DEAR DRS. DONOHUE AND ROACH: I’m a 56-year-old woman in good health. I have been diagnosed with mononucleosis. This is the second time in three years. I also had this at age 19. Can you please clarify this and why I might be prone to have this diagnosis? — M.M.

ANSWER: Acute mononucleosis refers to acute infection by the Epstein-Barr virus, one of the viruses in the herpes family. It is an infectious disease, usually spread by saliva, hence the appropriate nickname “the kissing disease.” Once mononucleosis has resolved, which can take months, people usually have no further symptoms. Recurrence does happen, but it is rare. Chronic EBV is a rare syndrome. Both chronic and recurrent EBV should lead to suspicion of a defect in the immune system.

I suspect that what is happening is a confusion of EBV acute mononucleosis and “mononucleosislike syndrome.” Many diseases can look just like mononucleosis — the symptoms are nonspecific and include fever, swollen lymph nodes, fatigue and sore throat. These other conditions include cytomegalovirus, human herpesvirus 6 (both different herpes viruses), toxoplasmosis and many others. Very often, we never find the exact cause.

It seems much more likely to me that the two “mononucleosis” diagnoses you have had in the past three years are these other conditions that look and feel like EBV. Usually, only sophisticated blood tests — beyond what most doctors do — can separate recurrent EBV mono from the other conditions that cause mononucleosislike illnesses.

DEAR DRS. DONOHUE AND ROACH: I’m writing in reference to the antibiotic drug Levaquin. I contracted bronchitis in January 2012 and was treated with this drug, and it gave me tendonitis of my left Achilles’ tendon. In July 2012, my tendon ruptured. I’ve had to wear a boot for three months. Can you explain why this drug is on the market if it can cause a problem like this? Also, can you tell me if this rupture will heal? I have been told it will heal in time by a specialist in joints and tendons. — J.F.

ANSWER: Levaquin (levofloxacin), like all drugs like in the quinolone class of antibiotics, may have as a rare side effect a full or partial rupture of the Achilles’ tendon. This is a very bad occurrence but is fortunately quite rare, about 12 times in every 100,000 treatment episodes.

For a complete tear, consultation with a surgeon is essential, and should be done immediately. The surgeon can discuss the merits of surgery and conservative treatment. A partial tear usually heals with rest. The risk of tendon rupture is higher in patients over 60.

No drug is perfect, and all have the possibility of side effects. Levofloxacin can be a life-saving drug. The Food and Drug Administration has to balance risks against benefits, and they felt in this case that the benefits outweighed the risks. Levofloxacin is a powerful medication, reserved for serious infections. Most cases of bronchitis are caused by viruses, and get better without antibiotics. Before prescribing an antibiotic, doctors always consider risks and benefits. Having patients understand these risks might reduce unnecessary antibiotic use.

TO READERS: Questions about the common problem of uterine fibroids are answered in the booklet of that name. To obtain a copy, write: Dr. Donohue — No. 1106, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475 or email ToYourGoodHealth@med.cornell.edu with medical questions. Readers also may order health newsletters from www.rbmamall.com.

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