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Mononucleosis

Introduction:

Infectious mononucleosis, or mono, is often called "the kissing disease" because that’s one of the ways you can get it. It’s caused by a virus spread through saliva. Symptoms include fever, sore throat, and swollen glands. Mono can also be spread by sharing eating utensils or glasses. A person is contagious several days before symptoms appear and for some time after.



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 not show up until 4 - 7 weeks after you’ve been exposed to the virus. Symptoms may last only a few days or as long as several months. In most cases, they go away in 2 - 6 weeks.



What Causes It?:

The Epstein-Barr virus (EBV) causes mono. Direct contact with saliva that’s infected with the virus, mainly through kissing, can pass the virus on. You can also get mono through transfusions with infected blood products.

Mono affects about 45 of 100,000 people, mostly 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 to the virus.



Who's Most At Risk?:

The following factors can raise your risk for developing mono:

  • Age -- Mono is most common among people ages 15 - 19. After age 35, the rate is low.
  • Blood transfusion
  • Weakened immune system


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 swelling of your spleen or liver. Your doctor may also do a blood test to confirm the diagnosis.



Treatment Options:

Prevention

Someone who has mono doesn't need to be isolated because the virus isn't usually spread through the air. Family members or college roommates have only a slight risk of being infected, unless they kiss the person. It's best not to share eating utensils or toothbrushes.

Treatment Plan

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 get better after about 2 weeks. People with mono 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 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, you may need surgery to remove it.

Complementary and Alternative Therapies

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

While no herbs or supplements treat mono specifically, some may help reduce the long-term effects of EBV infection and complications linked to EBV.

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

Nutrition and Supplements

These nutritional tips may help reduce symptoms and strengthen your immune system:

  • 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 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.
  • 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 caffeine, alcohol, and tobacco.
  • Drink plenty of 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, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources. Fish oil may increase the risk of bleeding, especially if you also take blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.
  • Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for gastrointestinal and immune health. Taking antibiotics can upset the balance between good and bad bacteria in your gut and cause diarrhea. Taking probiotics, or "friendly" bacteria, may help restore the right balance. If you take drugs to suppress your immune system or have a weakened immune system, ask your doctor before taking probiotics.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting treatment.

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

  • Green tea (Camellia sinensis) for antioxidant, anti-inflammatory, and immune effects. Use caffeine-free products. You may also make teas from the leaf of this herb.
  • Echinacea (Echinacea purpurea) to strengthen the immune system. Do not give echinacea to a child without talking to your doctor first. People with autoimmune diseases, such as rheumatoid arthritis, should not take echinacea.
  • Astragalus (Astragalus membranaceus) has not been studied for mono, but it does seem to kill viruses, at least in test tube studies. Researchers don't know whether it would work against the Epstein-Barr virus. People who have autoimmune diseases, such as rheumatoid arthritis, or who take anticoagulants (blood thinners), diuretics (water pills), lithium, cyclophosphamide (Cytoxan), medication for high blood pressure, or medication to lower blood sugar should not take astragalus without talking to their doctor first.
  • Cranberry (Vaccinium macrocarpon) appears to fight viruses, although no one knows whether it works against the Epstein-Barr virus. Cranberry may increase the risk of bleeding, especially if you also take blood thinners. People who are allergic to aspirin should not take cranberry supplements or drink large amounts of cranberry juice.

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 have fewer 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. Chinese herbs are prescribed on an individual basis. They may have side effects and can interact with many medications and with other herbs and supplements. You should not take these herbs without the supervision of a practitioner trained in traditional Chinese medicine.



Prognosis and Possible Complications:

Most people with mono recover fully 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. They may include anemia, problems with the central nervous system or liver, rupture of the spleen, or inflammation of the heart.



Supporting Research:

Beers MH, Porter RS, et al. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:1610-1612.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr. 2006;25(2):79-99.

Carillo-Vico A, Reiter RJ, Lardone PJ, et al., The modulatory role of melatonin on immune responsiveness. Curr Opin Investig Drugs. 2006;7(5):423-31.

Chiang LC, Ng LT, Cheng PW, Chiang W, Lin CC. Antiviral activities of extracts and selected pure constituents of Ocimum basilicum. Clin Exp Pharmacol Physiol. 2005;32(10):811-6.

Clancy RL, Gleeson M, Cox A, et al. Reversal in fatigued athletes of a defect in interferon gamma secretion after administration of Lactobacillus acidophilus. Br J Sports Med. 2006;40(4):351-4.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-75.

Fujimoto H, Asaoka K, Imaizumi T, Ayabe M, Shoji H, Kaji M. Epstein-Barr virus infections of the central nervous system. Intern Med. 2003 Jan;42(1):33-40.

Mayer KE, Myers RP, Lee SS. Silymarin treatment of viral hepatitis: a systematic review. J Viral Hepat. 2005;12(6):559-67.

Petersen I, Thomas JM, Hamilton WT, White PD. Risk and predictors of fatigue after infectious mononucleosis in a large primary-care cohort. QJM. 2006 Jan;99(1):49-55.

Reiche EM, Morimoto HK, Nunes SM. Stress and depression-induced immune dysfunction: implications for the development and progression of cancer. Int Rev Psychiatry. 2005;17(6):515-27.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-19.

Yao Y, Duan HM, Yan HM, Zhen XF, Pan YC, Yao Y, Chen L, Jing XF, Chen HL. Clinically controlled study on children's infectious mononucleosis treated by Chinese medicine. Chin J Integr Med. 2009 Oct;15(5):347-52.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.



Alternative Names: Epstein-Barr virus


Review Date: 6/22/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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