Why is spleen enlarged with mono

Most people recover from mononucleosis mono without any complications. But there are many possible complications of mono. These include:. Other complications of mono can occur but are very rare. While it is not a complication specific to mono, a serious disease known as Reye syndrome can develop if you give aspirin to a person younger than 20 to treat symptoms of mono.

Aspirin should not be used to treat symptoms of mono. Other medicines, such as acetaminophen for example, Tylenol or ibuprofen for example, Advil can help relieve fever and pain caused by mono. Be safe with medicines. Read and follow all instructions on the label. Even if you have a complication of mono, it is likely that you will recover completely. Rhoads MD - Internal Medicine. Author: Healthwise Staff. Medical Review: E. So doctors recommend that teens who have mono avoid contact sports for at least a month after symptoms are gone.

Don't do any strenuous activities until your doctor says it's OK. In most cases, mono symptoms go away in a matter of weeks with plenty of rest and fluids. If they seem to linger or get worse, or if you have any other questions, call your doctor. Larger text size Large text size Regular text size. What Is Mononucleosis? What Causes Mono? These include: fever sore throat with swollen tonsils that may have white patches swollen lymph nodes glands in the neck being very tired A person also can have: headaches sore muscles weakness belly pain with a larger-than-normal liver or spleen an organ in the upper left part of the belly skin rash loss of appetite Is Mono Contagious?

How Is Mono Diagnosed? How Is Mono Treated? How Long Does Mono Last? Can Mono Be Prevented? The cytotoxic T lymphocytes release a multitude of cytokines that cause the classical IM symptoms. Additionally, the T-lymphocyte response produces lymphoid hyperplasia, a marked lymphocytosis, and atypical lymphocytes in a peripheral blood smear. The history and physical examination are pertinent for making the correct diagnosis. The long incubation period makes it difficult to determine the source or onset of IM, yet there is a classic 3- to 5-day prodromal period consisting of malaise, fatigue, and anorexia.

At times, the presentation of IM is much more atypical and can affect many different organ systems. Fatigue and pharyngitis are the most debilitating symptoms and often present as the chief complaint. The posterior cervical lymph nodes are more commonly involved in IM, with axillary and inguinal lymphadenopathy less likely to occur. Often, the signs of IM may be subtle, with the athlete presenting with nothing more than fatigue, lack of energy, or diminished performance.

Other features of IM may include posterior palatine petechiae, jaundice, exudative pharyngitis, rash, and splenomegaly. Posterior palatine petechiae occur in about one third of cases and are highly suggestive of IM.

Exudative pharyngitis and concomitant tonsillar enlargement can cause obstruction of the airway, leading to devastating consequences. The enlargement of the tonsil is due to lymphoid hyperplasia and pharyngeal inflammation. Often mistaken for streptococcal pharyngitis, the clinician must be vigilant for clues of IM such as fatigue, the appropriate age group, or posterior cervical lymphadenopathy.

The rash is transient and generalized with maculopapular, petechial, or urticarial features Figure 1. This is more commonly seen in a patient who has been treated with penicillin in an effort to eradicate a presumed group A Streptococcus infection. This is almost pathognomonic for IM. Other antibiotic classes have been implicated, but the penicillins are the most widely reported to produce this effect.

Rash presenting with infectious mononucleosis. Splenomegaly in IM occurs as a result of lymphocytic infiltration enlarging the spleen beyond protection from the rib cage and creating an organ that is susceptible to rupture either spontaneously or traumatically. Since baseline spleen size measurements on competitive athletes are impractical, serial ultrasound measurements may be employed to determine the course of splenomegaly in IM.

Peak splenic enlargement was typically seen within 2 weeks but, in some, extended to 3. For the majority, splenomegaly resolved in 4 to 6 weeks. The long incubation period and variable nature of the disease can make the task of identifying onset of illness a challenge.

The acute phase of IM can resolve as quickly as 7 days, but usually takes between 2 and 3 weeks from the onset of symptoms. The diagnosis of IM can be made through history and physical examination as well as atypical laboratory findings Table 1. Heterophile antibodies are a characteristic feature of IM. Rapid monospot tests for these heterophile antibodies are used to screen patients for IM. Viral capsid antigen testing is useful for patients who initially had a negative heterophile antibody test.

There is no specific treatment for IM. Supportive therapy is the mainstay of care, which includes adequate rest, hydration, and analgesics. Acetaminophen is appropriate but used judiciously because of potential liver complications, as IM frequently causes elevation in liver function tests. 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.

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. 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.

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. 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. They ought to be afebrile and well hydrated.

Keeping in mind that the highest risk for splenic injury is during the first 21 days of illness, it has not been shown that early return to light activity causes deleterious effects. The return to activities that place the spleen at risk for injury is a confounding matter.

At this time, recommendations vary, and there is a lack of evidence-based protocols. Most recommendations support that the athlete with IM should rest for 3 weeks and then begin resumption of light activity. Ultrasonography may play a role in return-to-play decisions, but the variability in baseline spleen size can limit its utility. Any return to competition must include a detailed explanation of the risk of splenic injury, since full recovery may take months Figure 2.

Return-to-play recommendations for infectious mononucleosis IM. However, specific laboratory tests may be needed to identify the cause of illness in people who do not have a typical case of infectious mononucleosis. The blood work of patients who have infectious mononucleosis due to EBV infection may show—. Skip directly to site content Skip directly to page options Skip directly to A-Z link.

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