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The Gleason Twins - Mono in stereo - (6/19/2018)

By Dr. Ron Gasbarro 

Mrs. Gleason was in the pharmacy getting her prescriptions refilled when the pharmacist asked how her twin 16-year old girls were doing. “They both have mononucleosis,” she lamented. “That wraps up their summer. We canceled their summer jobs at the amusement park. And we scrapped our road trip to the national parks.”

Mononucleosis, also called “mono,” is a disease usually caused by the Epstein-Barr virus (EBV). It is very common in teens and young adults. There are more than 3 million cases of mono each year in the US. Because it is transmitted through saliva, mono is also called the kissing disease. The virus infects most people as children when the disease produces few or no symptoms. In young adults, the disease often results in fever, sore throat, enlarged lymph nodes in the neck, and tiredness. Most people get better in two to four weeks; however, the fatigue may last for months. The liver or spleen may also become swollen, and in less than 1% of cases, the spleen may rupture. Mono has made its way through schools, families, and even groups of friends. Over 98% of the world’s population is infected with the virus even though most do not have symptoms. 

The main symptom of mono is a sore throat. This is not the simple soreness that is associated with the common cold. The throat soreness that is caused by infectious mononucleosis is extremely intense. Ingesting anything can become difficult, if not impossible, including the swallowing of one’s own saliva. The defining factor that sets a sore throat caused by mononucleosis apart from that caused by a cold is that the other common symptoms of a cold will be absent. There is no sneezing, coughing, or runny nose, as one would experience with a cold. Exhaustion is another crippling symptom of mononucleosis. One may feel extremely fatigued as one does with influenza. The patient will want to stay in bed for as long as the illness persists.

Mono can produce some complications, albeit rarely. Meningitis, blood disorders, jaundice, hepatitis, and even cancers of the blood have been reported. Once the acute symptoms of an initial infection disappear, they often do not return. But once infected, the patient carries the virus for the rest of his or her life. While dormant, the virus typically lives in the B-lymphocytes, a type of white blood cell that secretes antibodies. Independent infections of mononucleosis may be contracted multiple times, regardless of whether the patient is already carrying the virus in its dormant state. Periodically, the virus can reactivate, during which time the patient is again infectious, but usually without any symptoms of illness. Even though 95% of all people house the Epstein-Barr virus, the disease is rarely, if ever, fatal.

There is no specific treatment for mononucleosis. Antibiotic treatment does not work against a viral infection. Instead, the patient should get bed rest, eat nutritious foods, and drink plenty of water. Use ibuprofen for mild to moderate pain. Use an antipyretic, such as acetaminophen (Tylenol®) to bring down the temperature and treat fever. In cases that are more complex, patients may be prescribed corticosteroids such as prednisone or methylprednisolone to help control any systemic effects occurring from the virus.

Lisa and Melanie, the Gleason twins, will be spending the summer indoors, watching TV, and sleeping. Mom will make sure they eat well and are as comfortable as possible. “Hopefully, they will be well enough to start their high school senior year in September,” said Mrs. Gleason. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com   

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