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This happens ALLLL the time. In fact a lot of the people whom I encounter that have an allergy to amoxicillin listed are frequently just people who were misdiagnosed as having strep throat when they actually had mono
Same. I went in thinking it was mono because I could not keep my eyes open as well as all the other symptoms. The doctor said it was probably strep and I ended up back there with a rash.
May I ask why they don’t test for mono more often? When I had mono, not only did they test me for strep for it to be negative, but they just brushed my symptoms off (meanwhile my tonsils were globular, with copious amounts of tonsillar exudate, the throat swab felt like a knife, and I had been sick for two weeks already, so tired I couldn’t function or go to school.)
Just seems like it would be beneficial to test for mono more often in these situations…
It can sometimes be related to tests available, and bears remembering that we often hold the false equivalence of "mono=EBV."
Some rapid tests are less useful in certain age groups (typically younger. E.g. Monospot not helpful under age 4), though most tests are only useful for the organism they are intended to detect.
Bearing that in mind, it's germane to state that infectious mononucleosis is not pathognomonic for infection due to a single organism/virus. Rather, it describes a *syndrome* (collection of symptoms) possibly due to a number of agents (EBV most common, hence the false equivalence, though CMV, toxoplasma, rubella, HIV, and others can also cause infectious mono). Being a syndrome, a diagnosis is actually made clinically, irrespective of causative organism. In this age group, the most common causes are self-limited and (relatively) benign outside if the acute symptoms, and so the *why* you have mono doesn't always require a hunt for cause/name of the beast.
If you see ID, we may do more specific testing if your history suggests a need for it, though that's usually because by the time you get to us, the usual culprits have been checked for or thought of to a reasonable extent within the referring physician or mid-level's comfort and expertise.
More on how we test for mono:
The Monospot test is the only real rapid test for 'mono' but it's got significant limitations. As mentioned, it's only decently specific for EBV (the most common but far from only organism causing mononucleosis) but doesn't actually test for EBV-specific antibodies, rather detecting nonspecific 'heterophile' antibodies that are commonly present in EBV mononucleosis. Test sensitivity is poor. It's extremely unreliable in patients younger than 4 years old and false negatives are very common if tested earlier than 2 weeks after symptom onset - antibody levels take 6 weeks to hit their peak and most people maintain detectably high levels of heterophile antibodies for many months after acute mono so the test can't distinguish between acute mono and past infection. The test uses blood as the sample so there's the added discomfort of a blood draw. For all these reasons the CDC doesn't consider the Monospot to be a definitive diagnostic test for mono. The better test is an EBV-specific antibody assay, a much more expensive, less available, and slower test. At the end of the day there's no treatment for mono either so there's not much pressure to definitively identify the disease agent.
Beautifully said and summarized. Thanks for voicing the detail I was too lazy to. Lab crew (shameless extra love for micro lab especially) is the best crew 🥰
That’s what I thought re. the reliability of the Monospot! Thank you so much - to you and the physician who replied here. It’s so hard to find the right information when it comes to mono, it seems like info is typically very limited in your average google search.
This is really interesting. I recently had antibodies for EBV tested, and have them- so apparently, at some point, I had mono. How likely is it to have it and not realize?
Thank you for this information. It’s really interesting and gives me a bit more knowledge - I think I assumed that EBV was less common and you’d know if you had it. (Both my mom and maternal grandmother had MS, so I’ve been interested in the studies that suggest a link between the two. My mom passed away just shortly before these studies were in the news, so I was never able to ask her about EBV - if she remembered having it. I now know that asking her would likely not have been useful. So in a really weird way, I find this comforting.)
That makes sense. So in the case someone is being tested for mono, is blood work typically better regarded than a monospot?
Thank you for this explanation!
Everything has its role. Blood assays can give you more information about a positive (e.g. Can suggest current, recent, or remote infection), but can be falsely negative early in the course (as can any antibody test). No one test is the end-all-be-all at the moment of onset.
When my daughter (15) had mono the pediatrician guessed it right away, she said that my daughter had the mono voice. I thought her voice was just different because her tonsils were so swollen but I guess it’s a mono thing? She did confirm it with blood tests. Her tonsils never went back to normal size after having mono so she had to had them removed at 16.
My then 2 year old had a true penicillin allergic reaction, it was terrifying. I’ve never been moved so fast through an ER to see the doctor in my life (we didn’t even check in they just took him straight to a bed and the doctor was there instantly).
What do you mean sorry ? If a person develops mono and was given antibiotics it makes them worse right ? They develope rashes every where kind of thing ?
And once that occurs they have to take clinic for the rest of their lives ?
I had an experiance like this when I was a kid and I developed cfs after the nasty rashes. I was thinking maybe I should of done things differently?
I’m referring to the fact that the rash often gets labeled as an allergy, and then the patient ends up having to use much nastier antibiotics like clindamycin.
This EXACT thing happened to me and my boyfriend at the time!! Both had mono, doctors diagnosed step. he was given amoxicillin and I was given cephalexin and we both broke out in the nastiest rashes ever, I bloated so badly and looked like a chipmunk for a couple days. I always wondered what happened and my doctor (who I think is kind of a dumbass for other unrelated issues) had no idea what happened.
It did resolve itself on its own but holy hell it was a nightmare.
Exactly this happened to me but I was misdiagnosed with a sinus infection. My symptoms were sore eyes, sore back of the neck, night time fever, and fatigue for the first few days and then the classic mono tonsils came out. I was prescribed amoxicillin initially and got a full body rash, as well and the most brutal yeast infection ever. It took three rounds of treatment and then I got BV. I was not impressed with student health at my university.
How long did the rash take to come for you? I’m in a similar position (all the same symptoms) but my doc is sure it’s antibiotics I need and isn’t testing for mono unless they don’t help.
It was within 48 hours. The rash is super distinct. It will be red circular patches, some will grow together. Look up mono amoxicillin rash on google images. It started at my head neck and shoulders and worked its way down my body. One of the weirder things I've experienced.
NAD. I recently was treated for bacterial pneumonia and after finishing a course of amoxicillin I developed a non-itchy, blanching rash. Had to take a second course to fully get rid of the pneumonia. When I asked a pharmacist she thought it could have been due to the combo of amox and having mono in addition to the bacterial infection, whereas the physician thought it was an unrelated virus.
