`Adult Mono` Diagnosis Difficult, May Easily Be Abused

February 03, 1986|By G. Timothy Johnson, M.D.

Dear readers: One topic I`m often asked about is so-called chronic Epstein-Barr virus (EBV) disease. Many people know this as ``chronic mono`` or ``adult mono.`` It is a syndrome that is being increasingly identified as a long-term consequence of having acute mononucleosis (infectious mono), which is known to be caused by the same virus.

This syndrome, which consists of chronic fatigue, low-grade fever, recurrent sore throats, etc., is a common one in our society. Therefore, it is understandable that patients and physicians might wish to latch onto an explanation for these common symptoms that provides a diagnosis and possible treatment.

Unfortunately, our understanding of chronic EBV disease is still embryonic and confusing. A recent review of this subject (Infectious Disease Alert, Jan. 2, 1986) asserts: ``Chronic EBV infections have almost become a fad, replacing hypoglycemia and other causes of fatigue and abnormal behavior among young individuals. EBV infections are ubiquitous and lend themselves to such abuse.

``Certainly there is growing evidence that young patients presenting chronic fatigue, low-grade fever and a multitude of other symptoms can often be examples of true chronic EBV.``

A major problem, according to the review, is that there are few clear-cut, objective signs to look for that will tell a physician whether a chronic EBV infection is present. Furthermore, ``. . . it is likely that a continuum of EBV illnesses exist . . .,`` ranging from cases too mild to be noticed to the deadly variety involving the lymphatic system (a vital link in the body`s disease-fighting immune system.)

``The age and inheritance of the host, as well as the current state of the immune system, probably all contribute to determining which form of the illness will occur in an individual. The use of antiviral agents and immune modulation offers hope for relief in patients who, although not critically ill, are incapacitated by this incidious syndrome.``

Dear Dr. Johnson: What is postural hypertension? Does it have anything to do with posture, as the word would suggest?

The phrase is actually postural hypotension--using the prefix ``hypo,``

not ``hyper`` as in hypertension (high blood pressure). It refers to the phenomenon of a drop (the meaning of the prefix hypo) in blood pressure upon a change in posture--usually from a flat or supine position, as when lying in bed, to an upright position, as when trying to get out of bed.

The reason for the drop in blood pressure has to do with several mechanisms that ordinarily function to keep our blood pressure in a normal range, even when we change posture. However, in some individuals those mechanisms will not work effectively and there will be a sudden drop in blood pressure.

The two most common causes of postural hypotension are changes in control systems as a result of aging and medications that impair those systems. The reason for concern about postural hypotension is that the sudden drop in pressure may in fact lead to poor blood flow to the brain, which in turn can result in fainting and falling.