Mononucleosis

Signs and Symptoms

• Chills
• Fever
• Fatigue
• Weakness
• Sore throat, often severe
• Loss of appetite
• Swollen tonsils
• Swollen lymph nodes in the neck
• Enlargement of the spleen
• Enlargement of the liver
• Rash
• Headache
• Sensitivity to light

The fever usually drops in 10 days, and swollen lymph glands and spleen heal in 4 weeks. Tiredness usually goes away within a few weeks, but it may linger for 2 to 3 months. Nearly everyone recovers completely.

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 500 out of 100,000 people worldwide, mostly teens and young adults. It usually isn't a serious disease. But 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 to 24. After age 35, the rate is low.
• Blood transfusion.
• Weakened immune system.

What to Expect at Your Doctor's Office

Your doctor 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. Symptoms typically begin to improve after about 2 weeks. People with mono should avoid contact sports and heavy lifting for at least a month due to the risk of rupturing the spleen. Talk with your doctor about when you can return to vigorous activities.

Drug Therapies

There is no cure for mono, but your health care provider may prescribe the following medications to treat your 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.
• 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 oils, such as olive oil and canola 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 reduce 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), 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. People who have ragweed allergies should be extra cautious since they may be allergic to Echinacea as well.
• 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 EBV. 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 EBV. 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

According to the National Institutes of Health, there is little evidence to support homeopathy as an effective treatment for any specific health condition. Also, while most homeopathic remedies contain small amounts of the active ingredient, they may still have side effects and drug interactions. If you choose a homeopathic product to use on your own, it's best to talk with your health care provider before you use it to check for possible side effects or drug interactions.

If you decide to work with a homeopath, choose someone with training and experience and discuss any potential treatments carefully.

A professional homeopath may recommend one or more treatments for mononucleosis based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, which includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular person.

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.

Professional homeopaths may also recommend the following remedies:

• Mercurius. For individuals with a fever accompanied by profuse sweating, alternating hot and cold body temperature, sore throat, and swollen glands.
• Phytolacca. For pain caused by throat inflammation that radiates to the ears upon swallowing.

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. People who have had mononucleosis are at increased risk of developing multiple sclerosis (MS).

Supporting Research

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Bokelmann JM. Echinacea (Echinacea purpurea, Echinacea angustifolia) leaf, flower, stem, root. In: Bokelmann JM, ed. Medicinal Herbs in Primary Care. Philadelphia, PA: Elsevier; 2022:chap 41.

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