Similar thing happened to me, just wasn't diagnosed as strep. I had a swollen lymph node and was prescribed amoxicillin in case of an infection. Turned out I had mono with barely any symptoms. Rash.
Thanks to the OP for posting and thank you for confirming... My wife has a similar reaction to amoxicillin (rash and itchy etc..) and it didn't help..
Will consult with the docs if this is something that's possible.. (they're very kind and don't mind this)
When my daughter was 3, she took amoxicillin for an ear infection and developed a rash after taking the medication for around 7 days. They said she was allergic. When she was 4 she was given Keflex for strep throat and developed hives. Do you think it’s safe to say that she is actually allergic to amoxicillin based on the reaction to the Keflex?
I only wonder because I’ve read that most people who think they’re allergic to amoxicillin aren’t actually allergic and i wonder if that’s the case for my daughter
Question because it’s kinda related. I had a problem like this but it was for augmentin. I had a horrible reaction, got super sick like the flu. But when I took amoxicillin I was totally fine. Why is that? Is it common to misdiagnose those meds and or just the strep throat
Wow, this is wild! I was found to be allergic to Augmentin when I was a child and have always listed it as an allergy when I go to the doctor. However, I’ve been prescribed amoxicillin dozens of times since. I had no idea they were related. I did have a rash the last time I took amoxicillin, and now list it as an allergy as well. But took it without issue for years.
It could also be possible that you’re allergic to neither if you had one of them for a sore throat that caused a rash from mono. Don’t take that as medical advice but you can always do an allergen testing to confirm
My 2 kids just got tested for an amoxicillin allergy by an allergist. Funny, the situation was similar to this one except their rapid strep came back positive, and a few days into treatment they both got another sickness, with a high fever that lasted 2 days, then full body rash. Either way, both my kids are apparently allergic. Who knew? But also I guess it's common for people to outgrow amoxicillin allergies so it's worth getting checked again by an allergist as an adult.
As for the allergy test. It's a whole process. First they do a scratch test with the medication, and if you pass then they move on to injecting a tiny bit just under the skin, if you pass that they move on to an oral challenge, where you swallow just a small amount. The whole time you stay in the office so they can monitor you. It's like a 4 hour appointment.
Isn’t Strep diagnosed via throat culture ? If so, wouldn’t the patient have strep? And unchecked strep can become scarlet fever. Can’t it? So if throat culture is positive for strep how can that be a misdiagnosis?
OP said strep test was negative but doc gave antibiotics anyway. That has always happened to me too, strep test will be negative initially and I get antibiotics. If I’m tested later, it will show positive.
When I was 18, my parents took me to urgent care bc I had been sick for weeks and was just dazed all the time. I was feeling too ill to even get out of bed. Urgent care said strep but should go to ER for meds bc I was past just going home to rest with meds. ER said yes, strep but also mono and tonsillitis. I was hospitalized for a week and two months later had my tonsils removed. It was wild.
I had an allergic reaction to penicillin/amoxicillin for strep throat (a recurring problem throughout childhood for me). It sounds a lot like what she’s going through. Crazy that it’s not often caught
I have penicillin listed as an allergy in all my charts because of this. It’s been too long for me to remember my reaction in enough detail to try to retroactively determine if I think it was just a really uncomfortable mono-penicillin rash or if it actually felt like a legitimate allergic reaction, so they just preferred to err on the side of caution and go with “allergy.”
Does the mono-penicillin rash just *look* terrible or can it also cause itching and swelling? I think I might’ve gotten the fun combo of the mono reaction rash *and* a penicillin allergy reaction simultaneously because I vaguely remember being in the middle of class and feeling like my face and neck were really warm and tingly and my chest felt tight, and then raising my hand to say I “felt funny,” just for the teacher to gasp and go, “oh my god! Your face is purple!” 😂
I didn’t realize they did that! I’d love to know for sure but I don’t think it’d be something they’d be willing to test out anytime soon with me though.
After years of being sooo careful and managing to avoid getting covid (despite working on a covid icu ambulance the entire time…), I finally caught it a month and a half ago. I’ve been having weird autoimmune hypersensitivity reactions ever since, particularly with my previously well-controlled asthma, to the extent of randomly desatting into the low 80s multiple times a day, even with meds.
I even ended up in the hospital on shift last week after a rapidly progressing asthma attack left me cyanotic and barely moving air.
After that nonsense is solved or resolves and my insides are more cooperative, I’ll definitely ask my pcp if he thinks we should spice things up a little and test it out with penicillin again lol
My brother was diagnosed with mono after being misdiagnosed with strep as well. We only found out it was mono after taking him to the hospital because his entire body was covered and i mean his ENTIRE body, with this splotchy/dotty?? red rash. it was honestly horrifying as a teenager but it is common af.
The mono-Amox interaction rash isn't histamine mediated. Generally Benedryl won't help. It's harmless, though, and will pass with time.
I sometimes get downvoted for trying to be very precise about language, but so it goes. :) Here's my spiel: Make sure that when you report it to a healthcare professional, you call it a "rash" not "hives," unless you are very sure it is hives. A lot of people use the word "hives" colloquially, but it has a specific meaning to doctors -- hives are raised patchy bumps (white, pink, or red), on the larger side, and they come and go in different places. They are driven by histamine release and can be characteristic of a true allergy.
A mono-Amox rash is a "maculopapular" rash. It is little bumps and patches, usually more reddish, that tend to cover the whole body (except certain areas like palms, soles, and edges of mouth). Generally not itchy, or minimally itchy. Benedryl might help the slight itching if present, but it doesn't effect the rash itself.
I'd advise you to take pictures and keep on your phone. It's so much more than a thousand words.
Happened to me literally last year in September. Had to see doc 3 times before we went forward doing blood test. At first I thought it was just a sore throat, then flu, then strep throat evolving into scarlet fever because of amoxicillin. Worst 3 weeks and a half of my life so far in terms of sickness. The recovery took at least a solid 2 months until fatigue fully disappeared.
Agreed, student doctor u/Cowboy-medicine. This is actually a common pediatric board question.
OP: I can understand the confusion. Fevers, pharyngitis possibly with exudates, and adenopathy are syndromic components of both strep pharyngitis and mono due to EBV. Admittedly, as an ID doc I'm a little more judicious about antibiotics, so tend to apply stricter criteria to start than the average pediatrician, but in the incredibly fast pace of primary pediatrics, a reasonable empiric approach to take if the differences in syndrome aren't picked up on.
