Infectious mononucleosis, also referred to as "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. Direct contact
with virus-infected saliva, mainly through kissing, can transmit the virus and
cause mono. Mono affects about 45 people out of 100,000.
Signs and Symptoms
The following signs and symptoms accompany mono:
Sore throat, often severe
Swollen lymph nodes in the neck
Enlargement of the spleen
Enlargement of the liver
Symptoms may take between 4 and 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 to 6 weeks.
What Causes It?
The Epstein-Barr virus (EBV) causes the vast majority of mono cases; 90% of
adults have antibodies to the virus reflecting former exposure and immunity
against EBV. EBV infects and reproduces in the salivary glands. Direct contact
with virus-infected saliva, such as by kissing, can transmit the virus and cause
mono. You can also get mono through transfusions with infected blood
Who's Most At Risk?
The following factors can put a person at higher risk for developing
Age: the incidence peaks in the 15- to 19-year age group; after age
35, the rate is low
Delayed exposure: mono is more prevalent in areas with higher
standards of hygiene, where infection with EBV is often delayed until
Getting a blood transfusion
Diminished or suppressed immune
What to Expect at Your Provider's Office
Your healthcare 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.
Since 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.
Rest is necessary when symptoms are severe; increased activity is allowed as
the symptoms improve, generally after about 2 weeks. Contact sports and heavy
lifting should be avoided for 2 months due to the risk of rupturing the
Your provider may prescribe the following medications:
Corticosteroids, such as prednisone, are used only to treat airway
obstruction from enlarged tonsils
Children with EBV should not take aspirin because of the risk of developing
Reye's syndrome, a rare condition that can cause vomiting and can affect the
liver, brain, and other organs.
Surgical and Other Procedures
In the case of a ruptured spleen associated with mono, surgical removal of
the spleen may be necessary.
Complementary and Alternative Therapies
Several studies show that stress and relaxation affect our immune systems.
Stress can increase susceptibility to infection. Steps that reduce stress may
help prevent infection with viruses such as EBV.
A meta-analysis (summary of the results of several studies) of 24 studies
reviewed immune changes in healthy people under short-term stress. Results
showed that the subjects' immune systems did not respond as well during stress
to phytohemagglutinin, a plant compound that normally boosts immune system cells
called T cells. A similar meta-analysis looked at the results of 10 relaxation
studies. It showed that relaxation methods reduced white blood cells (which rise
in number during infection), and increased the number of antibodies (which fight
infection) and the activity of "natural killer" cells (immune cells that attack
infected cells and other harmful cells). Stress-reduction measures included
guided imagery, meditation, and biofeedback. It's not clear yet what this may
mean for prevention or treatment of EBV specifically. But it sheds light on the
ways relaxation methods may boost immune function in general and reduce risk of
There is some evidence that nutrition and plant-based medicines may help
reduce the long-term effects of EBV infection and complications linked to
When you have an infection, your immune system needs more folate (vitamin
B9) to make new cells and antibodies. Blood levels of folate were
tested in 260 patients with a variety of viral and other infections, 15 of whom
were infected with EBV. Nine of these 15 patients with mono had insufficient
amounts of folate; patients with other infections had similar deficiencies. The
authors of the study suggest that the folate shortage may relate to fatigue and
a long recovery period following a viral infection, including EBV. It is not
definitive without additional research, but taking folate supplements may
No scientific studies have reviewed the value of herbs in treating EBV
specifically. However, herbalists may use herbs that boost the immune system to
try to prevent or treat viral infections in general. Echinacea (Echinacea
spp.), wild indigo (Baptisia tinctoria), and licorice
(Glycyrrhiza glabra) are used in acute conditions to boost immunity and
improve the flow of lymph. Retinoic acid and glycyrrhetinic acid are derivatives
of licorice root (Glycyrrhiza glabra) and may be used for similar
purposes. Astragalus (Astragalus membranaceus) and lomatium (Lomatium
dissectum), which have deeper immune-enhancing properties, are used to treat
established infections or chronic problems.
There have been few studies examining 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. In homeopathic terms, a person's constitution is
his or her 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 were found to be effective for fever related to
Belladonna — for early stages of
mononucleosis with sudden onset of fever; this remedy is most appropriate for
individuals who have a red face, red lips and a dry, throbbing throat with
swollen tonsils; despite these symptoms the individual tends not to be thirsty
Ferrum phosphoricum — for individuals
with the early stages of a fever accompanied by a painful cough and sore chest;
this remedy is most appropriate for individuals who feel exhausted and have
night sweats but are not as red and hot as those who are appropriate for
Belladonna; symptoms tend to worsen at night
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
Professional homeopaths may also recommend the following
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; the individual for whom
this remedy is appropriate tends to have a high fever with chills and
exhaustion; he or she may also be averse to hot drinks
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.
No scientific studies have reviewed the use of acupuncture for mono; however,
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
Traditional Chinese Medicine
Studies have shown that individuals 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.
No scientific studies have reviewed the use of massage for mono; however, it
may help relieve the muscle aches and pains associated with chronic EBV
infection and reduce stress. As discussed earlier, stress can increase a
person's susceptibility to infections.
Most people with mono recover uneventfully and can return to school or work
in a few weeks. Fatigue can continue for months for a small percentage of
people. Severe complications are uncommon, and may include problems with the
central nervous system or liver, rupture of the spleen, or difficulty
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Review Date: October 2000
Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD,
Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University
and Senior Medical Editor Integrative Medicine, Boston, MA; Richard A. Lippin,
MD, President, The Lippin Group, Southampton,
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