Guest guest Posted March 10, 2004 Report Share Posted March 10, 2004 > The doc said that if he still has swollen glands two weeks from now > he would recommend a low dose short course of steroids (like what > they use in asthma). Using steroids is problematic. Besides the toxicity, it generally treats the symptom, but doesn't resolve the problem. If your doctor can't figure it out, I recommend finding another doctor who is interested in discovering the source of the problem. Lynne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2004 Report Share Posted March 10, 2004 A further drawback to steroids is that they impair immunity. If the child has an underlying, possibly already chronic infection, then steroids will exacerbate the problems (perhaps after a very short period of pseudo-improvement). That he has ear tubes suggests an ongoing inflammation that could be viral and/or bacterial and/or related to food allergies (via the gut-ear links within the common mucosal immune system). He may have an acquired or genetic problem with glutathione, thereby allowing chronic infections and otitis to linger (1). Getting a herpes virus panel may be instructive, esp since most cases of mono have an underlying, not fully immunosuppressed EBV as the etiologic agent 2a-8). Soon after the blood is drawn for the viral panel, Valtrex might be helpful because it helps knock down many strains of EBV. Mention to the physician the mono can occur in young'uns: " A case of infectious mononucleosis (IM) in a two-year-old patient is presented. The clinical presentation and diagnosis of IM in young children are discussed. " (8) 1: Laryngoscope. 2001 Aug;111(8):1486-9. Management of chronic otitis media with effusion: the role of glutathione. Testa B, Testa D, Mesolella M, D'Errico G, Tricarico D, Motta G. Department of Otolaryngology-Second University School of Medicine of Naples, Italy. BACKGROUND: The inflammatory cells documented in chronic otitis media with effusion (OME) spontaneously release oxidants which can induce middle ear (ME) epithelial cell damage. Glutathione (GSH), a major extracellular antioxidant in humans, plays a central role in antioxidant defense. PURPOSE: To evaluate the effects of GSH treatment on chronic otitis media with effusion (OME). SUBJECTS AND INTERVENTION: Sixty children with chronic OME were enrolled, 30 of whom were randomly assigned to the treatment group and 30 to the placebo group. Patients in the treatment group received 600 mg glutathione in 4 mL saline per day subdivided into five 2-minute administrations given by nasal aerosol every 3 or 4 waking hours for 2 weeks. Patients in the control group received 4 mL saline per day following the same procedure as for GSH treatment. RESULTS: Three months after therapy improvement had occurred in 66.6% of patients in the GSH-treated group and in 8% of the control subjects (P <.01). CONCLUSION: On the basis of these results, GSH treatment could be considered for the nonsurgical management of chronic OME. Publication Types: Clinical Trial Randomized Controlled Trial PMID: 11568588 [PubMed - indexed for MEDLINE] 2a: Clin Otolaryngol. 2001 Feb;26(1):3-8. Epstein-Barr virus infectious mononucleosis. Papesch M, Watkins R. Department of Otolaryngology/Head and Neck Surgery, Whipps Cross Hospital, Paddington, London, UK. The Epstein-Barr virus (EBV) is the aetiological agent of classical infectious mononucleosis. This review article describes the antigenicity of the virus, the specific antibody response and the stimulated polyclonal heterophile antibody production in the host. The diagnostic tests for EBV infection are discussed, with particular attention drawn to the pitfalls of the Monospot test. Complications are listed and management strategies are outlined. The uses and complications of steroids are discussed. The importance of avoidance of contact sport and the association with splenic rupture is described. Publication Types: Review Review, Tutorial PMID: 11298158 [PubMed - indexed for MEDLINE] 2b: Postgrad Med. 2000 Jun;107(7):175-9, 183-4, 186. Infectious mononucleosis. Complexities of a common syndrome. Godshall SE, Kirchner JT. Department of Family and Community Medicine, Lancaster General Hospital, PA 17604-3555, USA. Infectious mononucleosis is common in adolescents and young adults. Although the syndrome is most often associated with Epstein-Barr virus, several other organisms can also cause infectious mononucleosis. Diagnosis is based on clinical findings and the presence of heterophil antibodies and atypical lymphocytes. Diagnosis may be more difficult in older adults because the presenting symptoms often differ from those seen in children. Symptoms usually resolve in 2 to 3 weeks. Treatment of uncomplicated infectious mononucleosis is supportive, but corticosteroids may be beneficial for the treatment of several complications associated with Epstein-Barr virus. Physically active patients should be counseled about the risks of splenic injury. Publication Types: Review Review, Tutorial PMID: 10887454 [PubMed - indexed for MEDLINE] 3: Curr Opin Pediatr. 