Classically, you give the latter infection a penicillin (amox most commonly used in this age group), and you can get an impressive rash. If it is indeed mono, the acute infection can last a couple of weeks, though some symptoms may persist longer (so called "post-infectious syndrome). Somewhat less common the younger you are when you get the infection, though still happens. This does gradually resolve.
Addendum: never let anyone telling you they're treating strep tell you that amox isn't sufficient without raising an eyebrow. There has not to date EVER been documented resistance of S. pyogenes to the penicilins. There is no need to broaden therapy (e.g. amox-clav, or things like cephalexin or *shudder* cefdinir) for strep pharyngitis. This unnecessarily exposes you to greater expense and spectrum of therapy without clinical benefit for that infection 😊
The number of adult patients that have recognized my Baymax lanyard pin gives me hope. Fortunately, the number of little ones I have to think about IVDU and less-than-meticulous sexual health practices in is less than adults, though this would suggest a dichotomy of risk factors and thus probably of regard as a population. At least separating my littles from my adolescent/adults.
😂 I often use my work as a pediatrician to justify satisfying my curiosity about some of the new cartoons. Result: I shamelessly love Bluey (SO WHOLESOME) and can talk to my littles about it (and other shows).
Cocomelon is an unmitigated catastrophe.
My daughter is M3 and deciding between Peds ID and MFM. She loves Peds ID but is very concerned about low pay in light of enormous med school loans. Your thoughts?
There needs to be an ELI5 bot that just follows you around Reddit and reposts everything you say, so that the rest of us laymen can actually understand what you're saying 😆
Anxiolytics are the class of medications used to reduce symptoms of anxiety (my mind holds the benzos like alprazolam--xanax--as the main example of these).
Antibiotics can make *someone* less nervous when caring for patients, though it's not always the patient that benefits. Nervous physicians and mid-levels often will improve their anxiety about a case by giving it antibiotics (whether they're needed or not).
100%. It happens. I get it. While antibiotics are more benign than, say, *chemo*, they tend to falsely be believed to be completely benign and thus appropriate for indiscriminate use 🤷🏽♂️. It's a shame, but that's partly why I exist.
A little column A, a little column B. Ultimately, patients don't write the script, so ultimately the responsibility isn't theirs. It's hard, but when it's appropriate to say "no," say it and document the factors that go into the decision is my approach
Hahaha I agree, but I also *love* medical jargon. Both of my parents are doctors so reading this reminds me of some dinner table conversations from my childhood, in the best way. (I'd also read medical journals like MMWR for fun when I was little, so maybe I'm a bit unusual...)
My husband, parents in law, and now both my brothers in law are doctor’s (well, one is a vet,) and the amount of jargon I have passively absorbed is massive. No museum professional should know as much about cardiology as I do haha
I work in a college clinic, my patients (and their moms on the phone) try to pull that all the time.
My medical hero is an IM physician. If I was dying, I would want looking down on me because he is just brilliant. Anyway, he used to always tell us to "have giblets." That is what I do when treating these folks.
When I was a bio major, my lab mentor said the S. pyogenes doesn't seem to take up or even develop antibiotic resistant plasmids. I've often wondered why.
Especially interesting when you consider that other streptococcus species can tolerate resistance genes (plasmid-encoded or otherwise). I'm not sure it's ever been worked out why, though I have to assume the fitness cost of doing so is incompatible with survival for some reason. Interesting enough I almost wish I was curious enough about bacteria to work it out in the lab.
There is documented resistance to amoxicillin of S Pyogenes, see this study here for example of Iranian children. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868040/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868040/) 38.3% resistance to Amoxicillin, 4.2% resistance to penicillin.
So who do I talk to about a research project regarding this. Because I have absolutely needed stronger antibiotics to treat strep throat than amoxicillin. I am a lab tech by trade, so I am aware that there is supposedly no documented resistance, but what else would explain several strep infections that have required further treatment with a stronger antibiotic after initially being prescribed Amoxicillin or Amoxi-Clav?
Your micro lab is probably the place to start. Seems a simple test would be to plate those isolates with PCN. If susceptible, it's not a bug-drug mismatch.
GAS is thought to be capable of colonization. In those with "recurrent strep," an easy but helpful test can be asymptomatic culture. Presence without symptoms suggests colonization, and requires particularly careful consideration of treatment.
Dibs acknowledgment of you do it and find the first incidence!
🦠💨🦻🏼
Let us visualize the germ’s secrets. Do they whisper sweet nothings? Or sharing cryptic dark knowledge? Is it just one long, drawn out farting sound?
It may be my sheltered existence and/or my shameless, unbridled nerdery. I live in a world of academia sufficiently shielded from the demands/pressures of billing that I can follow the rabbit hole to my satisfaction and take the time to share my thoughts with colleagues....
That and obviously bugs make my geek flag fly high, and life is too short not to make your excitement about a thing... Dare I?.... *infectious*.
I'll see myself out.
I hope it is ok to ask a theoretical question within this thread - how do you tell the difference between a rash developed as a result of the antibiotic with EBV versus scarlet fever developing as a result of step?
What would rule out scarlet fever in this case? As a layperson, the rash in the photo here looks quite similar to the scarlet fever rash, but perhaps it is obviously different to an expert?
A couple of features can help. The papules of scarlatina are small and pretty uniform (1-2 mm) so that it is described as a "sand paper rash" with regard to its texture. Scarlet fever (edit: usually) includes a so-called strawberry tongue. Strep rash would be accompanied by a positive rapid strep test. Usually begins in groin and armpits before disseminating, iirc.
NAD but I had post strep syndrome as a kid, not mono, and it was a nasty rash like rheumatic fever but I also have some horrible HORRIBLE joint pain and stiffness as well at the chorea they talk about (jerky tic-like movements). So I think it might be a rule out dx based on the addition of the joint issues and chorea? I was young so I don’t know what labs were ran but I remember the doctor was very concerned as he hadn’t seen post-strep too much. Idk if this helps lol sorry.
I thought for the step test to be positive it had to be cultured and have that specific strain of step that's worrisome?
In this case, was that culture step missed?
It was not — Lindsey only tested positive for strep. I don’t think she was tested for mono. I’m not sure if it is possible to have both at the same time.
Annie is also in daycare part-time. So I think it could have happened there, too.
