The University of Georgia’s Dr. Mark Ebell was not impressed with research on infectious mononucleosis when he wrote his first published review on it back in the 1990s. He still is not — a subject he discusses in the April issue of the Journal of the American Medical Association.
[Photo: Dr. Mark Ebell]
Early diagnosis of mono is key in expediting proper treatment, said Dr. Ebell, a professor of epidemiology in the College of Public Health. When mono patients present with enlarged tonsils and swollen glands, many physicians assume the issue is strep throat and prescribe antibiotics, the preferred treatment for bacterial strep infection but completely useless against viral mono.
The over-prescription of antibiotics has important detrimental effects, he explained.
“By overusing antibiotics, we increase resistance of bacteria to antibiotics,” he said. “We waste money. We sometimes cause very serious adverse effects like allergic reactions or Clostridium difficile infection,” the latter being a bacterial overgrowth that causes severe diarrhea.
In addition to preventing the prescription of useless antibiotics, Dr. Ebell also wanted this study to inform the prognosis and recommendations given to patients after diagnosis.
Mono patients should expect to have persistent symptoms of the virus for three to four weeks, possibly longer, Dr. Ebell said. Patients should not expect to get out and play contact sports any time soon, as the virus enlarges the spleen and puts it at risk of rupturing.
In the 1990s, when Dr. Ebell first published on mono, “what I was struck by then was how limited the research was on what is really a fairly common problem, especially among adolescents and young adults,” he explained. “So I wanted to revisit that area and see if the research had improved over the past 20 years.”
To determine whether that was the case, Dr. Ebell and his colleagues in the department of epidemiology and biostatistics set out to systematically review studies involving the clinical diagnosis of mono. The goal was to determine how clinicians can best use the presence of signs or symptoms of the illness and white blood cell counts to diagnose mono.
They found that the best predictors of mono were swollen posterior cervical or axillary lymph nodes, fatigue, and enlarged spleen, as well as the percentage of a patient’s white blood cells that are lymphocytes or atypical lymphocytes. Having more than 50 percent lymphocytes or 10 percent atypical lymphocytes greatly increased the likelihood of mono.