Can young athletes return to play after infectious mononucleosis?
Returning to play after injury or illness can be a tricky situation, especially following certain illnesses, like Infectious Mononucleosis (“mono”). I thought I would discuss mono as a disease and how it particularly affects young athletes. What is Infectious Mononucleosis and how does a teen get it?
What is the treatment for mono?
Treatment consists of bed rest, PLENTY of fluids, warm water and salt gargles for sore throat, and a well balanced diet. Sometimes strep throat can coincide with mono and should be treated with the appropriate antibiotics. What are the complications from mono, particularly involving the young athlete?
What should I do if my teen or young adult has mono?
Call the healthcare provider if your teen or young adult has: Infectious mononucleosis (mono) is often caused by the Epstein-Barr virus (EBV). It may also be caused by cytomegalovirus (CMV). Mono is most often spread by contact with infected spit (saliva).
What happens if you play sports with mono?
The danger is that, especially during contact sports, the spleen might rupture and cause severe blood loss, sometimes occurring after a significant hit to the chest or stomach. The risk of spleen rupture is highest during the first 3 weeks after a teen gets mono. When should a young athlete return to play after being infected with mono?
What happens if you have mono and play sports?
Along with extreme fatigue, sore throat, fever and swollen glands, "mono" causes spleen enlargement. That can be dangerous for athletes because the impacts and pressure on the abdomen that occur during many sports can cause the spleen to burst.
How do you treat mono in a teenager?
How is mono treated in a teen or young adult?Get lots of rest.Drink plenty of fluids to stay hydrated.Take over-the-counter medicine for fever and discomfort.
How long do you need to be out of sports with mono?
For athletes, the key issue with mononucleosis is the risk of a ruptured spleen if the athlete returns to sports activity too soon. Return to sport requires a minimum of 3 to 4 weeks after the start of the illness. (Dr. Dev K.
Why should you avoid contact sports with mono?
Because your spleen may become enlarged as a result of infectious mononucleosis, you should avoid contact sports until you fully recover. Participating in contact sports can be strenuous and may cause the spleen to rupture.
What helps mono go away faster?
Home remediesStay hydrated. Drink plenty of water, fruit juice, herbal tea, soup, and broth. ... Over-the-counter (OTC) medications. Use OTC pain relievers to help bring down a fever and ease headaches and muscle aches. ... Throat gargles. ... Cool down a fever. ... Rest. ... Boost your immune system. ... Supplements.
Can you exercise with mono?
Typically, a mono patient should not return to strenuous exercise or contact sports for a minimum of one, and sometimes two, months. Regardless, sports should not be resumed until cleared by the medical provider.
Under what conditions can an athlete with mono return to participation?
There is general consensus that the athlete must be asymptomatic with resolution of symptoms such as fever, fatigue, and pharyngitis before they initiate any return to activity.
Can you lift weights with mononucleosis?
You should avoid heavy lifting and any kind of jarring activity or contact sport for about 1 month. If your spleen is enlarged from the mono, it could rupture if it is hit or strained. A rupture of the spleen causes severe bleeding and is a medical emergency.
What are the four stages of mono?
Stages of MonoThe prodrome stage. Mono infection occurs in three stages. ... The acute phase. The acute phase, which can last for 2 to 6 days, is when the symptoms begin to worsen. ... The convalescent stage. The last stage is the convalescent or recovery stage, which can last from 2 to 6 months.
Should you take steroids for mono?
Symptom relief and rest are common treatments. Doctors commonly use prednisone, a steroid, to reduce the symptoms of sore throat or enlarged tonsils. However, there is no agreement on its use due to the possibility of little benefit and the chance of side effects.
Can you play sport with glandular fever?
People with glandular fever should avoid contact sports, vigorous activities and heavy lifting while unwell to reduce the risk of rupturing their spleen. Most people recover from glandular fever after a week or 2, but in some people tiredness and swollen lymph nodes can persist for several weeks.
What causes mono flare ups?
But rarely, mononucleosis symptoms may recur months or even years later. Most cases of mononucleosis are caused by infection with the Epstein-Barr virus (EBV). Once you're infected with EBV, you carry the virus — usually in a dormant state — for the rest of your life. Sometimes, however, the virus may reactivate.