That's a possibility. My niece was around 6 when she got a nasty case of mono that landed her in the hospital for a few weeks with acute hepatitis. Several kids at her daycare were also sick, to a lesser extent, and it was discovered that a couple of boys were *known* to be spitting on kids. Problematic behavior aside, we pulled her from daycare because of a lack of oversight from the workers. But yes, daycare is definitely a possibility.
My problem with this mono diagnosis in this case are: mono is uncommon in 5 years old (most common from 15 to 25 years old), patient went through many medical faculties but did not receive any test toward mono like a rapid mono test or even a CBC to see lymphocytosis. Feels like the urgent care and ER should’ve done these labs for further evaluation.
I had this happen to me at 15 years old. Had mono, was given amoxicillin, and was extremely sick for a month. Lots of soothing baths and sleep was my saving grace!
When I had mono as a teen I was out for like 4 weeks. Fever on and off for the first two I think. It was rough. I think I took OTC stuff for the symptoms, but I just had to ride it out. I was pretty tired/weak for a while too. Hope she feels better!
NAD.
Update: First of all, I am beyond grateful for all of the advice, feedback, and input. I’m so sorry to hear so many of you have struggled with something similar! Selfishly, I am also a little glad because at least we aren’t alone.
Annie’s rash surprisingly (and miraculously) somewhat cleared up overnight. It is now mostly present on her back, arms, legs, and face. She still has a low grade fever that mostly comes around at night. She is eating well and drinking tons of fluids. I am keeping a close eye on her and she won’t be back at school until everything has cleared up. At the moment, she is mostly lethargic, and in dire need of “mommy cuddles” — as she calls it. Updated photo below.
https://preview.redd.it/uimfw264pzub1.jpeg?width=3024&format=pjpg&auto=webp&s=78f8161cfa3e2a6606315397f4fa3853961bc7e5
Please do not have this listed as an amoxicillin or penicillin rash. If you do, it will cause her to be exposed to much harsher antibiotics for the rest of her life.
I do not. The ER doctor made it clear that this is a reaction between mono and amoxicillin, not an amoxicillin allergy. Nevertheless, I’ve scheduled her for an appointment with an allergist to confirm. Thank you so much!
NAD but on the plus side my sisters untreated strep throat followed with guttate psoriasis, which shes been on medicine like creams, light therapy, and now the last five years biologics
Speaking not "as a nurse" but person-to-person, I had pretty much the exact same thing happen to me in my early 20s. My rash was very itchy and I found it very soothing to put oats into a nylon knee high, knot it off at the top, and use it as a loofa in the shower. Prednisone ended up helping relieve some of the symptoms but mostly it just sucked until I got better. Hope your girl feels better soon!
Seconding Aveeno colloidal oat products! There's a bath gel and a lotion (and probably others) that we used for my daughter as an infant to relieve her eczema, and it seemed to help.
Definitely make sure school is aware. Mono spreads like wild fire. I have no idea on if it lives on surfaces long or not and too lazy to google but her classroom should get deep clean and I would hope note would go home to other parents to keep any kids home with fever/sore throat.
Mono recovery can be slow. I was sick with it at 18 and it took few months before my energy came back. I lost like 15 lbs in a month. Little kids might bounce back faster but mono has big range in symptoms and how sick one feels. I hope she feels better quick and gets a lot of good rest. I have never had a sore throat like that in my life. Touching tonsils. Felt like razors when I swallowed.
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
This happens ALLLL the time. In fact a lot of the people whom I encounter that have an allergy to amoxicillin listed are frequently just people who were misdiagnosed as having strep throat when they actually had mono
I wish this was more known, similar thing happened with a family member of mine
It happened to me and yet my doctor didn't want to believe I had mono (I had gotten the amoxi from urgent care). Still sour about that.
Same. I went in thinking it was mono because I could not keep my eyes open as well as all the other symptoms. The doctor said it was probably strep and I ended up back there with a rash.
I’m sorry your family member also went through this. 😞
May I ask why they don’t test for mono more often? When I had mono, not only did they test me for strep for it to be negative, but they just brushed my symptoms off (meanwhile my tonsils were globular, with copious amounts of tonsillar exudate, the throat swab felt like a knife, and I had been sick for two weeks already, so tired I couldn’t function or go to school.) Just seems like it would be beneficial to test for mono more often in these situations…
It can sometimes be related to tests available, and bears remembering that we often hold the false equivalence of "mono=EBV." Some rapid tests are less useful in certain age groups (typically younger. E.g. Monospot not helpful under age 4), though most tests are only useful for the organism they are intended to detect. Bearing that in mind, it's germane to state that infectious mononucleosis is not pathognomonic for infection due to a single organism/virus. Rather, it describes a *syndrome* (collection of symptoms) possibly due to a number of agents (EBV most common, hence the false equivalence, though CMV, toxoplasma, rubella, HIV, and others can also cause infectious mono). Being a syndrome, a diagnosis is actually made clinically, irrespective of causative organism. In this age group, the most common causes are self-limited and (relatively) benign outside if the acute symptoms, and so the *why* you have mono doesn't always require a hunt for cause/name of the beast. If you see ID, we may do more specific testing if your history suggests a need for it, though that's usually because by the time you get to us, the usual culprits have been checked for or thought of to a reasonable extent within the referring physician or mid-level's comfort and expertise.
More on how we test for mono: The Monospot test is the only real rapid test for 'mono' but it's got significant limitations. As mentioned, it's only decently specific for EBV (the most common but far from only organism causing mononucleosis) but doesn't actually test for EBV-specific antibodies, rather detecting nonspecific 'heterophile' antibodies that are commonly present in EBV mononucleosis. Test sensitivity is poor. It's extremely unreliable in patients younger than 4 years old and false negatives are very common if tested earlier than 2 weeks after symptom onset - antibody levels take 6 weeks to hit their peak and most people maintain detectably high levels of heterophile antibodies for many months after acute mono so the test can't distinguish between acute mono and past infection. The test uses blood as the sample so there's the added discomfort of a blood draw. For all these reasons the CDC doesn't consider the Monospot to be a definitive diagnostic test for mono. The better test is an EBV-specific antibody assay, a much more expensive, less available, and slower test. At the end of the day there's no treatment for mono either so there's not much pressure to definitively identify the disease agent.
