August 9, 2016

Mononucleosis hits teens hardest. A Vanderbilt doctor discusses how to handle the virus.


Back to school time means parents need to do their own homework on illnesses that might crop up during the year. Mononucleosis is usually associated with teens because the virus (Epstein-Barr Virus) that causes it tends to bring about more severe symptoms in adolescents than it does in younger children.

“In adolescents, mononucleosis often lasts for several weeks, whereas most young children have no symptoms from EBV infection,” says Mary Ruth Scobey, M.D., Assistant Professor of Clinical Pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt.


How is mono spread?

You’ve likely heard of mono referred to as “the kissing disease.” That’s because Epstein-Barr Virus is spread through saliva. “Young children are often exposed to saliva by sharing and mouthing toys,” Scobey says, “whereas adolescents may contact saliva through kissing or sharing drinks.”


What are the symptoms?

The most common symptoms of mono are fatigue, fever, sore throat and enlarged lymph nodes in the neck. “Patients with mono can develop secondary bacterial infections, however, such as an abscess around the tonsils or a bacterial sinus infection,” Scobey adds.


When should you take your child to the doctor?

If you are concerned that your child has mono, you should seek medical care. Your pediatrician can rule out strep throat, which is a treatable condition. Your doctor can order a blood test for mono, although testing may not be positive in the early stages of infection.

“You should seek medical care and discuss testing for mono if your child has a negative strep test and has a sore throat and fatigue that is not better in one week,” Scobey says. Get emergency medical care if your child has severe pain in the left upper belly, which is a sign of spleen rupture, or if your child has trouble breathing or is unable to swallow.


How is mono treated?

The treatment for mono is to get plenty of rest and drink lots of fluids. Antibiotics are not helpful for mono because it is caused by a virus rather than a bacterial infection. Your child can return to classes once he or she is swallowing normally and has been fever free for at least 24 hours.


Are there complications with mono?

About half of adolescents with mono will develop an enlarged spleen and are at risk of splenic rupture. “Splenic rupture is not common but can be life threatening,” Scobey says, “so patients are advised to avoid contact sports and heavy lifting for at least four weeks after the date of symptom onset.”