Mystery Mono

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verivin - 12 Jul 2007 18:09 GMT

About 20 years ago I came down with an illness, lasting about 4 weeks,
with these symptoms: fatigue, fever/chills, nausea, loss of appetite,
headache, measles-like skin rash. My liver enzymes were very elevated
(but no jaundice) and a doctor made a preliminary diagnosis (using in-
office testing...not sent out to lab) of hepatitis B. I didn't think
I had been exposed to hepatitis B and asked that a core antibody test
(which I had read was definitive) be done by a lab. It came back
negative. One blood test at the time did register positive for CMV,
but it was back in the normal range when I had another blood test a
year later.

Since that time, every several years I have an attack of some kind of
"glandular fever". I feel terrible, have a sore throat, swollen
glands (under jaw), fever/chills, yet it pretty much disappears within
a week. I've gone to doctors, and each one has diagnosed me as having
mono, and taken blood to be analyzed. By the time I receive the
results (negative for mono) I'm fine again, so there's no further
investigation.

Any ideas on what this recurring glandular fever would be?

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Robert1 - 12 Jul 2007 18:27 GMT

> About 20 years ago I came down with an illness, lasting about 4 weeks,
> with these symptoms: fatigue, fever/chills, nausea, loss of appetite,
[quoted text clipped - 16 lines]
>
> Any ideas on what this recurring glandular fever would be?

There are no in office testing for hepatitis B. I think you have it
mixed up with some other test or condition. There needs to be a panel
of tests involving hepatitis in order to evaluate such results.
Elevated liver enzymes denote liver inflammation and there can be a
variety of conditions that can yield elevated enzymes.
CMV serology can come back as non reactive or no titer present or
positive with antibodies present denoting exposure. The rise in titer
can be diagnostic as a sign of recent exposure.
Any viral infection can cause glands to become swollen.

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verivin - 12 Jul 2007 19:24 GMT

> > About 20 years ago I came down with an illness, lasting about 4 weeks,
> > with these symptoms: fatigue, fever/chills, nausea, loss of appetite,
[quoted text clipped - 28 lines]
>
> - Show quoted text -

No, I definitely asked the doctor who said I had hepatitis B 20 years
ago whether he had sent the hep B surface antibody test out to a lab
or did it in-house, and he said in-house (http://www.medcompare.com/
matrix/1803/Hepatitis-B-Surface-Antibody-Test-Kits.html). I did not
trust the result, so requested that a core antibody test be done and
sent out. It was negative. As to CMV, the titer was 1:2048 at that
time, 1:1024 a year later. Lab report says: "Titers of <1:16
indicate no detectable antibody. Titers of 1:16 or greater are
positive for the antibody."

I'm only saying that I get the same kind of viral infection/outbreak
every 2 or 3 years that involves swollen glands, and each time that I
go to a doctor he/she identifies it as mono. This is always wrong,
but the real cause goes undiagnosed.

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JEDilworth - 13 Jul 2007 03:06 GMT

Twenty years ago the tests for Hep B were NOT being done in office labs.
I know this because I was a laboratory marketing rep from 1985-87. He
may have drawn your blood, but probably sent it out for testing.
However, if your doc is at a big clinic, they may have enough blood work
to perform the testing at the clinic lab. I have never heard of any
testing for this disease that could be done in an office setting.
Hepatitis tests are considered high-complexity tests and should be
performed by qualified laboratory personnel.

http://www.labtestsonline.org/understanding/analytes/hepatitis_b/test.html

This page gives lots of information on all the confusing tests for
hepatitis.

Hard telling what your swollen glands are from. I personally have rarely
seen mono in people older than 25 or so. If this started twenty years
ago you are probably at least in your 30's and may be in your early
40's. You're on the outer edge age-wise for Mono.

http://www.labtestsonline.org/understanding/analytes/mono/test.html

If you get this again, see an infectious disease doctor. Get copies of
all your previous lab tests so you can take them to someone else. You
paid for them and they are yours. Your doc should be able to give you
copies. ID are the ones that can probably make more sense of all of
this. Most regular docs refer to ID when they get lost in the land of
flu-like symptoms with no straight-forward answers.

http://www.cdc.gov/ncidod/diseases/ebv.htm - info on EBV and
Mononucleosis

http://www.cdc.gov/cmv/facts.htm - info on CMV

Judy Dilworth, M.T. (ASCP)
Microbiology

>> > About 20 years ago I came down with an illness, lasting about 4
>> > weeks,
>> > with these symptoms: fatigue, fever/chills, nausea, loss of
>> > appetite,
>> > headache, measles-like skin rash.

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Robert1 - 13 Jul 2007 21:47 GMT

On Jul 12, 7:06 pm, "JEDilworth" <bactit...@nospamhortonsbay.com>
wrote:

> Twenty years ago the tests for Hep B were NOT being done in office labs.
> I know this because I was a laboratory marketing rep from 1985-87. He
[quoted text clipped - 39 lines]
>
> - Show quoted text -

Twenty years ago and present day it is high complexity testing
although pretty much automated at present with an entire AHP acute
hepatitis panel being performed on the Axsym available results within
a little over one-half hour. Back then, I presume radioimmunoassay was
in use for Hepatitis testing. Certainly no office testing and would
really doubt that any small practice groups would even bother to do
low volume testing such as hepatitis.

My guess is that two separate situations with testing sent out for
hepatitis B and office testing with a Monospot.

Infectious disease consultation is a good call as one should have
objective criteria about what is going on rather than simply calling
it glandular fever everytime one gets whatever it is causing it.

I know of people who get seasonal allergic reactions with
lymphadenophy.

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verivin - 14 Jul 2007 14:31 GMT

> I know of people who get seasonal allergic reactions with
> lymphadenophy.- Hide quoted text -

Thanks all. Well, I can't say for sure what that particular doctor
did in or out of his office 20 years ago, but I was apparently given a
false diagnosis. That is, IF a hep B core antibody test is
definitive. As to the "seasonal" aspect of this, ALL of my attacks of
what I call "mystery mono" have been in the summer. And, I have
suffered from food allergies. (For years I developed chronic hives,
now the reactions are less and tend to be an internal, intense
esophagal/stomach pain). The mystery mono has all the classic mono
symptoms, except the period of weakness/tiredness doesn't last much
beyond a week.

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