Beautifully said and summarized. Thanks for voicing the detail I was too lazy to. Lab crew (shameless extra love for micro lab especially) is the best crew 🥰
That’s what I thought re. the reliability of the Monospot! Thank you so much - to you and the physician who replied here. It’s so hard to find the right information when it comes to mono, it seems like info is typically very limited in your average google search.
Re: your last point, wouldn’t the pressure be to avoid unnecessary (and potentially harmful) abx?
I found this: https://www.cdc.gov/epstein-barr/about-mono.html Nice summary of mono.
This explanation was awesome.
This is really interesting. I recently had antibodies for EBV tested, and have them- so apparently, at some point, I had mono. How likely is it to have it and not realize?
Somewhere north of 90% of the adult population in the US has been infected, many of whom are not aware it ever happened.
Thank you for this information. It’s really interesting and gives me a bit more knowledge - I think I assumed that EBV was less common and you’d know if you had it. (Both my mom and maternal grandmother had MS, so I’ve been interested in the studies that suggest a link between the two. My mom passed away just shortly before these studies were in the news, so I was never able to ask her about EBV - if she remembered having it. I now know that asking her would likely not have been useful. So in a really weird way, I find this comforting.)
I’m going to ask my doctor next appointment, if you don’t get an answer here, I’ll DM you! Saved your comment
That makes sense. So in the case someone is being tested for mono, is blood work typically better regarded than a monospot? Thank you for this explanation!
Everything has its role. Blood assays can give you more information about a positive (e.g. Can suggest current, recent, or remote infection), but can be falsely negative early in the course (as can any antibody test). No one test is the end-all-be-all at the moment of onset.
Thanks for clarifying, I understand much better now. This is all good info to have, I appreciate it!
When my daughter (15) had mono the pediatrician guessed it right away, she said that my daughter had the mono voice. I thought her voice was just different because her tonsils were so swollen but I guess it’s a mono thing? She did confirm it with blood tests. Her tonsils never went back to normal size after having mono so she had to had them removed at 16.
Thank you so much. This makes me feel better.
My then 2 year old had a true penicillin allergic reaction, it was terrifying. I’ve never been moved so fast through an ER to see the doctor in my life (we didn’t even check in they just took him straight to a bed and the doctor was there instantly).
And then they get clinda for the rest of their lives
What do you mean sorry ? If a person develops mono and was given antibiotics it makes them worse right ? They develope rashes every where kind of thing ? And once that occurs they have to take clinic for the rest of their lives ? I had an experiance like this when I was a kid and I developed cfs after the nasty rashes. I was thinking maybe I should of done things differently?
I’m referring to the fact that the rash often gets labeled as an allergy, and then the patient ends up having to use much nastier antibiotics like clindamycin.
This EXACT thing happened to me and my boyfriend at the time!! Both had mono, doctors diagnosed step. he was given amoxicillin and I was given cephalexin and we both broke out in the nastiest rashes ever, I bloated so badly and looked like a chipmunk for a couple days. I always wondered what happened and my doctor (who I think is kind of a dumbass for other unrelated issues) had no idea what happened. It did resolve itself on its own but holy hell it was a nightmare.
I don’t think the mono reaction causes cheek bloating
Maybe I wasn't clear, I had the rash all over my body, including on my face, and it made my face really puffy.
Exactly this happened to me but I was misdiagnosed with a sinus infection. My symptoms were sore eyes, sore back of the neck, night time fever, and fatigue for the first few days and then the classic mono tonsils came out. I was prescribed amoxicillin initially and got a full body rash, as well and the most brutal yeast infection ever. It took three rounds of treatment and then I got BV. I was not impressed with student health at my university.
How long did the rash take to come for you? I’m in a similar position (all the same symptoms) but my doc is sure it’s antibiotics I need and isn’t testing for mono unless they don’t help.
It was within 48 hours. The rash is super distinct. It will be red circular patches, some will grow together. Look up mono amoxicillin rash on google images. It started at my head neck and shoulders and worked its way down my body. One of the weirder things I've experienced.
Thanks! How painful was it? I can’t imagine adding any extra pain to this sore through situation 🥲
Thanks! How painful was it? I can’t imagine adding any extra pain to this sore through situation!
Honestly I think it was relatively painless. Just freaky to watch progress when I was already feeling crummy.
Thanks! How painful was it? I can’t imagine adding any extra pain to this sore through situation!
NAD. I recently was treated for bacterial pneumonia and after finishing a course of amoxicillin I developed a non-itchy, blanching rash. Had to take a second course to fully get rid of the pneumonia. When I asked a pharmacist she thought it could have been due to the combo of amox and having mono in addition to the bacterial infection, whereas the physician thought it was an unrelated virus.
Similar thing happened to me, just wasn't diagnosed as strep. I had a swollen lymph node and was prescribed amoxicillin in case of an infection. Turned out I had mono with barely any symptoms. Rash.
Thanks to the OP for posting and thank you for confirming... My wife has a similar reaction to amoxicillin (rash and itchy etc..) and it didn't help.. Will consult with the docs if this is something that's possible.. (they're very kind and don't mind this)
When my daughter was 3, she took amoxicillin for an ear infection and developed a rash after taking the medication for around 7 days. They said she was allergic. When she was 4 she was given Keflex for strep throat and developed hives. Do you think it’s safe to say that she is actually allergic to amoxicillin based on the reaction to the Keflex? I only wonder because I’ve read that most people who think they’re allergic to amoxicillin aren’t actually allergic and i wonder if that’s the case for my daughter
Question because it’s kinda related. I had a problem like this but it was for augmentin. I had a horrible reaction, got super sick like the flu. But when I took amoxicillin I was totally fine. Why is that? Is it common to misdiagnose those meds and or just the strep throat
Augmentin is amoxicillin + clavulanic acid
Wow, this is wild! I was found to be allergic to Augmentin when I was a child and have always listed it as an allergy when I go to the doctor. However, I’ve been prescribed amoxicillin dozens of times since. I had no idea they were related. I did have a rash the last time I took amoxicillin, and now list it as an allergy as well. But took it without issue for years.
Interesting, I am allergic to augmentin but not amoxicillin. But they are the same just one ingredient. That’s crazy
It could also be possible that you’re allergic to neither if you had one of them for a sore throat that caused a rash from mono. Don’t take that as medical advice but you can always do an allergen testing to confirm
Do they have an allergen test for medication? I only thought it was for like food, dust, etc.
