Talk:Infectious mononucleosis

There's a few facts I wanted to clarify (meaning I wasn't clear). By way of preamble, I'm not anywhere near an MD - I wanted to make sure the article's clear on any ambiguities in knowledge, but defer to those who know.

• The CDC page linked in the article seems to say that cytomegalovirus does not cause mono. Is this a fuzzy definition, i.e. some people define mono to include cytomegalovirus, while others don't? (Or did I just misinterpret)
• Similarly, the CDC page seemed to say that the mono spot test is specific to EBV, and can distinguish from other causes. Here's a quote: "When 'mono spot' or heterophile test results are negative, additional laboratory testing may be needed to differentiate EBV infections from a mononucleosis-like illness induced by cytomegalovirus, adenovirus, or Toxoplasma gondii." This implies that mono spots are normally negative for e.g. cytomegalovirus infections. My interpretation is that the mono spot is specific to EBV, but may have false positives/negatives for largely unknown reasons (yes, this is maybe a matter of perspective)
• The aspirin thing. It's maybe safer to just discourage people, but it seems like many places I looked (including webmd.com, which gives a medical dictionary entry) recommended aspirin, without mentioning the possibility of Reye's disease, and in lists of viral infection thought to be implicated in Reye's disease, only some web pages or academic paper abstracts mentioned EBV in the list. Is anyone more knowledgeable about the medical community's current understanding of EBV and Reye's?

--user:Zashaw

The relationship between Infectious mononucleosis and the diseases that cause it seems to be vague at best. A quick search showed a lot of contradictory information. I will attempt to look into it more throughly at a later date.

--user:Elfan

This is quite a good question, and one which I frequently educate medical students and residents on. The thing which makes mono "mono" is the clinical syndrome (sore throat, swollen "glands", and fatigue) plus the increase in lymphocytes and "atypical lymphocytes". This syndrome can be caused by both EBV and Cytomegalovirus. The specific virus in each case is usually not identified, but is by far more likely to be EBV. CMV Mono has slightly different characteristics (specifically re the severity of the sore throat) but is still "mono". Both EBV and CMV trigger a positive monospot test. The monospot is indirect evidence for one of these viruses; it relies on the fact that these (and unfortunately some other) viruses lead to the production of so-called "heterophile" antibodies, which cause red blood cells of other species to agglutinate. The confusion is added to by the fact that these viruses can cause other illnesses besides mono, and the presence of one of these viruses in situations where "mono" per se is not present is one of the possible causes of a false-positive monospot test. When the monospot test is negative in a patient whose picture looks like "mono", specific tests for the presence of antibodies to EBV and CMV should be performed. The aspirin warning kind of spooked me, since I routinely advise against acetaminophen in mono patients, since both mono and APAP can lead to liver toxicity. I found a few references including mono among the illnesses associated with aspirin use and Reyes, and I now suggest Ibuprofen or mild narcotics.Sfahey 20:32, 9 Nov 2004 (UTC)

Little to add 'cept the difficulty with nomenclature is because "mono" was named long before individual viruses were identified, or even known to exist. I agree with sfahey's explanation above, as do most physicians trained in the 20th century, but if the purists at the CDC are trying to make "mono" only the ebv version, this may eventually take hold. personally i think that, as with "pneumonia", "tonsillitis", and a myriad of other illnesses, there should be no problem with a disease or syndrome having both a clinical (signs, symptoms, lab/xray findings, and course) and a microbiological name. srf,md (usa)

I'm interested in the statement, "About 6% of people who have had mono will relapse," and wish it had been supported by a reference. Anyone know of any studies of the prevelance and course of mono relapse?Meg365@aol.com 15:26, 8 Jan 2005 (UTC)

I can't find any information to corroborate the statement that "Acetaminophen must also be used with caution, as it may worsen the hepatitis which often accompanies mononucleosis." --User:cbarrett

It has been suggested that since mono causes hepatitis and APAP is both metabolized by the liver and causes liver toxicity in (very) large doses, that caution is advised. I found only one report, from the (US) Southern Medical Journal, of APAP toxicity with Mono occurring. I originally put this item in the article, and as it is a VERY unlikely possibility given the mildness of the hepatitis usually seen with Mono, have no problem with it being removed. Sfahey 02:53, 27 Feb 2005 (UTC)

edit help needed

in the drug interactions section, someone "block" highlighted the subsections, but the * (which codes for the "block" symbol) remains as a * for amoxicillin. either none or all four little subsections should be so-highlighted. Sfahey 01:45, 26 May 2005 (UTC)

It'd just lost the line break some few edits ago. A * only codes for the bullet point followin a line-break I guess. I thought that para seemed non-sensical at the time, but hadn't clicked that the * meant it was supposed to be a different point.

NB: Thanks for your intelligent contributions on this talk page. It has provided some more subtle shades of information not on the front page. Limegreen 05:01, 28 May 2005 (UTC)

duration worth mentioning?

i thought this might be worth mentioning. I got mono from my girlfriend 15 months after she got over it. nothing about our kissing really changed over that time, and we had been together 14 of those 15 months. my doctor did some reading and found out it could lay dormant for up to 18 months after it had gotten to someone. he thought i had strep until that test came back neg - threw him for a loop. i'm not an MD so i don't want to contribute inaccurate / poorly stated info, but i thought this might be useful for people to know --Duozmo

How many "subtypes" of the virus are identified ?

213.6.141.37 21:13, 17 December 2005 (UTC)

Contagion

Just out of curiosity, why does it say "contrary to popular belief, it is non-contagious", then immediately following this line says, "...it is also easily spread..."? Sounds rather contradictory in my opinion. Also, is there any documented proof that explains how contagious this virus really is? --user:AWDRacer

Perhaps whoever wrote that forgot that skin- or mucosa-related transmission is also contagion. Feel free to change this, WP:BB. JFW | T@lk 08:13, 30 January 2006 (UTC)

Non-functional reference

The link to the UoM research about using antiviral therapy on mono is no longer functional and I haven't been able to find a replacement so far. Since I have mono right now (hey, what do you know!) I cannot think clearly, so if anyone feels like it, either help me find a better reference or perhaps quarantine this part of the article. Emp² 20:48, 21 June 2006 (UTC)

I found an article on the UMinn Health Center website that describes this research study; the principle investigator seems to be Henry Balfour. Here is the link:

http://www.ahc.umn.edu/news/releases/mono121905/home.html