Teens with extreme fatigue

As a physician, I sometimes have the job of treating my own family. My son came home from school one day soon after Christmas break with fever, sore throat and swollen lymph nodes. Like a good doctor-dad, I got out my flashlight and looked in his throat. His tonsils were red and swollen and I started him on an antibiotic for a likely strep-throat infection.

The problem is that two weeks later, he was still feeling wiped out, sleeping more than usual (if that can be possible for a teenager). He would come home after school and go to bed, too tired to get his homework done. His grades started to drop. Okay, I thought, something is going on. I began to wonder, is he depressed, working out too hard? What could this be?

I decided to take him to see his doctor. We decided to run some simple blood tests, including a complete blood count, thyroid test, and a Monospot test (used to diagnose infectious mononucleosis, or “Mono”). The Monospot was positive. In many ways, we were relieved to find out there was a reason for the recent changes in him.

What is Mono?

Officially called infectious mononucleosis, this infection is caused by Epstein-Barr virus. Symptoms of mono include: fever, sore throat, fatigue, weakness, swollen glands in your neck and armpits, loss of appetite, and night sweats. The incubation period, which is the time from infection to appearance of symptoms, ranges from four to six weeks. Persons with infectious mononucleosis may be able to spread the infection to others for a period of weeks. After the onset of symptoms, the infection usually resolves on its own within two to six weeks.

Who gets mono?

It is most common in people ages 15 to 35. Younger children can get mono, but symptoms in young children are often mild, while symptoms in adolescents and young adults tend to be more severe.

How is this virus spread?

Mono is not as easily spread as other viruses, such as the common cold. This virus is found in saliva and mucous. Often spread from one person to another through kissing, which is why it is called the “kissing disease”. It can also be spread through a cough or sneeze, or by sharing drinking glasses, forks, spoons, toothbrushes. Because it is a harder virus to catch, no isolation is needed. People with mono can usually work and go to school without restrictions.

How is the diagnosis made?

The diagnosis of infectious mononucleosis is made based on the classic triad of symptoms of fever, sore throat, swollen lymph glands and on the age of the patient. A positive “mono spot” lab test is also needed for confirmation.

How is mono treated?

Get plenty of rest, as sleep helps your body fight infection.  Drinks lots of fluids to stay well hydrated and avoid dehydration. Throat lozenges, popsicles, hard candy or other measures to soothe the sore throat can help.  Acetaminophen (Tylenol), ibuprofen (Advil), or Aleve can be used to relieve sore throat and fever. Avoid aspirin in children, as it can cause a serious condition called Reye’s syndrome. Steroids, such as prednisone, are sometimes prescribed briefly to help decrease throat swelling.

What about playing sports with mono?

The spleen is located in the left upper abdomen, and mono may cause the spleen to swell. If you are hit in the abdomen or lift something heavy, the enlarged spleen may rupture. Severe pain in the upper left part of your belly may mean that your spleen has burst and this is an emergency. A ruptured spleen is serious and requires immediate surgery. To reduce the risk of a ruptured spleen, avoid heavy lifting or contact sports for four weeks after you’ve had mono or until your doctor says it is safe.

By the way, my son is now back to his normal energy level. Thank goodness. Now his challenge is making up for those grades that suffered during his illness.

This article was written by Barry Holdampf, MD, a family practice physician who joined the Scott & White Taylor Clinic in November 2010. He specializes in providing medical care to families, including pediatric and adult patients.

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Teens with extreme fatigue