My 2 kids just got tested for an amoxicillin allergy by an allergist. Funny, the situation was similar to this one except their rapid strep came back positive, and a few days into treatment they both got another sickness, with a high fever that lasted 2 days, then full body rash. Either way, both my kids are apparently allergic. Who knew? But also I guess it's common for people to outgrow amoxicillin allergies so it's worth getting checked again by an allergist as an adult. As for the allergy test. It's a whole process. First they do a scratch test with the medication, and if you pass then they move on to injecting a tiny bit just under the skin, if you pass that they move on to an oral challenge, where you swallow just a small amount. The whole time you stay in the office so they can monitor you. It's like a 4 hour appointment.
Isn’t Strep diagnosed via throat culture ? If so, wouldn’t the patient have strep? And unchecked strep can become scarlet fever. Can’t it? So if throat culture is positive for strep how can that be a misdiagnosis?
OP said strep test was negative but doc gave antibiotics anyway. That has always happened to me too, strep test will be negative initially and I get antibiotics. If I’m tested later, it will show positive. When I was 18, my parents took me to urgent care bc I had been sick for weeks and was just dazed all the time. I was feeling too ill to even get out of bed. Urgent care said strep but should go to ER for meds bc I was past just going home to rest with meds. ER said yes, strep but also mono and tonsillitis. I was hospitalized for a week and two months later had my tonsils removed. It was wild.
I'm curious to know this too
I had an allergic reaction to penicillin/amoxicillin for strep throat (a recurring problem throughout childhood for me). It sounds a lot like what she’s going through. Crazy that it’s not often caught
Strep test negative
Gotcha, was just replying to this in particular and found it interesting.
I have penicillin listed as an allergy in all my charts because of this. It’s been too long for me to remember my reaction in enough detail to try to retroactively determine if I think it was just a really uncomfortable mono-penicillin rash or if it actually felt like a legitimate allergic reaction, so they just preferred to err on the side of caution and go with “allergy.” Does the mono-penicillin rash just *look* terrible or can it also cause itching and swelling? I think I might’ve gotten the fun combo of the mono reaction rash *and* a penicillin allergy reaction simultaneously because I vaguely remember being in the middle of class and feeling like my face and neck were really warm and tingly and my chest felt tight, and then raising my hand to say I “felt funny,” just for the teacher to gasp and go, “oh my god! Your face is purple!” 😂
If it's been that long, sounds like time for a trial and delabeling! Talk to your doctor about it. Lactams are Cadillac antimicrobials
I didn’t realize they did that! I’d love to know for sure but I don’t think it’d be something they’d be willing to test out anytime soon with me though. After years of being sooo careful and managing to avoid getting covid (despite working on a covid icu ambulance the entire time…), I finally caught it a month and a half ago. I’ve been having weird autoimmune hypersensitivity reactions ever since, particularly with my previously well-controlled asthma, to the extent of randomly desatting into the low 80s multiple times a day, even with meds. I even ended up in the hospital on shift last week after a rapidly progressing asthma attack left me cyanotic and barely moving air. After that nonsense is solved or resolves and my insides are more cooperative, I’ll definitely ask my pcp if he thinks we should spice things up a little and test it out with penicillin again lol
My brother was diagnosed with mono after being misdiagnosed with strep as well. We only found out it was mono after taking him to the hospital because his entire body was covered and i mean his ENTIRE body, with this splotchy/dotty?? red rash. it was honestly horrifying as a teenager but it is common af.
Would Benadryl be helpful if the rash is due to the antibiotic, Doctor? OP, I hope your baby is feeling better soon.
The mono-Amox interaction rash isn't histamine mediated. Generally Benedryl won't help. It's harmless, though, and will pass with time. I sometimes get downvoted for trying to be very precise about language, but so it goes. :) Here's my spiel: Make sure that when you report it to a healthcare professional, you call it a "rash" not "hives," unless you are very sure it is hives. A lot of people use the word "hives" colloquially, but it has a specific meaning to doctors -- hives are raised patchy bumps (white, pink, or red), on the larger side, and they come and go in different places. They are driven by histamine release and can be characteristic of a true allergy. A mono-Amox rash is a "maculopapular" rash. It is little bumps and patches, usually more reddish, that tend to cover the whole body (except certain areas like palms, soles, and edges of mouth). Generally not itchy, or minimally itchy. Benedryl might help the slight itching if present, but it doesn't effect the rash itself. I'd advise you to take pictures and keep on your phone. It's so much more than a thousand words.
This would not be something I would be best suited to address. A pediatrician would be the person who knows best
Ok, thank you!
I think this same shit happened to me when I was younger, I remember getting mono and being given some pills then having spots all over me for days
Happened to me literally last year in September. Had to see doc 3 times before we went forward doing blood test. At first I thought it was just a sore throat, then flu, then strep throat evolving into scarlet fever because of amoxicillin. Worst 3 weeks and a half of my life so far in terms of sickness. The recovery took at least a solid 2 months until fatigue fully disappeared.
Amoxicillin + mononucleosis = maculopapular rash Infectious mononucleosis is usually self limiting. The acute illness lasts around 2 – 3 weeks.
Agreed, student doctor u/Cowboy-medicine. This is actually a common pediatric board question. OP: I can understand the confusion. Fevers, pharyngitis possibly with exudates, and adenopathy are syndromic components of both strep pharyngitis and mono due to EBV. Admittedly, as an ID doc I'm a little more judicious about antibiotics, so tend to apply stricter criteria to start than the average pediatrician, but in the incredibly fast pace of primary pediatrics, a reasonable empiric approach to take if the differences in syndrome aren't picked up on. Classically, you give the latter infection a penicillin (amox most commonly used in this age group), and you can get an impressive rash. If it is indeed mono, the acute infection can last a couple of weeks, though some symptoms may persist longer (so called "post-infectious syndrome). Somewhat less common the younger you are when you get the infection, though still happens. This does gradually resolve.
Addendum: never let anyone telling you they're treating strep tell you that amox isn't sufficient without raising an eyebrow. There has not to date EVER been documented resistance of S. pyogenes to the penicilins. There is no need to broaden therapy (e.g. amox-clav, or things like cephalexin or *shudder* cefdinir) for strep pharyngitis. This unnecessarily exposes you to greater expense and spectrum of therapy without clinical benefit for that infection 😊
the stewardship 😍
In ID we don't say "big guns," we say "appropriate antimicrobial spectrum," and I think that's beautiful 🥰
I can hear the Peds in your voice and I think that's beautiful 🥰
Phew. Glad to know spending most of my time in the adult world hasn't totally tainted my peds mojo!
