Mono, or infectious mononucleosis, sometimes referred to as ‘kissing disease’ is a viral triad of pharyngitis, fever and cervical lymphadenopathy caused by the epstein-barr virus (EBV) and typically seen in teenagers or...
Mono, or infectious mononucleosis, sometimes referred to as ‘kissing disease’ is a viral triad of pharyngitis, fever and cervical lymphadenopathy caused by the epstein-barr virus (EBV) and typically seen in teenagers or young adults. As many as 50% of college freshmen are susceptible to infection and the annual incidence in that age group is estimated to be between 1-3%. By late adulthood, up to 90% of adults have been infected although many may never develop symptoms.
Case Vignette You are caring for a 16 year old high school athlete with mono. The athlete is anxious to return to play as the playoffs begin next week. Which of the following is considered the best guidance for athletes returning to light, non-contact activities from a mononucleosis infection?
A) Weekly ultrasound until the spleen is less than 7 cm B) 3 weeks from the onset of symptoms C) Until the spleen is no longer palpable D) 6 weeks from the onset of symptoms Transmission primarily occurs through oral secretions, although it can be shared through coughing, sneezing and other forms of close contact. Less commonly, EBV is transmitted through blood, solid organ and/lor hematopoietic cell transplant. In general, the illness is self limited with a long incubation period of 30-50 days which can make contact tracing challenging.
Acutely, patients may endorse a prodrome of fever, headache and malaise. The more classic triad of fever, pharyngitis and lymphadenopathy is only seen in about half of cases. Patients may also have palatal petechiae and a maculopapular truncal rash, especially if exposed to amoxicillin or ampicillin.
Of note, this is not considered an allergic reaction to the medication but an interaction with viral shedding. Splenomegaly is seen in up to 50% of patients and will be discussed in more detail below Less commonly you may see jaundice (especially in older adults), periorbital edema, CNS complications and myocarditis. Diagnosis is primarily clinical but confirmed with a positive heterophile antibody test and supported by a leukocytosis with a predominance of lymphocytes and atypical lymphocytes.
If you are experiencing symptoms that may be related to a brief recap of infectious mononucleosis in athletes, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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