When a big serve isn’t enough

Saturday, March 8, 2008

When the performance of an elite athlete falls off, speculation about the demise of their skills runs rampant. Roger Federer, undefeated in forever, loses in the Australian Open semis and then once more in the opening round in Dubai. His game is sluggish and the analysts suggest that he’s finished. Sometimes the answer isn’t a lack of focus or lax training; it’s in the lab.. Mr. Federer has succumbed to infectious mononucleosis, the kissing disease.

Infectious mono is caused by the Epstein Barr virus and most commonly affects teenagers and young adults. The virus causes inflammation of the lymph tissue in the body like the tonsils, the glands in the neck and the spleen. This causes the most common symptoms of fever, severe sore throat, swollen glands and an enlarged spleen. The liver can become inflamed and the bone marrow can get tired and not make enough platelets.

The disease spreads from person to person, often by saliva (where it gets its street name of the kissing disease) but that also includes using poorly cleaned kitchen utensils or from exposure to coughs and sneezes. It takes a while for the virus to incubate in the body and cause symptoms, sometimes a month or two, so it’s hard to sort out where or when the exposure occurred and who gave what to whom.

There is only so much energy in the body and when the body uses it to fight this infection, there isn’t much left to do daily activities, let alone perform as an elite athlete. Since it’s a viral infection, the care is supportive. Often, people are so tired, that they sleep many hours every day.

The key to treatment is prevention of complications. In mono, the spleen, located on the left side of the abdomen high under the ribs, can enlarge enough to grow beyond the protective border of the ribs and is at risk for injury and rupture. Return to activities that can cause abdominal injury may take weeks until the spleen return to its normal size.

With high fever, dehydration is always an issue, especially when a major sore throat makes it hard to swallow. Pushing fluids is painful but important. Sometimes, a short course of the steroid, prednisone can decrease the inflammation enough to help. Antibiotics don’t work, since it’s a virus infection and should amoxicillin be prescribed a classic red rash occurs that is one way to help make the diagnosis. The real way to diagnose mono is with a blood test, but don’t be in a rush. Testing too early in the disease may yield a false negative result.

The tough part of infectious mononucleosis is the time to recover. It’s measured in weeks instead of days. For college students, mono may mean a lost semester. For elite athletes it may mean the better part of a season. And for Roger Federer, it means an explanation for his tennis.

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