How is Mononucleosis Diagnosed?
Infectious mononucleosis is usually a clinical diagnosis and based on the symptoms of the athlete. In cases where its unclear if that athlete has mononucleosis, blood tests can be done to look for acute infection due to Epstein-Barr or the presence of heterophile antibodies.
How long after mononucleosis can you exercise?
Updated mononucleosis and sports participation recommendations now allow for light physical activity starting two weeks after diagnosis. It’s also recommended to evaluate the athlete for splenomegaly (enlarged spleen) based on physical exam and ultrasound.
What is the common viral infection in high school?
Mononucleosis (mono) is a common viral infection in high school and college students that can present with fever, body aches, fatigue, rash and respiratory symptoms. In rare causes of mononucleosis, there can be airway compromise due to pharyngeal or tonsillar swelling, cardiac complications, or enlargement of the spleen.
What is the cause of mononucleosis?
Most cases of infectious mononucleosis are caused by infection with the Epstein-Barr virus (EBV), which is a member of the herpes virus family. However other viruses such as cytomegalovirus (CMV), toxoplasmosis gondii infection, adenovirus.
What is the consensus statement on mononucleosis?
The American Medical Society of Sports Medicine had released their 2009 consensus statement, “ Mononucleosis and Athletic Participation: An Evidence-Based Subject Review “. The article discusses mononucleosis and sports participation risks with recommendations for the return-to-play of athletes suffering from mononucleosis.
Can mononucleosis cause sports?
Mononucleosis and Sports Participation. Infectious mononucleosis can limit athletic participation due to the risk of splenic rupture that occurs in a very small number of patients (thought to be less than 0.5% incident). The increased risk of rupture is due to enlargement of the spleen during the infection and typically athletes are held out ...
How does a teen get infectious mononucleosis?
It is spread by saliva and teens can acquire the disease by kissing, or by drinking from the glass or straw of an infected person.
How to treat strep throat with mono?
Sometimes strep throat can coincide with mono and should be treated with the appropriate antibiotics.
How long after illness can you play?
For more on general guidelines for return to play after illness click HERE. Most schools with a policy for return-to-play after mono state that 4 weeks following illness is an adequate amount of time for most athletes. The risk of spleen rupture is highest ...
What are the factors that determine a player's return to play after mono?
The primary factors playing a role in the decision to return to play are: extreme fatigue, the presence of an enlarged spleen, the risk of spleen rupture, and the resolution of the acute illness.
Can mono cause blood loss?
The danger is that, especially during contact sports, the spleen might rupture and cause severe blood loss, sometimes occurring after a significant hit to the chest or stomach. The risk of spleen rupture is highest during the first 3 weeks after a teen gets mono.
Can you have a palpable spleen after mono?
Athletes should have no palpable spleen and measurements can be followed by ultrasound or CT scan. All young athletes should be “cleared” by a physician before returning to play after mono.
How Is Mono Treated?
There is no cure for mono. The virus eventually goes away, but it can take a few weeks.
What tests can show if you have mono?
A monospot, which confirms that you've got mono. Blood tests that look for EBV antibodies and liver function tests can also help with a diagnosis of mono. A CBC (complete blood count) will show if your lymphocytes, a type of white blood cell, show certain changes that may be a sign of mono.
How Do I Know if I've Got Mono?
Sometimes you can have mono and not even know it. Young kids usually have pretty mild symptoms. But teens can have more severe symptoms.
How long does mono last?
Symptoms of mono can linger for weeks or even months. If you don’t feel better in a few weeks, you'll need to go back to the doctor. Even when you feel better, you will still need to avoid strenuous activity for about a month. Your spleen needs this time to heal.
What happens when you kiss someone with mono?
If you have mono and share saliva, you are sharing the virus, too. Kissing or having sex with someone with mono makes you more likely to get the infection.
What are the complications of mononucleosis?
Other rare complications are: Brain infections such as encephalitis or meningitis. Liver swelling. Swelling of the testes in boys ( orchitis) If you have a weakened immune system, you are more likely to have severe mononucleosis. Certain diseases and medicines can weaken the immune system.
