Infectious mononucleosis is an acute viral infection. It has its peak incidence in adolescents between the ages of 15 and 17, but it commonly affects a much broader range of ages, including preschool and school-age children, although it is rare in children under age two. In adolescents, the incubation period after exposure is estimated as four to seven weeks; the period in younger children is unknown.
WHAT CAUSES INFECTIOUS MONONUCLEOSIS?
It is caused by the Epstein-Barr virus, which multiplies in the lymphocytes, white blood cells that normally play a key role in the immune system's defenses. The virus is transmitted through exchange of saliva.
By adulthood, most people have been exposed to the Epstein-Barr virus, but for unknown reasons, only a small percentage develop mononucleosis. Epstein-Barr virus is a type of herpes virus; other herpes viruses are responsible for chicken pox, cold sores and genital herpes.
WHEN SHOULD I SUSPECT THAT MY CHILD HAS MONONUCLEOSIS?
A child with infectious mononucleosis may develop flulike symptoms, including headache, sore throat, malaise and fatigue, with or without fever. Two to five days later, the acute phase begins; it is characterized by fever and swollen lymph glands in the neck, under the arms and in the groin. The tonsils may swell, making swallowing difficult and painful. In some cases, the tonsils become so enlarged that they obstruct breathing.
IS MEDICAL ATTENTION NECESSARY?
Yes. It is vital for a doctor to diagnose mononucleosis so that the child will receive proper care.
HOW CAN THE PHYSICIAN DIAGNOSE INFECTIOUS MONONUCLEOSIS?
Frequently, the doctor can base the diagnosis on observation of a blood smear under the microscope: The presence of abnormal lymphocytes indicates mononucleosis. Further blood tests are performed, however, to confirm the diagnosis and to determine the extent of liver involvement.
CAN COMPLICATIONS RESULT FROM INFECTIOUS MONONUCLEOSIS?
Yes. If the child develops jaundice (a yellowing of the skin), it may indicate mild liver damage, which occurs in about ten percent of cases. Enlargement of the spleen frequently accompanies mononucleosis, and rupture of the spleen is the most serious potential complication. Anemia may develop late in the disease.
WHAT TREATMENTS ARE AVAILABLE?
No widely available drug is effective against mononucleosis. The standard treatment is usually rest to allow the immune system to recover. The physician will determine the amount of rest required and the extent to which activities must be curtailed on the basis of the severity of the child's symptoms.
Tylenol may help reduce the pain of swollen glands and sore throat, and an anesthetic gargle may relieve throat pain and increase the child's tolerance for eating and drinking. In the presence of severe anemia or tonsils so swollen that they obstruct breathing, the doctor may prescribe a cortico-steroid drug to alleviate these problems.
HOW LONG DOES MONONUCLEOSIS LAST?
The course of mononucleosis varies among individuals. Frequently, the disease goes unrecognized in infants and young children. Some patients experience only a mild form of the disease and recover with moderate amounts of rest, while others require bed rest for several weeks due to continuing severe fatigue. Fever may last about two weeks. Almost everyone recovers wihing four to six weeks, but it can take months before the child feels completely back to normal. Sleepiness, low energy, and depression may persist for two or three additional months. Liver and spleen involvement may take three months to disappear.
CARING FOR A CHILD WITH MONONUCLEOSIS
• Follow the physician's guidelines as to the amount of rest your child needs. Unfortunately, rest is one of the most difficult and frustrating treatments a normally energetic child has to tolerate. Your encouragement and support can go a long way toward making the recovery easier.
• Don't try to speed your child's recovery by encouraging activities too quickly; premature resumption of activities can cause a relapse.
• Swollen tonsils can make swallowing extremely painful, so a child with mononucleosis may have trouble taking in adequate fluids to prevent dehydration. High-calorie liquid supplements, such as Ensure, are appealing, and they have the added bonus of countering the weight loss that occurs as a natural part of the viral infection. Some experimentation will help you find fluids the child can tolerate best; fruit juices, broth and pudding are favorites among many sick children.
• When the child's strength returns and the physician advises resumption of some elements of normal routine, it may be helpful to ease the child back to school by starting with half days.
• Contact sports should be avoided until all traces of the disease have disappeared and the spleen is back to normal size.
GETTING HELP
Call your doctor if your child:
• Develops a high fever and severe sore throat after several days of fatigue and other vague symptoms