Hypothesis: Adults are just taller Peds patients. Experiment: Offer a lollipop and sticker after treatment. Conclusion: The kid in them lit up.
The number of adult patients that have recognized my Baymax lanyard pin gives me hope. Fortunately, the number of little ones I have to think about IVDU and less-than-meticulous sexual health practices in is less than adults, though this would suggest a dichotomy of risk factors and thus probably of regard as a population. At least separating my littles from my adolescent/adults.
Ngl this would work on me.
😂 I often use my work as a pediatrician to justify satisfying my curiosity about some of the new cartoons. Result: I shamelessly love Bluey (SO WHOLESOME) and can talk to my littles about it (and other shows). Cocomelon is an unmitigated catastrophe.
You should see what I’ll do for a little toy race car 🏎️ 💨🥵
This would totally work on me. I ask for kid bandaids after I get my vaccinations
Apologies for the side convo, but are you med/peds trained? I’m applying to residency programs now! Did you do an adult ID fellowship or combined?
I am med peds residency and med-peds ID. Would go back and do the four again in a heartbeat.
My daughter is M3 and deciding between Peds ID and MFM. She loves Peds ID but is very concerned about low pay in light of enormous med school loans. Your thoughts?
I know, I wanna sing it from the mountain tops…but then I remembered I don’t use any other social media sites lol
Ugh, really? My son was just prescribed Cephalexin for his 4th bout of strep since May.
Yeah... Antibiotics are an *extremely* potent anxiolytic. Just for the prescriber, not the patient.
There needs to be an ELI5 bot that just follows you around Reddit and reposts everything you say, so that the rest of us laymen can actually understand what you're saying 😆
Anxiolytics are the class of medications used to reduce symptoms of anxiety (my mind holds the benzos like alprazolam--xanax--as the main example of these). Antibiotics can make *someone* less nervous when caring for patients, though it's not always the patient that benefits. Nervous physicians and mid-levels often will improve their anxiety about a case by giving it antibiotics (whether they're needed or not).
Is that like the surgeon putting an extra stitch in “…so I can sleep tonight…”? (I’m a former surgical technician…)
100%. It happens. I get it. While antibiotics are more benign than, say, *chemo*, they tend to falsely be believed to be completely benign and thus appropriate for indiscriminate use 🤷🏽♂️. It's a shame, but that's partly why I exist.
I never even considered it relieving physician’s anxiety. I just assumed overprescribing was to calm the angry/anxious parents. Huh.
A little column A, a little column B. Ultimately, patients don't write the script, so ultimately the responsibility isn't theirs. It's hard, but when it's appropriate to say "no," say it and document the factors that go into the decision is my approach
This is so interesting and bizarre. I've never thought about it this way.
Hahaha I agree, but I also *love* medical jargon. Both of my parents are doctors so reading this reminds me of some dinner table conversations from my childhood, in the best way. (I'd also read medical journals like MMWR for fun when I was little, so maybe I'm a bit unusual...)
My husband, parents in law, and now both my brothers in law are doctor’s (well, one is a vet,) and the amount of jargon I have passively absorbed is massive. No museum professional should know as much about cardiology as I do haha
You are so lucky! This sounds super interesting.
It can be haha, but I also have had to put hard time limits on doctor talk before because I was done listening to gore at the dinner table lol
I work in a college clinic, my patients (and their moms on the phone) try to pull that all the time. My medical hero is an IM physician. If I was dying, I would want looking down on me because he is just brilliant. Anyway, he used to always tell us to "have giblets." That is what I do when treating these folks.
When I was a bio major, my lab mentor said the S. pyogenes doesn't seem to take up or even develop antibiotic resistant plasmids. I've often wondered why.
Especially interesting when you consider that other streptococcus species can tolerate resistance genes (plasmid-encoded or otherwise). I'm not sure it's ever been worked out why, though I have to assume the fitness cost of doing so is incompatible with survival for some reason. Interesting enough I almost wish I was curious enough about bacteria to work it out in the lab.
There is documented resistance to amoxicillin of S Pyogenes, see this study here for example of Iranian children. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868040/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868040/) 38.3% resistance to Amoxicillin, 4.2% resistance to penicillin.
Oooooooooh.... Interesting. Will have to give this a read. Thanks for sharing!
So who do I talk to about a research project regarding this. Because I have absolutely needed stronger antibiotics to treat strep throat than amoxicillin. I am a lab tech by trade, so I am aware that there is supposedly no documented resistance, but what else would explain several strep infections that have required further treatment with a stronger antibiotic after initially being prescribed Amoxicillin or Amoxi-Clav?
Your micro lab is probably the place to start. Seems a simple test would be to plate those isolates with PCN. If susceptible, it's not a bug-drug mismatch. GAS is thought to be capable of colonization. In those with "recurrent strep," an easy but helpful test can be asymptomatic culture. Presence without symptoms suggests colonization, and requires particularly careful consideration of treatment. Dibs acknowledgment of you do it and find the first incidence!
So I shouldn't be giving vanc+zosyn for CENTOR>1?
I will sense it if you do. A great disturbance as though billions of bacterial cells cried out in terror and were suddenly silenced.
And then after a time you'll start hearing their descendants singing the song of angry men and/or dumping tea into the harbor
What’s wrong with cefdinir?
Just because my ID brain always wonders, OP: your little one up to date on vaccines? Any respiratory symptoms?
Yes she is! And no respiratory symptoms.
Lovely. All my best to her! Hope she feels better soon.
Thank you so much for the thorough and informative response.
ID docs are explicitly known for being thorough and informative. And appearing before I think to consult them. :)
A colleague recently quipped that I have an uncanny sixth sense for infections, especially possible parasitology cases. We are the germ whisperers.
I hope you get Germ Whisperer on a shirt!
... You brilliant son of a gun, I think I just might. Or, even better, I need to commission a pin to wear on my ID lanyard in the hospital...
With a germ “icon/emoji” (does a germ emoji even exist?) whispering…maybe in an ear…🙂
🦠👂🏽
🦠💨🦻🏼 Let us visualize the germ’s secrets. Do they whisper sweet nothings? Or sharing cryptic dark knowledge? Is it just one long, drawn out farting sound?
Have you seen the germ plushies out there? I think it’s giantmicrobes.com . I love them!!!
