Mononucleosis (mono)

Related Terms

Antibodies, antibody, antibody test, Burkitt's lymphoma, cancer, corticosteroids, enlarged spleen, fatigue, heterophile antibody test, infection, latent infection, lymphoma, mono, monocytes, monospot, nasopharyngeal carcinoma, ruptured spleen, spleen, white blood cells, viral infection, virus.

Background

The Epstein-Barr virus (EBV) can cause many different infections in humans, including mononucleosis (also called mono or the kissing disease). Many EBV infections produce mild symptoms that are similar to the common cold. However, individuals who develop mono may experience more serious symptoms, such as extreme fatigue, sore throat, enlarged lymph nodes, fever, headache, swollen tonsils, loss of appetite, soft and swollen spleen, and night sweats. EBV infections in adolescents and young adults typically cause mono.
EBV, a member of the herpes virus family, is among the most common human viruses. Even though it is less contagious than the common cold, about 95% of Americans who are between the ages of 35-40 and 50% of children who are five years old have been infected with the virus at some point in their lives. Once infected, the body builds up antibodies to the virus. It is very rare for an individual to become re-infected with the virus.
Once an individual becomes infected with EBV, the virus remains dormant (inactive) inside the person's immune system cells. The virus may be present in the saliva for several months after symptoms go away. Individuals are typically contagious for several weeks after the infection develops. However, some individuals may carry and spread the virus intermittently throughout their lives.
In rare cases, EBV has been linked to the development of several uncommon types of cancer, including Burkitt's lymphoma and nasopharyngeal carcinoma. Researchers believe that the viral genes change the way the person's infected immune cells grow, causing them to become cancerous. However, EBV is not considered the sole cause of these cancers.
In the past, researchers thought that EBV may cause chronic fatigue syndrome. Recent evidence suggests that this condition does not occur in response to EBV infections. Instead, patients may have dysfunctional immune systems.
There is currently no effective treatment for EBV. Instead, treatment focuses on reducing symptoms until the infection goes away on its own. Medications, such as pain relievers and steroids, may help reduce symptoms. Patients should also drink plenty of fluids and rest until the infection is gone.

Signs and symptoms

General: Symptoms of the Epstein-Barr virus vary depending on the specific strain (type) of the virus. Children younger than five years old usually do not experience any symptoms of an infection. Adolescents and adults may or may not experience symptoms. If symptoms do develop, they usually appear 30-50 days after exposure to the virus. The duration of symptoms also varies. In general, symptoms start to lessen after about two weeks. However, fatigue may last for several more weeks or months.
Common symptoms: Often, the first signs of an infection is a general feeling of discomfort and tiredness that may last anywhere from several days to a week. The four main symptoms of EBV infections are: fatigue, sore throat, fever, and enlarged lymph nodes (especially in the neck). Fatigue is generally the worst two to three weeks after symptoms develop, and it may last six weeks or longer. Fatigue may be severe and interfere with a person's ability to perform normal daily activities. A pus-like substance may also be present in the back of the throat. Other common symptoms include swollen tonsils, headache, loss of appetite, and night sweats.
About half of patients with mononucleosis develop an enlarged spleen. This is because the immune cells in the spleen destroy the virus that is present in a person's blood. Most patients experience few, if any symptoms, indicating an enlarged spleen. This is typically identified during a physical examination.
Less common symptoms: The liver may become enlarged in some patients. In less common cases, the patient's skin and eyes may appear yellow in color (a condition called jaundice).

Diagnosis

General: In many cases, infections with the Epstein-Barr virus (EBV) go undiagnosed. This is because some patients experience mild or no symptoms. Many cases are mistaken for the common cold.
Heterophile antibody test (monospot): A heterophile antibody test, also called a monospot, is considered the standard test to diagnose EBV infections. A sample of the patient's blood is taken and analyzed for the presence of EBV antibodies. When the EBV virus enters the body, the patient's immune system develops these antibodies to fight against the infection. If antibodies are present, a positive diagnosis is made.
Sometimes, early in the infection or in young children, the antibody test produces false negative results. This means the patient tests negative for the infection even though he/she is, in fact, infected. Therefore, if patients test negative, but EBV is strongly suspected, additional antibody tests may be performed.

Complications

Ruptured spleen: Many patients with mononucleosis caused by the Epstein-Barr virus develop an enlarged spleen. In extreme cases, the spleen may rupture. This is most likely to happen if the person participates in rigorous physical activities while he/she is sick. Patients who rupture their spleens typically experience a sharp and sudden pain in the upper-left side of the abdomen. If this type of pain develops, patients should be taken to the nearest hospital immediately. A ruptured spleen generally requires surgery.
Nerve problems: Complications of the nervous system are rare, but may include nerve damage, seizures, behavioral changes, inflammation of the brain (called encephalitis), and inflammation of the tissues surrounding the brain and spinal cord (called meningitis).
Blocked airways: In rare cases, the lymph nodes in the neck may become extremely large and block the airways. This may make it difficult for the patient to breathe.

