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Ask The Doctors

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DEAR DOCTOR: When we dropped off our daughter at camp this summer, our main worry was that she might get exposed to COVID-19. Instead, she came home with mono. I would like to know more about this disease and what it means for her in the future.

DEAR READERS: Mono, which is short for mononucleosis, is a contagious disease that is common in teens and young adults. The primary cause is infection with the Epstein-Barr virus, or EBV.

Someone is at risk of getting mononucleosis when they come into direct contact with an infected individual's bodily fluids. Most often this is saliva, which is how mono has come to be known as "the kissing disease." It can spread via the droplets of a sneeze or a cough; through shared objects, such as eating utensils, a glass or a toothbrush; and, yes, with a kiss.

When the Epstein-Barr virus reaches the back of someone's throat, it begins to replicate. It then spreads throughout the body via the lymph system. Healthy people who are infected often show no symptoms. That makes identifying or controlling an outbreak difficult. So does the fact that symptoms arise four to six weeks after the initial infection. The disease usually makes itself known with a persistent sore throat that is accompanied by low-grade fever and swollen glands or tender lymph nodes. Fatigue or exhaustion are also often present. Additional symptoms include headache, body aches, rash or an enlarged spleen. Some individuals with mono may experience liver inflammation, which can cause jaundice.

The unique combination of disease symptoms is usually adequate to guide a diagnosis. It can be confirmed with blood tests to assess liver function, white blood cell count and the presence of antibodies to the virus. Treatment focuses on managing those symptoms to keep the person comfortable. This begins with plenty of rest, hydration and a healthful diet. Fever, aches and pains can be addressed with acetaminophen or ibuprofen. It's important not to give aspirin to children and teens who have flulike illness, as it has been linked to Reye's syndrome. This is a rare but serious disease that can lead to liver failure, and which can be fatal. Secondary infections sometimes arise in people with mono and must be addressed by a physician. Depending on the severity of the illness, it's possible that the person's spleen may become enlarged. Vigorous activity or contact sports must be avoided for the course of the illness, as there's a risk that the spleen could rupture.

Recovery from mono takes up to a month, and often longer. Even when someone begins to feel better, it's important to take it easy in order to facilitate a full recovery. Someone infected with EBV carries the virus for life, but in a dormant state. Very rarely, the virus can reactivate, which may cause additional symptoms in someone with a weakened immune system. In the vast majority of cases, though, the virus doesn't cause additional problems. The symptoms of mono are similar to other conditions, such as hepatitis and toxoplasmosis, so whenever the disease is suspected, it's important to seek medical care.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.

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