Is mononucleosis contagious?
Here are some quick facts about mononucleosis. It's an infection caused by a virus (the Epstein-Barr virus or EBV ). Mono is very common in teens. Mononucleosis is contagious! If you've got mono, you can spread it to others.
What to take for mono?
For fever and achiness, you can take acetaminophen (marketed as Tylenol, Datril and others) or ibuprofen (marketed as Advil, Motrin, Nuprin, and others). If you're under 20, don't take aspirin unless your doctor approves it. In children and teens, aspirin taken for viral illnesses has been associated with the potentially fatal disease Reye syndrome. Sometimes a person with mono may have trouble breathing because of swelling in the throat, and doctors have to use other medications and treatment. A person who has mono -- or those caring for the person -- should contact a doctor immediately if the person starts having breathing problems.
How does mono affect you?
Missed parties. Postponed exams. Sitting out a season of team sports. And loneliness. These are a few of the ways that scourge of high school and college students known as " mono " can affect your life.
What are the two viruses that cause mono?
Two viruses can cause mono: Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Both viruses are in the herpes family, whose other members include viruses responsible for cold sores and chickenpox. EBV causes 85 percent of mono cases.
How is mono transmitted?
Here's how. Mono is usually transmitted though saliva and mucus--which is where the "kissing disease" nickname comes from . But the kissing or close contact that transmits the disease doesn't happen right before you get sick.
Why does mono cause breathing problems?
Sometimes a person with mono may have trouble breathing because of swelling in the throat, and doctors have to use other medications and treatment. A person who has mono -- or those caring for the person -- should contact a doctor immediately if the person starts having breathing problems.
How common is mononucleosis?
The disease whose medical name is infectious mononucleosis is most common in people 10 to 35 years old, with its peak incidence in those 15 to 17 years old. Only 50 people out of 100,000 in the general population get mono, but it strikes as many as 2 out of 1,000 teens and twenty-somethings, especially those in high school, college, ...
What is the temperature of mono?
Another common mono symptom is fever. A temperature as high as 39.5 degrees Celsius (103 degrees Fahrenheit) is not uncommon. Other symptoms include a tired achy feeling, appetite loss, white patches on the back of the throat, and tonsillitis.
What does mononucleosis mean for young people?
For young people, having mononucleosis will mean some missed activities — classes, team practices and parties. Without a doubt, you'll need to take it easy for a while. Students need to let their schools know they are recovering from mononucleosis and may need special considerations to keep up with their work.
What to do if you suspect mononucleosis?
If you suspect you have mononucleosis, see your family doctor. Here's some information to help you get ready for your appointment and know what to expect from your doctor.
How long does it take to recover from mononucleosis?
Wait to return to sports and some other activities. Most signs and symptoms of mononucleosis ease within a few weeks, but it may be two to three months before you feel completely normal. The more rest you get, the sooner you should recover. Returning to your usual schedule too soon can increase the risk of a relapse.
How do you know if you have mononucleosis?
Your doctor may suspect mononucleosis based on your signs and symptoms, how long they've lasted, and a physical exam. He or she will look for signs such as swollen lymph nodes, tonsils, liver or spleen, and consider how these signs relate to the symptoms you describe.
What test is done to check for Epstein-Barr?
Antibody tests. If there's a need for additional confirmation, a monospot test may be done to check your blood for antibodies to the Epstein-Barr virus. This screening test gives results within a day. But it may not detect the infection during the first week of the illness.
What is the treatment for narrowing of the airway?
Severe narrowing of your airway may be treated with corticosteroids.
Can a streptococcal infection go with mononucleosis?
Treating secondary infections and other complications. A streptococcal (strep) infection sometimes goes along with the sore throat of mononucleosis. You may also develop a sinus infection or an infection of your tonsils (tonsillitis). If so, you may need treatment with antibiotics for these accompanying bacterial infections.
Why do athletes with infectious mononucleosis need to be individualized?
Return-to-play decisions for the athlete with infectious mononucleosis need to be individualized because of the variable disease course and lack of evidence-based guidelines.
What is infectious mononucleosis?
Infectious mononucleosis is a disease primarily of adolescence and early adulthood. The risk of splenic injury and chronic fatigue make return-to-play decisions a challenge for the clinician caring for athletes with infectious mononucleosis.