Treatment

General: There is currently no treatment available to cure infections with the Epstein-Barr virus. Patients do not receive antiviral medications because they may actually worsen the condition. Instead, treatment focuses on reducing symptoms until the infection goes away on its own. Most symptoms begin to improve after a few weeks. However, fatigue and an enlarged spleen and lymph nodes may take several weeks to months to improve.
Over-the-counter pain relievers: Acetaminophen (Tylenol?) or ibuprofen (Advil? or Motrin?) may be taken to help relieve fevers, reduce inflammation of the throat, and lessen aches and pains.
Bed rest: Patients with EBV infections should get plenty of rest. This allows the body to focus most of its energy on fighting off the infection.
Individuals who have mononucleosis should avoid vigorous physical activities, including heavy lifting and contact sports, for about one month, even if the spleen is not noticeably enlarged. This helps reduce the risk of rupturing the spleen. Some doctors may ask patients to come back for follow-up exams to ensure that the spleen has returned to its normal size before engaging in rigorous physical activities.
Individuals who return to their usual activities too soon have an increased risk of experiencing a relapse.
Drink plenty of fluids: Individuals with EBV infections should drink plenty of fluids, especially water. This helps reduce fevers and improve symptoms of a sore throat. It also helps prevent dehydration.
Steroids: In some cases, a doctor may prescribe a corticosteroid medication, such as prednisone, to help reduce swelling of the throat and tonsils. Some evidence suggests that these medications may also help reduce the length and severity of the infection. However, additional research is needed to confirm these claims.