2000 Jun;12(3):263-8. Acute complications of Epstein-Barr virus infectious mononucleosis. Jenson HB. Department of Pediatrics, and Microbiology, University of Texas Health Science Center, San 78229-3900, USA. jenson@... Infectious mononucleosis caused by Epstein-Barr virus (EBV) usually resolves over a period of weeks or months without sequelae but may occasionally be complicated by a wide variety of neurologic, hematologic, hepatic, respiratory, and psychological complications. The strength of association of EBV with many of these complications remains based on scattered case reports, often using unsophisticated diagnostic tests, and the evidence for causation in many instances is unconvincing. There is little benefit of antiviral treatment of uncomplicated or complicated infectious mononucleosis. Corticosteroids may have a role in hastening resolution of some complications, especially upper airway obstruction and possibly immune-mediated anemia and thrombocytopenia, but should be used judiciously. Publication Types: Review Review, Tutorial PMID: 10836164 [PubMed - indexed for MEDLINE] 4: Pediatr Rev. 1998 Aug;19(8):276-9. Infectious mononucleosis. J, Ray CG. Department of Pediatrics, St. Louis University School of Medicine and Cardinal Glennon Children's Hospital, MO., USA. EBV-induced IM is a generally self-limited infection characterized by fever, pharyngitis, and adenopathy. Management consists of basic supportive measures and treatment of streptococcal pharyngitis when present. Corticosteroids may be considered for individuals who exhibit evidence of significant upper airway obstruction. To date there is little evidence to support the use of antiviral agents in immunocompetent patients. Complications of IM may arise, which can be life-threatening, but these are relatively rare. Publication Types: Review Review, Tutorial PMID: 9707718 [PubMed - indexed for MEDLINE] 5: Pediatr Clin North Am. 1997 Dec;44(6):1541-56. What every pediatrician should know about infectious mononucleosis in adolescents. Hickey SM, Strasburger VC. Division of Infectious Diseases, University of New Mexico Health Sciences Center, Albuquerque, USA. Infectious mononucleosis (IM) is one of the most common diseases occurring during adolescence. Appreciation of IM's varied clinical presentations, its differential diagnosis, and the difficulties involved in making the laboratory diagnosis will enable clinicians to treat teenagers more effectively in their office practices. Publication Types: Review Review, Tutorial PMID: 9400586 [PubMed - indexed for MEDLINE] 6: Nurse Pract. 1996 Mar;21(3):14-6, 23, 27-8. Infectious mononucleosis. Cozad J. Huntington Beach Community Clinic, Calif., USA. Infectious mononucleosis is an acute, self-limiting, nonneoplastic lymphoreticular proliferative disorder characterized by peripheral lymphocytosis and circulating atypical lymphocytes. Epstein-Barr virus is the causative agent in 90% of cases. Highest incidence is in the 15- to 25-year-old age-group, with 1% to 3% of all college students in the United States affected each year. Clinical manifestations vary according to age at presentation. Incubation period is 4 to 7 weeks. Diagnosis is primarily made with the monospot test but may include throat culture and complete blood count with differential. Cytomegalovirus and human immunodeficiency virus are among the many other conditions that may present initially as infectious mononucleosis. Treatment is supportive with prevention of complications as the goal; good personal hygiene and avoidance of contact sports should be stressed. Publication Types: Review Review, Tutorial PMID: 8710247 [PubMed - indexed for MEDLINE] 7: Ear Nose Throat J. 1995 Sep;74(9):630-8. Airway obstruction in children with infectious mononucleosis. Wohl DL, Isaacson JE. Department of Otolaryngology, Head and Neck Surgery, Medical College of Virginia/Virginia Commonwealth University and Children's Hospital, Richmond, 23298-0416, USA. Epstein-Barr Virus (EBV) infection generally has a benign clinical course. Upper airway obstruction is a known complication requiring the otolaryngologist's attention. EBV is usually associated with adolescence but has been increasingly documented in younger children. We review 36 pediatric admissions for infectious mononucleosis over a 12-year period at our institution, 11 of which required consultation for airway obstruction. Airway management was based on clinical severity and ranged from monitored observation, with or without nasopharyngeal stenting, to prolonged intubation or emergent tonsilloadenoidectomy. A rare case of a four-year-old with near total upper airway obstruction secondary to panpharyngeal and transglottic inflammatory edema prompted this review and is reported. The otolaryngologist must recognize the potential severity of EBV-related airway compromise and be prepared to manage it. Publication Types: Case Reports PMID: 8565864 [PubMed - indexed for MEDLINE] 8: Am J Emerg Med. 1995 Jul;13(4):438-40. Infectious mononucleosis in young children. Schaller RJ, Counselman FL. Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, USA. A case of infectious mononucleosis (IM) in a two-year-old patient is presented. The clinical presentation and diagnosis of IM in young children are discussed. Publication Types: Case Reports Review Review, Tutorial PMID: 7605534 [PubMed - indexed for MEDLINE] 9: Pediatr Neurol. 1994 May;10(3):181-4. Neurologic complications of infectious mononucleosis. Connelly KP, DeWitt LD. Department of Pediatric Neurology, New England Medical Center Hospitals, Boston, Massachusetts. A review of the neurologic complications of Epstein-Barr viral (EBV) infections is presented. EBV has been associated with a wide range of acute neurologic diseases in children. Encephalitis, meningitis, cranial nerve palsies, mononeuropathies, and many other neurologic ailments have been described since the confirmation of EBV as the etiology of infectious mononucleosis. It is important to recognize that EBV can cause a myriad of neurologic illnesses with or without the stigmata of infectious mononucleosis. Publication Types: Review Review, Tutorial PMID: 8060419 [PubMed - indexed for MEDLINE] Lynne Arnold wrote: > > The doc said that if he still has swollen glands two weeks from now > > he would recommend a low dose short course of steroids (like what > > they use in asthma). > > Using steroids is problematic. Besides the toxicity, it generally > treats the > symptom, but doesn't resolve the problem. If your doctor can't figure it > out, I recommend finding another doctor who is interested in > discovering the > source of the problem. > > Lynne > Jack (3.8) has had swollen glands for almost 4 weeks now. Been to > the docs 3 times and done throat cultures for strep (all negative). > He's had a low grade fever off and on during this time, went through > a phase of sore throat and not wanting to eat and now has a cough and > swollen tonsils. He also had a day of vomitting early on in this > illness. He's not very tired though, but definitely has been 'off' > since this all started. > We haven't done a blood test yet though. > We took him to the ENT today to get his ears checked (he has tubes) > and also his tonsils. He thought mono was a good possibility. > > Is mono a real risky situation for our kids??? > What can I do to help him? > The doc said that if he still has swollen glands two weeks from now > he would recommend a low dose short course of steroids (like what > they use in asthma). > Any help is greatly appreciated. > Sharon > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2004 Report Share Posted March 11, 2004 Thanks , Interesting enough, Jack has been on acyclovir for two months until a week ago (well into this strange illness). The reason I stopped was because I wondered if it was doing anything or if it may be a problem. I also wanted to see if he really needed it. We will definitely do the herpes panel next blood draw - I think we'll do the McCandless panel from ISL which checks for most of those. We have done HHV6 titers and also EBV (last August) and both were negative. I'm going to forward the articles below to Jack's ENT. He's a good guy by the way (always willing to run any tests for us when Jack is in for ear tubes). The steriod thing (he said what they use is asthma type doses for a short time 4-5 days) was just something he mentioned but then as he thought about Jack, thought we should definitely wait. We definitely won't go that route based on all the good info. you guys have put forth. Thank you again, Sharon > > > > The doc said that if he still has swollen glands two weeks from now > > > he would recommend a low dose short course of steroids (like what > > > they use in asthma). > > > > Using steroids is problematic. Besides the toxicity, it generally > > treats the > > symptom, but doesn't resolve the problem. If your doctor can't figure it > > out, I recommend finding another doctor who is interested in > > discovering the > > source of the problem. > > > > Lynne > > Jack (3.8) has had swollen glands for almost 4 weeks now. Been to > > the docs 3 times and done throat cultures for strep (all negative). > > He's had a low grade fever off and on during this time, went through > > a phase of sore throat and not wanting to eat and now has a cough and > > swollen tonsils. He also had a day of vomitting early on in this > > illness. He's not very tired though, but definitely has been 'off' > > since this all started. > > We haven't done a blood test yet though. > > We took him to the ENT today to get his ears checked (he has tubes) > > and also his tonsils. He thought mono was a good possibility. > > > > Is mono a real risky situation for our kids??? > > What can I do to help him? > > The doc said that if he still has swollen glands two weeks from now > > he would recommend a low dose short course of steroids (like what > > they use in asthma). > > Any help is greatly appreciated. > > Sharon > > > > > > > Quote Link to comment Share on other sites More sharing options...
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