I would recommend that until your daughter recovers, she should avoid kissing friends or relatives. She does not need, however, to be isolated from friends and family. The glasses, dishes and silverware she uses need to be washed very thoroughly before another person uses them. Hand washing with hot water will do, but machine washing is a little better.

There is no specific treatment for mono. Medicines like Acyclovir that help with some types of viral infections offer no benefit for those with mono. Instead, general measures that promote good health are used. The person should be relatively quiet until he or she no longer has a fever. Moderate physical activity does not slow the recovery from mono; however, vigorous exercise and contact sports must be avoided. A balanced diet and plenty of rest are important. There are no specific immune boosters to expedite her recovery.

Complications are rare with mono. The liver and the spleen can become enlarged to the point of great pain and - very rarely - to the point that the spleen ruptures. Mono can also cause problems with the body's defense system and at times also produce anemia. About 1 percent of mono patients develop confusion, headache, convulsions, paralysis and other serious problems from involvement of the nervous system. The most common of these generally uncommon complications, however, is a prolonged recovery. It may take six months or more to regain the previous physical endurance and intellectual vigor.

There are no tests to determine that your daughter has recovered from mono. Instead of a medical test, she should continue to increase her physical activity as her tolerance allows and periodically check back with her doctor to be sure that no complications are developing.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.