Mono and the Study Abroad Student
July 21, 2010
By Frank Gillingham, MD

Mononucleosis—better known as “mono” or “kissing disease”—is a common viral illness that afflicts thousands of young adults each year. Although usually a benign condition, with symptoms of fever, headache, sore throat, fatigue and swollen lymph nodes—particularly in the neck—mononucleosis can occasionally lead to much more severe problems, and rarely even death, particularly in those with compromised immune systems such as people with HIV/AIDS or those taking drugs to suppress immunity after an organ transplant.

Students abroad seem to be particularly susceptible to contracting mononucleosis. Over the past two months, HTH Worldwide has had two study abroad participants experience severe symptoms of mono. One student developed significant abdominal tenderness with an enlarged spleen and hepatitis (liver inflammation), anemia (a low red blood cell count) and difficulty swallowing. Her condition prompted her transfer from a rural area with marginal medical facilities to an urban hospital, where she did not start improving until given very high doses of steroids. The second patient developed dehydration from an inability to swallow, along with ataxia (loss of coordination) due to inflammation of the cerebellum (the part of the brain responsible for balance).

Indeed, patients with mononucleosis have been diagnosed with a number of other neurological complications, including Guillain-Barre syndrome (loss of motor strength similar to polio), meningitis, encephalitis and seizures. Other rare conditions seen with mononucleosis include pericarditis (inflammation of the lining of the heart), thrombocytopenia (a drop in platelets, the small cells responsible for blood clotting) and airway obstruction due to extraordinary tonsil enlargement. Although some enlargement of the spleen is quite common in mononucleosis—almost fifty percent of all patients who are diagnosed with mono have some splenomegaly—life-threatening splenic rupture may also occur either spontaneously or as a result of minor trauma, in a small number of cases.

Mononucleosis is extremely contagious and seems to have a predilection for groups in close confinement. In addition to kissing, the virus spreads easily from shared drinking glasses and utensils. Rarely, the virus can be contracted from a blood transfusion. Mononucleosis can remain contagious for weeks after the onset of symptoms, or even after most of the symptoms have resolved. Although there is no cure for mononucleosis, symptoms seem to improve with steroids. Other measures that help alleviate symptoms include salt water gargles and anti-inflammatory medications such as acetaminophen (Tylenol) or ibuprofen (Advil). Aspirin should be avoided, as its use has been linked to the development of Reyes syndrome—a liver disorder—particularly in those under 21. Those infected should avoid heavy lifting or contact sports to reduce the risk of injuring the spleen.

The test for mononucleosis is not universally available, and the diagnosis is often missed outside of the United States, so maintain a high index of suspicion if you are a young student heading abroad for studies or leisure.

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About the Author

Frank Gillingham, MD