Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The diagnosis of mono is suspected by the doctor based on the above symptoms and signs. Mono is confirmed by blood tests that may also include tests to exclude other possible causes of the symptoms, such as tests to rule out Strep throat. Early in the course of the mono, blood tests may show an increase in one type of white blood cell (lymphocyte). Some of these increased lymphocytes have an unusual or "atypical" appearance when viewed under a microscope, which suggests mono.
More specific blood tests, such as the monospot
and heterophile antibody tests, can confirm the diagnosis of mono. These tests
rely on the body's immune system to make measurable antibodies against the EBV.
Unfortunately, the antibodies may not become detectable until the second or
third weeks of the illness. A blood chemistry test may reveal abnormalities in
liver function. Diagnostic tests performed in the laboratory may be of value to rule out other causes of sore throat and fever, including cytomegalovirus infection, Strep throat, and less common conditions such as acute
HIV infection or toxoplasmosis.
What is the usual course and treatment of mono?
In most cases of mono, no specific treatment is necessary. The illness is
usually self-limited and passes much the way other common viral illnesses
resolve. Treatment is directed toward the relief of symptoms. Available antiviral drugs have
no significant effect on the overall outcome of mono and may actually prolong
the course of the illness. Occasionally, Strep throat occurs in conjunction
with mono and is best treated with penicillin or erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone). Ampicillin (Omnipen, Polycillin, Principen)
and amoxicillin (Amoxil,
DisperMox, Trimox) should be avoided if there is a possibility of mono since up to 90% of patients with mono
develop a rash when taking these medications. They may then be inappropriately
thought to have an allergy
to penicillin.
For the most part, supportive or
comfort measures are all that is necessary. Acetaminophen (Tylenol) can be given for fever and any headache or body aches. A sufficient amount of sleep and rest is important. The throat soreness is
worst during the first five to seven days of illness and then subsides over the
next seven to 10 days. The swollen, tender lymph nodes generally subside by the third week.
A feeling of fatigue or tiredness may persist for months following the
acute phase of the
illness. It is recommended that patients with mono avoid participation in any contact sports for
three to four weeks after the onset of symptoms to prevent trauma to the enlarged spleen. The enlarged spleen is susceptible to rupture, which can be life threatening. Cortisone medication is
occasionally given for the treatment of severely swollen tonsils or throat
tissues which threaten to obstruct breathing.
Patients can continue to
have virus particles present in their saliva for as long as 18 months after the
initial infection. When symptoms persist for more than six months, the
condition is frequently called "chronic" EBV infection. However, laboratory
tests generally cannot confirm continued active EBV infection in people with
"chronic" EBV infection.
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Most sore throats are caused by viruses or mechanical causes (such as mouth breathing) and can be treated successfully at home. However, a person should be seen by a health care professional if they have a sore throat that has a rapid onset, and is associated with a fever or tenderness of the front of the neck; a sore throat that causes the person to have difficulty swallowing (not just pain swallowing) or breathing; or if a sore throat lasts for more than a week.
Strep throat is a sore throat caused by a bacterium called streptococcus (strep) that can be treated through antibiotics. Common symptoms of strep throat include pinkeye, runny nose, skin rash, cough, hoarseness, diarrhea and more. Complications of untreated strep throat include middle ear infections, meningitis, pneumonia, rheumatic fever, and more.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
An upper respiratory infection is a contagious infection of the structures of the upper respiratory tract, which includes the sinuses, nasal passages, pharynx, and larynx. Common causes of an upper respiratory infection include bacteria and viruses such as rhinoviruses, group A streptococci, influenza, respiratory syncytial, whooping cough, diphtheria, and Epstein-Barre. Examples of symptoms of upper respiratory infection include sneezing, sore throat, cough, fever, and nasal congestion. Treatment of upper respiratory infection are generally with OTC medication and home remedies.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
The spleen enlarges if it is asked to do excessive work in filtering or manufacturing blood cells, if there is abnormal blood flow to it, or if it is invaded with abnormal cells or deposits. Symptoms of an enlarged spleen may include weakness and fatigue, easy bleeding, and poor white blood cell function. Treatment of an enlarged spleen is focused toward the cause of the splenomegaly. Surgery may be required to remove the spleen.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Neuropathic pain is chronic pain resulting from injury to the nervous system. The injury can be to the central nervous system (brain and spinal cord) or the peripheral nervous system (nerves outside the brain and spinal cord).
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Children's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health and community health.
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