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Symptoms

The early symptoms of infectious mononucleosis appear 4 to 6 weeks after exposure to the virus and resemble those of the flu (see page 649), including fever, headache, sore throat, swollen tonsils, and fatigue. Later symptoms may include painful, swollen glands in the neck, armpits, or groin (a condition called lymphadenopathy). Some people may also develop a rash over their entire body. In some cases, mono affects the liver and can cause jaundice (yellowing of the skin and the whites of the eyes; see page 785). If you have mono and you have a feeling of fullness in your upper left abdomen, you may have an enlarged spleen (an organ of the immune system that stores red blood cells and platelets). The symptoms of mono usually go away within 2 to 3 weeks, but you may continue to feel weak for a couple of weeks to several months.

Diagnosis

If you have flulike symptoms that persist for more than a week, especially if you have swollen glands, a sore throat, and fatigue, your doctor will take a detailed health history and order blood tests to check for an increased number of white blood cells (which fight infection) and antibodies (specific proteins the body produces to fight the virus). You may have a test in the doctor’s office (called a mono spot test) that gives immediate results. If the test result is negative but the doctor still thinks you may have mono, he or she will recommend an antibody test to make a definite diagnosis.

Treatment

Because infectious mononucleosis is caused by a virus, doctors do not prescribe antibiotics to treat it. Getting plenty of rest is essential. Your doctor may recommend taking an over-the-counter pain reliever such as ibuprofen or acetaminophen. (Do not give aspirin to a child or adolescent who has a fever from any cause, because aspirin has been linked to Reye’s syndrome, a potentially fatal condition; see page 411.) The doctor also will probably recommend drinking plenty of water, especially while you have a fever. In severe cases, a doctor may prescribe corticosteroids to control swelling in the throat and tonsils. If your spleen is enlarged, your doctor will recommend avoiding any activities that could cause injury, such as contact sports. An injury to your upper left abdomen could cause your spleen to rupture, which can be life-threatening.

Tetanus

Tetanus, also called lockjaw, is a potentially life-threatening infection caused by clostridium bacteria that live in soil. The bacteria can enter the body through a cut in the skin that comes in contact with contaminated soil or through a wound caused by a contaminated object such as a nail or thorn. People who use drugs intravenously and share needles or who get tattoos or body piercings under unsanitary conditions are also at risk of infection. A toxin produced by the bacteria binds to the nerves in the spinal cord that control muscle activity and prevents them from functioning normally.

Symptoms

The symptoms of tetanus appear after an incubation period that can be as short as 3 days or longer than 3 weeks and can include headache, cramping and stiffness in the jaw (lockjaw), a stiff neck, and difficulty swallowing. Later symptoms include painful spasms and stiffness of the muscles in the neck, arms, legs, and stomach. Tetanus can affect the muscles involved in breathing, causing life-threatening breathing problems.

Diagnosis and Treatment

If you have not had a tetanus shot within the past 10 years and you get a puncture wound, call your doctor or your local emergency number, or go to the nearest hospital emergency department to have the wound cleaned and examined to determine the appropriate treatment.

If tetanus develops, you will be hospitalized immediately and given antibiotics and an injection of tetanus antitoxin. You may also be given sedatives (such as benzodiazepines) or muscle relaxants to prevent muscle spasms. You may need a mechanical ventilator to help you breathe. The goal of treatment is to keep