Dr. Beth Sullivan | September 12th, 2019
Thursday morning our routine was interrupted with news that Sam Darnold was ruled out for Sunday’s game against the Cleveland Browns after being diagnosed with mononucleosis. A lot of folks were surprised they were making the announcement this early in the week. Fans are going to have to wait a little longer for the anticipated matchup between Darnold and the 2018 NFL Draft number one pick Baker Mayfield.
I am sure most of you are asking … Who has he been kissing? but mono isn’t just a kissing disease. It can be a serious infection and has been linked to long-term complications in people who had acute infection up to six months after the initial diagnosis. It can take 30-50 days after exposure to the virus for symptoms to first be noticed which is why sometimes it is very difficult to determine the source of the infection.
Mononucleosis is a viral infection which means antibiotics are useless against it. The body has to fight off the infection and unfortunately, this takes a little time. 90% of all cases are caused by the Epstein Barr Virus. This is the same virus that has also been linked to chronic fatigue syndrome. The most common symptom is a severe sore throat with white patches on the throat and tonsils. In fact, the tonsils can become so enlarged with an acute infection, they can impact the windpipe because of swelling.
Normally a patient will initially be tested for Strep Throat, but if that test is negative, a mono test will be done. Mono can also damage the liver and spleen. In fact, the patient’s spleen will be examined for enlargement and blood tests will be done to check the liver enzyme levels and these tests will be followed throughout the illness to monitor whether the patient is recovering from the infection.
It is the involvement of the liver and spleen in mono infections that make playing football out of the question due to the risk of injury to the liver and spleen by the forceful contact that occurs in football. The greatest risk occurs in the second to third week after diagnosis in the form of a splenic rupture which might require surgery.
Because of the nature of the infection and the significant risks associated the medical community has developed a set of return to participation guidelines. The significant fatigue associated with the infection needs to have resolved, blood tests for liver enzymes need to be back to normal and physical exam needs to show no evidence of splenic enlargement. The main guideline says “Patients should not participate in contact sports or heavy lifting (Valsalva precautions) for at least 2-3 weeks or until all symptoms clinically resolved and no SPLEEN ENLARGEMENT palpated.
For all of these reasons, I would be highly surprised to see Darnold on the field again until after the Jets return from their bye. Trevor Siemian is going to have to be the next man up for the Jets at least for a few weeks.
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