How to treat IM?
There is no specific treatment for IM. Supportive therapy is the mainstay of care, which includes adequate rest, hydration, and analgesics.14,20,33Over-the-counter pain medication, such as anti-inflammatories, is generally sufficient to manage the myalgias and pharyngitis. Acetaminophen is appropriate but used judiciously because of potential liver complications, as IM frequently causes elevation in liver function tests.15Aspirin should be avoided because of bleeding risks and an association of IM with Reye syndrome in children.14,33There is no role for antivirals or antibiotics.14,15,20,34Despite the fatigue, there is no role for strict bed rest. For patients with a quick recovery of symptoms, a return to light exercise in as little as 2 weeks from the onset of illness may provide a benefit. Close follow-up is recommended to ensure resolution of all symptoms as the athlete may risk progression to more chronic symptoms, specifically fatigue.20,46
Is isolation necessary for EBV?
Transmission is by close contact via saliva, so isolation is not necessary. Common sense precautions such as hand washing and not sharing water bottles are typically adequate. Unfortunately, the long incubation period can confound efforts to prevent infecting others.17,34Current advances are being made to develop an EBV vaccine. In a phase 2 trial, vaccine recipients were less likely to have symptoms of IM during primary EBV infection compared with those who were not vaccinated.38However, the recipients were not protected against acquiring EBV.38
Do corticosteroids help with IM?
The role of corticosteroids in the treatment of IM is of interest but there is insufficient evidence to recommend their use in uncomplicated IM. There does not appear to be any improvement in duration of symptoms or progression to chronic symptoms.4,44In spite of this, a significant number of patients are given corticosteroids for symptom control in the absence of the complications of IM.41There is general consensus that corticosteroids do have a role when there is airway obstruction as a result of laryngeal edema.4,33,41Other severe complications of IM warranting corticosteroid treatment include hepatitis, myocarditis, or hematologic abnormalities.4,33,41Risks and benefits must be weighed, as the adverse effects of corticosteroids in IM may include infection or even femoral head necrosis.4,14,20,41
Can an athlete return to play after IM?
The question of when an athlete can return to play following contraction of infectious mononucleosis (IM) is complex because of the serious complication of splenic rupture.1,43Splenic injury is rare but may occur spontaneously or with modest abdominal trauma.26,32Protecting the athlete from splenic rupture should be at the forefront when making return-to-play decisions. The natural progression of splenic enlargement can be unpredictable, and splenic dimensions vary with body size and type so the role for ultrasonography is unclear. IM also carries the risk of persistent or chronic symptoms, most notably fatigue, as well as neurologic, hematologic, cardiac, and respiratory complications.1,14The variable presentations and course of this disease pose a challenge for physicians, as evidence-based protocols for return to competition are lacking. Therefore, decisions regarding athletic participation should be made on an individual basis.
What is Mono?
The term mono actually refers to a group of viruses, says Rebekah Diamond, MD, a pediatric hospitalist in New York City and Assistant Professor of Pediatrics at Columbia University. “It’s an old term that describes a group of viruses with similar symptoms and laboratory findings.
How It Spreads
Mono is typically spread through saliva, which is why it earned its nickname “the kissing disease.” But kissing is not the only way teens can catch the virus.
Symptoms of Mono
When symptoms do appear, they can be tough for teens. “The classic presentation of mono is fevers, sore throat, and swollen lymph nodes and/or tonsils. Throat pain and swelling can be significant so some kids have trouble drinking and eating,” says Dr. Diamond. “Many people also experience a lot of fatigue and this can be pretty long lasting.
Diagnosis and Treatment
If you visit your teen’s pediatrician with a suspicion of mono, a simple blood test can confirm the diagnosis. 2 From there, since mono is a virus (and not a bacterial infection like strep throat that can be treated with antibiotics), treatment is supportive.
When to Go Back to the Doctor
After your child’s initial diagnosis, there are two situations in which you may want to give the pediatrician another call. “Any new symptoms are always something to tell them about, and any symptom that was getting better (like fever) but starts to come back should be looked into,” Dr. Diamond says.