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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
Question: How long is mononucleosis contagious for?
Answer: Hard to know, appears to be the first week or so-but, only mildly
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.
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
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