Integrative therapies

Unclear or conflicting scientific evidence:
Alizarin: Limited available evidence suggests that alizarin may be effective for viral infections, such as various herpes infections. Additional study is needed before a conclusion can be made.
Avoid if allergic or hypersensitive to alizarin or any plants in the Rubiaceae family. Alizarin may be toxic and should not be handled for long periods of time, rubbed in the eyes or eaten. Avoid if pregnant or breastfeeding.
Blessed thistle: Available laboratory studies do not report activity of blessed thistle against herpes viruses, influenza, or poliovirus. Human research of blessed thistle as a treatment for viral infections is currently lacking.
Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers, and vomiting. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding.
Cranberry: Cranberries come from small evergreen shrubs with tart, red, edible berries. The berries are used in sauces, jellies, and drinks. Limited laboratory research has examined the antiviral activity of cranberry. These antiviral properties may help the body fight against viruses, such as the Epstein-Barr virus (EBV). However, reliable human studies demonstrating the antiviral and antifungal effects of cranberry are currently lacking. Additional research is warranted.
Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Avoid more than the amount usually found in foods if pregnant or breastfeeding.
Focusing: Focusing (experiential therapy) is a method of psychotherapy that involves being aware of one's feelings surrounding a particular issue and understanding the meaning behind words or images conveyed by those feelings. Early research suggests that increased experiential involvement (an indication of focusing taking place) does not have an effect on Epstein-Barr virus antibody titers. More studies in the area of immune function and antibody production are required before a conclusion can be made in this area.
Reports of side effects with using focusing therapy are currently lacking. Patients should consult with their qualified healthcare practitioners before making decisions about medical conditions and practices. Individuals with severe emotional difficulties should not abandon proven medical and psychological therapies. Instead, focusing should be used as a possible adjunctive therapy.
Sorrel: There is currently not enough evidence on the antiviral effects of sorrel. Additional research is needed.
Avoid large doses of sorrel because there have been reports of toxicity and death. This may be because of the oxalate found in sorrel. Many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. High alcohol content sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl?) or disulfiram (Antabuse?). Avoid if pregnant or breastfeeding.
Turmeric: Evidence suggests that turmeric may help treat viral infections. However, there is not enough human evidence in this area. Well-designed trials are needed to determine if these claims are true.
Avoid if allergic or hypersensitive to turmeric, curcumin, yellow food colorings, or plants belonging to the Zingiberaceae (ginger) family. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, diabetes, hypoglycemia, or gallstones. Use cautiously with blood-thinners, such as warfarin (like Coumadin?), and blood sugar-altering medications. Avoid in medicinal amounts if pregnant or breastfeeding. Turmeric should be stopped prior to scheduled surgery.
Traditional or theoretical uses lacking sufficient evidence:
Chaparral: Native Americans have used chaparral leaves and stems to treat cancer, arthritis, and colds. Although chaparral has been suggested as a possible treatment for the Epstein-Barr virus, research is lacking in this area. It remains unknown if this is a safe and effective therapy in humans.
Avoid if allergic to chaparral or any of its components, including nordihydroguaiaretic acid. Chaparral has been associated with multiple serious and potentially fatal adverse effects in animals and humans. Therefore, it is not recommended for general use. Avoid with kidney or liver dysfunction. Use cautiously if taking blood thinners, blood sugar medications, or drugs that are broken down by the liver (such as amiodarone, phenobarbital, or valproic acid). Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously if driving or operating heavy machinery. Avoid if pregnant or breastfeeding.
Chrysanthemum: Chrysanthemum is a popular plant for its ornamental, food, and insecticidal uses. Worldwide, chrysanthemums are planted in gardens for their flowers and are often associated with autumn in temperate climates. Early laboratory evidence suggests that the constituents of chrysanthemum may help the body fight against the Epstein-Barr virus. However, this cannot be verified until well-designed human trials are performed.
Use cautiously if allergic to chrysanthemum, feverfew, tansy, chamomile, Artemisia vulgaris, Liliaceae plants, tulip, Easter lily, Gerbera, lettuce, Senecio cruentus, Aster, Matricaria, Solidago, daisy, dandelion, Parthenium hysterophorus L., Xanthium strumarium L., Helanthus annuus L., Frullania dilatata, Frullania tamarisci, Arnica longifolia Eaton, Arnica montana L., primrose, sunflower, ragweed, the pollen of the Amaryllidaceae family, or mugwort. Avoid if sensitive to light or if taking agents that cause sensitivity to light. Avoid large acute or chronic doses of ingested pyrethrin. Avoid pyrethrin in patients with compromised liver function, epilepsy, asthma, or who are pregnant or breastfeeding. Do not expose the eyes to pyrethrin. Use cautiously if immunocompromised. Use cautiously if taking medications for gout, HIV, or cancer.
Colon therapy/colonic irrigation: Colon therapy is the use of herbs or water to clean out the colon or large intestine to treat certain health conditions. It has been suggested, but not scientifically proven, that colon therapy may help treat infections with the Epstein-Barr virus.
Excessive treatments may allow the body to absorb too much water, which causes electrolyte imbalances, nausea, vomiting, heart failure, fluid in the lungs, abnormal heart rhythms, or coma. Infections have been reported, possibly due to contaminated equipment or as a result of clearing out normal colon bacteria that destroys infectious bacteria. There is a risk of the bowel wall breaking, which is a serious complication that can lead to septic shock and death. Avoid with diverticulitis, ulcerative colitis, Crohn's disease, severe or internal hemorrhoids, rectal/colon tumors, or if recovering from bowel surgery. Avoid frequent treatments with heart or kidney disease. Colonic equipment must be sterile. Colonic irrigation should not be used as the only treatment for serious conditions. Avoid if pregnant or breastfeeding due to lack of scientific data.
Licorice: Licorice is harvested from the root and dried rhizomes of the low-growing shrub Glycyrrhiza glabra. It has been proposed that licorice may help treat infections with the Epstein-Barr virus. However, studies have not been performed to determine if this therapy is safe and effective in humans.
Avoid if allergic to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney disease, liver disease, fluid retention, high blood pressure, or hormonal abnormalities. Avoid if taking diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.

Prevention

Because the Epstein-Barr virus is extremely common, and some individuals can carry and spread the virus intermittently throughout their lives, it is almost impossible to prevent an infection. That is why more than 95% of American adults have been infected with EBV at some point in their lives.
Avoiding close contact with individuals who have contagious illnesses may help reduce the risk of acquiring infections. Practicing good hygiene, regularly washing the hands with soap and warm water, and using hand sanitizers may help reduce the risk of acquiring infections.
Individuals should not share kitchen utensils with individuals who have EBV, unless they are properly cleaned with soap and warm water first.
Individuals should not share food or beverages with individuals who have EBV.
Individuals should not open-mouth kiss individuals who have EBV.
Individuals who have been diagnosed with mononucleosis should not donate blood for at least six months after the onset of the infection.

Author information

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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Causes

Although the Epstein-Barr virus (EBV) is less contagious than the common cold, it may still be passed on to others. It is transmitted through contact with an infected person's saliva. For instance, individuals can acquire the disease after kissing an infected person or sharing food or beverages with an infected person. The infection is rarely transmitted through airborne mucus droplets or contact with infected blood.
Individuals are typically contagious for several weeks after signs and symptoms develop. However, some people may carry and spread the virus intermittently throughout their lives. For this reason, it is almost impossible to prevent transmission of the virus.
Individuals who have already been infected with EBV rarely become infected again.