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Dear Dr. Roach: Our 18-year-old has been exposed to mono. Can you provide some information about this disease, including nd dangers of exposure to other family members?

— F.J.M.

Dear F.J.M.: Infectious mononucleosis symptoms can be caused by several viruses and one parasite (toxoplasmosis), but classically, it is caused by Epstein-Barr virus, of the herpes family. Its symptoms can be quite varied.

The cardinal symptoms in mononucleosis are fever; fatigue; a sore, inflamed throat; and enlarged lymph nodes. It is mostly shed by saliva, and infected people are often contagious for six months.

The fatigue is difficult to overstate. In some people, it can be profound, preventing exercise and studying abilities for a few weeks, up to six months. The sore throat and drainage can look like strep throat, and many people are mistakenly given amoxicillin or other antibiotics. This is a problem, because rash is common and not due to allergy to the antibiotic.

The spleen can get very enlarged, as can other lymph organs, especially the lymph nodes in the throat, which occasionally can swell enough to threaten the airway. Fortunately, a rupture of the spleen and acute airway closure are rare complications.

Neurologic complications can include Guillain-Barre syndrome and damage to individual nerves. Hepatitis is more common than most people realize, but it rarely causes serious problems.

Senior citizens are not likely to be at high risk: 90-95% of adults have evidence of immunity in the blood. Immunocompromised people, like people with cancer or HIV, are at high risk from this disease.

Treatment usually is neither given nor effective for mononucleosis. There are a few exceptions: Airway obstruction and severe liver disease are treated with high-dose steroids.

Dear Dr. Roach: Is there an over-the-counter substance or prescription that can keep me from dreaming? My dreams are exhausting.

— Anon.

Dear Anon: Disturbing dreams and nightmares are fairly common, but they are very rarely reported to physicians. Medications, would not be my first recommendation for treatment.

The level of disturbance you describe makes me concerned about nightmare disorder.

The first line of treatment for recurring disturbing dream and for nightmare disorder starts with good sleep hygiene. Get moderate exercise, not before bed; avoid alcohol, caffeine and nicotine, especially before bed; sleep on a consistent schedule; avoid any screensfor an hour or two before bed.

An evaluation for anxiety disorders, by your physician or a mental health professional, might be wise.For the person who may still require medication, prazosin is the one best-studied.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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