Jason is a sixteen year old high school football player admitted to the hospital with fever, sore throat and dehydration and diagnosed with mono. The first thing I hear on the day of discharge from most young athletes is “When can I go back to play?” 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?

Infectious mononucleosis, or “mono,” is sometimes referred to as the “kissing disease.” 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. The illness is mostly caused by the Ebstein-Barr virus, and while it can occur at any age, the peak incidence is between ages fifteen and thirty.

What are the symptoms of mono?

Symptoms of mono include

  • Fever (usually above 101 degrees) and chills
  • Sore throat
  • Fatigue
  • Enlarged lymph nodes, especially around the neck
  • Lack of appetite
  • Achiness
  • Enlarged spleen

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?

The most severe and important complication has to do with the enlarged spleen which happens in about 50% of patients with mono. The spleen is an organ which contains an enormous amount of red blood cells, and while it’s normally protected from injury by the rib cage, it can be exposed when enlarged. 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?

Guidelines for return-to-play after mono can be tricky and have been controversial in the past. Many athletic programs, especlally at the college level, have policies regarding safe and timely 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. Athletes should have no fever, have enough energy and always return to play gradually. 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 during the second and third weeks after illness. 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.

What are the signs of a spleen rupture?

Young athletes who suffer from a spleen rupture will have abdominal pain, a tender mass on the left upper side of the abdomen (stomach area), and sometimes pain on the left shoulder. If a young athlete has these symptoms, he or she should be immediately transported to the nearest hospital, and keep in mind the spleen can rupture spontaneously (without a hit or other trauma).

Explaining to a young athletes the potential risk of lifelong injury from a ruptured spleen is important in helping them understand the need for a slow and gradual return-to-play after mono. For more information, go to Guidelines for return to play.

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