tired teenager

The effects of a bout with mononucleosis can linger for months afterward, having an impact on other health issues as well. 

Question: My 15-year-old daughter had mono last year. Ever since then she gets sick more often. She gets sore throats that often last three or four days. They seem to be spreading out now, but are still happening. Is this chronic mono? What can I do to make it better?

Answer: Mononucleosis (mono) is a series of symptoms caused by Epstein-Barr virus (EBV). Ninety-five percent of adults have antibodies to this virus, which indicates that they were at some time infected.

The symptoms of EBV include fever, sore throat, sore neck, cough and severe fatigue. A physical exam may reveal swollen lymph nodes, swollen tonsils, an enlarged spleen and a rash. Laboratory tests can confirm the presence of active virus, as well as the antibodies that your body produces to fight off this virus. Other lab tests may show liver dysfunction, anemia and low platelet count. These findings are most common in teenagers and young adults. Mono in young children is typically milder.

Most patients will recover from mono symptoms such as sore throat and swollen lymph nodes within two weeks. Fatigue will usually last six to eight weeks, but has been reported to last for up to a year after infection. For this reason, it is commonly mistaken that EBV causes Chronic Fatigue Syndrome, but there is not an association between the two disorders.

EBV is not your typical cold virus. It is a member of the herpes family and causes a very distinctive immune response in humans. Our bodies launch a major proliferation of specific attack cells called T8 lymphocytes. This T lymphocyte expansion and activation causes lymph node and spleen swelling. This response is a very effective mechanism to force the virus into latency.

A virus that is “latent” is suppressed but not completely dead. When a virus is latent in the body it does not cause any symptoms or any immune response, but it can reactivate when its host becomes immunocompromised. It is reactivation that may be triggering many of your daughter’s symptoms.

After mono infection, we all carry the virus in its dormant state. Studies report that some people experience reactivation of the virus in the form of sore throat, swollen lymph nodes, increased susceptibility to other viruses and fatigue. Reactivation is more common in those who are experiencing other “hits” to the immune system, such as lack of sleep, stress, poor nutrition or lots of germ exposure. Reactivation symptoms will typically resolve on their own and are less severe than the original mono infection. With time this becomes less common, and in most people will eventually resolve entirely.

For all the above reasons it is critical after mono that young people take very good care of themselves. A diet high in antioxidants such as fruits and vegetables, and getting at least eight hours of sleep at night, will boost the immune system and help to prevent reactivation. I find mono to be a vicious cycle because the patient often misses a lot of school and then falls behind. This leads to a lot of catch-up work in the weeks that they are recovering, which forces the student to sacrifice sleep, exercise and healthy meals in exchange for school work. Lack of sleep leads to immune depression, and often leads to another infection such as a cold or flu.

pia fenimore

Dr. Pia Fenimore

For this reason, I will often encourage parents to speak to teachers and guidance counselors on behalf of their child. Request that only critical work be required, and that tutoring or other support mechanisms be put in place to allow the child the catch up at his or her own pace without compromising health.

There is something called Chronic Active EBV infection, which is extremely rare and found mostly in Asian countries. This is when patients who are infected with EBV have a persistently high level of viral DNA and show long-lasting symptoms of mono. These symptoms include chronic fevers, liver dysfunction and swollen lymph nodes. This disorder is very rare. Its cause is not yet known, but is hypothesized to be related to a defect in white blood cells.

Many physicians consider mononucleosis a rite of passage for the growing immune system and, in fact, most of the population experiences this infection. Each person is different in the way that he or she recovers from mono. Dormant virus can reactivate and create small illnesses after the main infection for months or even years afterward. It is important to put priority on sleep, healthy eating, stress management and infection control (wash hands, don't share drinks, etc.) all the time, but especially after this viral infection.