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.

The following signs and symptoms accompany mono:

• Fever
• Fatigue
• 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 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.

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 products.

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

• 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 adulthood
• Getting a blood transfusion
• Diminished or suppressed immune function

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 spleen.

Your provider may prescribe the following medications:

• Acetaminophen
• 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.

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

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 any infection.

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.

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 improve recovery.

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 EBV:

• 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 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; 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 lymph.

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 breathing.

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