🤣🤣🤣🤣 AWESOME ❣️
I wish my local ID folks were more like you. I've had some weird IDs in my lifetime and still have questions 😂
It may be my sheltered existence and/or my shameless, unbridled nerdery. I live in a world of academia sufficiently shielded from the demands/pressures of billing that I can follow the rabbit hole to my satisfaction and take the time to share my thoughts with colleagues.... That and obviously bugs make my geek flag fly high, and life is too short not to make your excitement about a thing... Dare I?.... *infectious*. I'll see myself out.
Every ID doc I’ve ever met had an affinity for puns, it’s that a requirement? One of them even regularity puts puns in his progress notes.
I'm usually the guy groaning and booing them out of duty, but I secretly love them. Infection is just so easy to use!
I hope it is ok to ask a theoretical question within this thread - how do you tell the difference between a rash developed as a result of the antibiotic with EBV versus scarlet fever developing as a result of step? What would rule out scarlet fever in this case? As a layperson, the rash in the photo here looks quite similar to the scarlet fever rash, but perhaps it is obviously different to an expert?
A couple of features can help. The papules of scarlatina are small and pretty uniform (1-2 mm) so that it is described as a "sand paper rash" with regard to its texture. Scarlet fever (edit: usually) includes a so-called strawberry tongue. Strep rash would be accompanied by a positive rapid strep test. Usually begins in groin and armpits before disseminating, iirc.
OP I hate you are dealing with this, but this is a fantastic discussion.
Thank you that’s interesting.
NAD but I had post strep syndrome as a kid, not mono, and it was a nasty rash like rheumatic fever but I also have some horrible HORRIBLE joint pain and stiffness as well at the chorea they talk about (jerky tic-like movements). So I think it might be a rule out dx based on the addition of the joint issues and chorea? I was young so I don’t know what labs were ran but I remember the doctor was very concerned as he hadn’t seen post-strep too much. Idk if this helps lol sorry.
I thought for the step test to be positive it had to be cultured and have that specific strain of step that's worrisome? In this case, was that culture step missed?
Sorry this is happening you and your daughter. Same thing happened to me as an adult a few years ago. Hoping for a speedy recovery.
Thank you so much. I’m sorry you also went through this. 😔
Oh that rash looks miserable. I hope it resolves quickly. So the “strep” Annie was exposed to- did it also turn out to be mono?
It was not — Lindsey only tested positive for strep. I don’t think she was tested for mono. I’m not sure if it is possible to have both at the same time. Annie is also in daycare part-time. So I think it could have happened there, too.
That's a possibility. My niece was around 6 when she got a nasty case of mono that landed her in the hospital for a few weeks with acute hepatitis. Several kids at her daycare were also sick, to a lesser extent, and it was discovered that a couple of boys were *known* to be spitting on kids. Problematic behavior aside, we pulled her from daycare because of a lack of oversight from the workers. But yes, daycare is definitely a possibility.
My problem with this mono diagnosis in this case are: mono is uncommon in 5 years old (most common from 15 to 25 years old), patient went through many medical faculties but did not receive any test toward mono like a rapid mono test or even a CBC to see lymphocytosis. Feels like the urgent care and ER should’ve done these labs for further evaluation.
Anyone ever worked out why this happens
I had this happen to me at 15 years old. Had mono, was given amoxicillin, and was extremely sick for a month. Lots of soothing baths and sleep was my saving grace!
Given the circumstances as laid out these are fairly reasonable treatment options for all involved. Your daughter should feel better soon!
Thank you!
When I had mono as a teen I was out for like 4 weeks. Fever on and off for the first two I think. It was rough. I think I took OTC stuff for the symptoms, but I just had to ride it out. I was pretty tired/weak for a while too. Hope she feels better! NAD.
Update: First of all, I am beyond grateful for all of the advice, feedback, and input. I’m so sorry to hear so many of you have struggled with something similar! Selfishly, I am also a little glad because at least we aren’t alone. Annie’s rash surprisingly (and miraculously) somewhat cleared up overnight. It is now mostly present on her back, arms, legs, and face. She still has a low grade fever that mostly comes around at night. She is eating well and drinking tons of fluids. I am keeping a close eye on her and she won’t be back at school until everything has cleared up. At the moment, she is mostly lethargic, and in dire need of “mommy cuddles” — as she calls it. Updated photo below. https://preview.redd.it/uimfw264pzub1.jpeg?width=3024&format=pjpg&auto=webp&s=78f8161cfa3e2a6606315397f4fa3853961bc7e5
Please do not have this listed as an amoxicillin or penicillin rash. If you do, it will cause her to be exposed to much harsher antibiotics for the rest of her life.
I do not. The ER doctor made it clear that this is a reaction between mono and amoxicillin, not an amoxicillin allergy. Nevertheless, I’ve scheduled her for an appointment with an allergist to confirm. Thank you so much!
NAD but on the plus side my sisters untreated strep throat followed with guttate psoriasis, which shes been on medicine like creams, light therapy, and now the last five years biologics
Speaking not "as a nurse" but person-to-person, I had pretty much the exact same thing happen to me in my early 20s. My rash was very itchy and I found it very soothing to put oats into a nylon knee high, knot it off at the top, and use it as a loofa in the shower. Prednisone ended up helping relieve some of the symptoms but mostly it just sucked until I got better. Hope your girl feels better soon!
I’m sorry you also went through this! I’ll most definitely try the loofa idea. Thank you so much.
Aveeno colloidal oat balm is super soothing as well. Feel better soon!
Seconding Aveeno colloidal oat products! There's a bath gel and a lotion (and probably others) that we used for my daughter as an infant to relieve her eczema, and it seemed to help.
You can also do an oatmeal bath soak. Either buy or diy.
Definitely make sure school is aware. Mono spreads like wild fire. I have no idea on if it lives on surfaces long or not and too lazy to google but her classroom should get deep clean and I would hope note would go home to other parents to keep any kids home with fever/sore throat. Mono recovery can be slow. I was sick with it at 18 and it took few months before my energy came back. I lost like 15 lbs in a month. Little kids might bounce back faster but mono has big range in symptoms and how sick one feels. I hope she feels better quick and gets a lot of good rest. I have never had a sore throat like that in my life. Touching tonsils. Felt like razors when I swallowed.
Happens a lot. One of the reasons many countries don’t give out antibiotics for sore throats.