Introduction:

Infectious mononucleosis, also called "mono" or "the kissing disease," causes symptoms that include fever, sore throat, and swollen glands. A person is infectious several days before symptoms appear and for some time after, possibly for months or, rarely, even years.

Signs and Symptoms:

• Fever
• Fatigue
• Weakness
• Sore throat, often severe
• Swollen tonsils
• Swollen lymph nodes in the neck
• Enlargement of the spleen
• Enlargement of the liver
• Rash
• Headache

Symptoms may take 4 - 7 weeks to develop after exposure to the virus. Symptoms can last only a few days or as long as several months. In most cases, they disappear in 2 - 6 weeks.

What Causes It?:

The Epstein-Barr virus (EBV) causes the vast majority of mono cases. Direct contact with virus-infected saliva, mainly through kissing, can transmit the virus and cause mono. You can also get mono through transfusions with infected blood products.

Mono affects about 45 of 100,000 people, usually teens and young adults. It usually isn’t a serious disease, although it can cause fatigue and weakness that interfere with daily life.

About 90% of adults have been exposed to EBV and have antibodies, meaning they are immune the virus.

Who's Most At Risk?:

The following factors can put a person at higher risk for developing mono:

• Age -- Mono is most common among people ages 15 - 19. After age 35, the rate is low
• Blood transfusion
• Diminished or suppressed immune function

What to Expect at Your Provider's Office:

Your health care provider will do a physical examination, checking for fever, sore throat, swollen glands, and for swelling of your spleen or liver. A blood test is performed to make the diagnosis of mono.

Treatment Options:

Prevention

Because mono is not generally spread through the air, a person who has mono does not need to be isolated. Household members or college roommates have only a slight risk of being infected unless they kiss the person.

Treatment Plan

Common treatment for mono includes bed rest and plenty of fluids. You may feel so tired and weak that you can hardly get out of bed for about a week, but symptoms generally begin to improve after about 2 weeks. Patients should avoid contact sports and heavy lifting for 2 months due to the risk of rupturing the spleen.

Drug Therapies

There is no cure for mono, but your health care provider may prescribe the following medications to treat some symptoms:

• Pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Advil) for fever. Do not give over-the-counter pain relievers to children without talking to your doctor first. Children under the age of 18 should not take aspirin because of the risk of developing Reye syndrome, a rare condition that can cause vomiting and can affect the liver, brain, and other organs.
• Corticosteroids, such as prednisone, may be used to ease swelling of tonsils
• Antibiotics don’t work against mono, but your doctor may prescribe them to treat strep throat.

Surgical and Other Procedures

In the case of a ruptured spleen, surgical removal of the spleen may be necessary.

Complementary and Alternative Therapies

Several studies report that stress and relaxation affect our immune systems. Stress can make your body more susceptible to infection. Steps that reduce stress may help prevent infection with viruses such as EBV.

There is some evidence that nutrition and plant-based medicines may help reduce the long-term effects of EBV infection and complications linked to EBV.

Always tell your doctor about the herbs and supplements you are using or considering using.

Nutrition and Supplements

These nutritional tips may help reduce symptoms:

• Eat more antioxidant-rich foods (such as green, leafy vegetables and peppers) and fruits (such as blueberries, tomatoes, and cherries).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink plenty of filtered water daily.
• Gargling with warm salt water may help soothe a sore throat.

These supplements may also help:

• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil two to three times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources. People who take blood-thinning medications such as warfarin (Coumadin) should talk to their doctor before taking fish oil.
• Probiotic supplement (containing Lactobacillus acidophilus ), 5 - 10 billion CFUs (colony forming units) a day, for gastrointestinal and immune health. Taking antibiotics, in particular, can upset the balance between good and bad bacteria in your gut. Taking probiotics, of “friendly” bacteria, may help restore the right balance.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of your health care provider. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

The following herbs have not been studied for treating mono, but are sometimes suggested because they strengthen the immune system:

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory, and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Echinacea (Echinacea purpurea) 900 mg per day, for 5 – 7 days, to strengthen the immune system. Do not give echinacea to a child without talking to your doctor first.
• Astragalus (Astragalus membranaceus) has not been studied for mono, but it does seem to have anti-viral properties, at least in test tube studies. It isn’t known whether it would work against the Epstein-Barr virus. People who take anticoagulants (blood-thinners), diuretics (water pills), or medication for high blood pressure or medication to lower blood sugar should not take astragalus without talking to their doctor first.
• Cranberry (Vaccinium macrocarpon), from 15 - 30mL of unsweetened 100% cranberry juice each day or one to five 300 - 400mg capsules of juice extract two times per day 1 hour before or 2 hours after meals. Cranberry appears to have antiviral properties, although no one knows whether it is effective against the Epstein-Barr virus.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for mono based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following remedies may be effective for fever related to EBV:

• Belladonna -- for early stages of mononucleosis with sudden onset of fever
• Ferrum phosphoricum -- for individuals with the early stages of a fever accompanied by a painful cough and sore chest
• Kali muriaticum -- typically used for individuals with extremely swollen tonsils, but may also be useful for treating infectious mononucleosis when administered in conjunction with Ferrum phosphoricum

Professional homeopaths may also recommend the following remedies:

• Mercurius -- for individuals with a fever accompanied by profuse sweating, alternating hot and cold body temperature, weakness in the limbs and painful, aching bones, a bluish-red throat with a constant desire to swallow, excessive salivation, teeth marks around the edges of a swollen tongue, and tremendous thirst
• Phytolacca -- for pain caused by throat inflammation that radiates to the ears upon swallowing

Other helpful remedies include Lachesis, Conium, Hepar sulphuricum, and Baryta carbonica.

Research also suggests that a combination of homeopathy and Traditional Chinese Medicine (TCM) may effectively improve symptoms of mononucleosis. The most common homeopathic remedies used with TCM include Lycopodium, Silicea, Phosphorous, Sulphur, Mercurius, Nux vomica, Sepia, and Pulsatilla.

Acupuncture

Although no scientific studies have reviewed the use of acupuncture for mono, it may help to reduce symptoms, to improve immune function, and to relieve congestion (blockage of qi, or energy flow) of the liver, spleen, and lymph.

Traditional Chinese Medicine

Studies have reported that people with Epstein-Barr virus experience an improvement in symptoms when given a combination of homeopathic remedies noted in the section on homeopathy and TCM remedies including Atractylodes alba, Glycyrrhiza recens, Rehmannia preparata, Bupleurum, Cortex magnolia, Phragmites, Belamcanda, Sophora, subprostrata, Siler, Angelica dahurica, Paeonia alba, Dendrobium, Polygonatum officinal, and Cnidium.

Prognosis and Possible Complications:

Most people with mono recover uneventfully and can return to school or work in a few weeks. A small number of people may experience fatigue for several months. Severe complications are uncommon, and may include anemia, problems with the central nervous system or liver, rupture of the spleen, or inflammation of the heart.

Alternative Names:

Epstein-Barr virus