Mononucleosis

Overview and Alternative Names

Mononucleosis has several names such as mono, kissing disease, Pfeiffer’s disease, Filatov’s disease, and glandular fever. Regardless of the name, infectious mononucleosis is an infection caused by the Epstein-Barr virus, which produces flu-like symptoms and extreme fatigue.

Causes

Infection mononucleosis is caused by the Epstein-Barr virus. Viruses are microscopic pathogens made up of RNA or DNA that invade an organism’s cells in order to reproduce. Viruses infect all kinds of life including humans. When a virus enters a healthy cell, it begins to take over the cell and introduces its genetic code into the host cell’s DNA. Soon, after genetically manipulating the cell’s DNA, the virus gains complete control over the cell’s functions. When this occurs, the virus can use the cell to make copies of itself so that it can reproduce.

Symptoms of Mono

The copies are then released, which allows them to be free to infect other cells. The process repeats itself until the body’s immune system kills the virus or acquires immunity to it. The body’s immune system is its system of defenses that protect it from invading pathogens such as bacteria and viruses. When the body detects a foreign object or organism, it produces an immune response in an effort to rid the body of the pathogen. Specialized white blood cells are released in order to hunt down the bacteria or viruses and to kill them.

Epstein-Barr

The Epstein-Barr virus is a member of the herpes virus family. Epstein-Barr virus is a common virus to which more than 90% of the population has been exposed over the course of a life time. In those who do not show immunity to the virus, it may produce infectious mononucleosis, particularly in adolescents and adults. The Epstein-Barr virus has also been shown or theorized to cause a number of diseases such as some cancers and some autoimmune diseases such as multiple sclerosis.

The Epstein-Barr virus is primarily transmitted through saliva. For this reason, it has become known as the “kissing disease.” Once the virus has been passed from one person to another, there is a period of between 4-7 weeks from the time of infection till symptoms appear.

This is referred to as the incubation period. After the first symptoms appear, most symptoms resolve themselves after 2-3 weeks. Fatigue, however, may last much longer. Although greater than 90% of the population has been infected with Epstein-Barr virus, only between 35% and 69% of infected people go on to develop infectious mononucleosis.

Once a person is infected with the Epstein-Barr virus, they will have traces of the virus in their bodies for the duration of their lifetime. The immune system never completely removes the virus, which goes into a dormant phases when the symptoms of mononucleosis have subsided. A dormant phase is a period of inactivity where the virus goes into a kind of sleep mode and does not reproduce. Because the virus is a permanent part of the person’s body after infection, it can change from being dormant to being active again without warning. It is therefore possible that individuals infected with mononucleosis can have repeat occurrences of the disease.

Research is not conclusive over how long a person is contagious after the symptoms of the virus have subsided. Some studies show that a person is contagious for only a few weeks during and after symptoms appear, while other data show that a person can transmit the virus for as many as 18 months after symptoms subside.

Symptoms of Infectious Mononucleosis

In most cases of infectious mononucleosis, the disease causes several nondescript, flu-like symptoms that may include fever, sore throat, and swollen lymph nodes. Another aspect of infectious mononucleosis is its ability to cause extreme fatigue in even the most robust individual. Occasionally, mononucleosis can cause inflammation of the liver, which can cause jaundice and hepatitis. Also, the spleen may become inflamed. Less common symptoms include low platelet count, low blood count, pericarditis, inflammation of the lungs, and rash on the skin. Severe swelling of lymph nodes in a person’s neck may cause serious problems such as difficulty breathing and swallowing. Immediate medical attention should be sought if breathing problems develop. Trouble swallowing can lead to dehydration if adequate fluid intake is not maintained.

Diagnosis

Diagnosis of infectious mononucleosis is generally made with blood tests in combination with a full patient history. When a person shows symptoms of fever, sore throat, fatigue, and swollen lymph nodes, a doctor may suspect mononucleosis. However, this in of itself is not enough to make a diagnosis. In conjunction with general symptoms, a physician will do blood work on the patient. If the tests come back and show that at least 50% of white blood cells with at least 10% being abnormal are present, and the patient presents with typical symptoms of mononucleosis, a diagnosis of infectious mononucleosis can be made.

Tests for antibodies can be performed, but they frequently lack sensitivity. In other words, they produce a high number of false positive and false negative results, rendering their use ineffective without taking into account physical symptoms experienced by a patient. More recent test have been developed which can detect the Epstein-Barr virus. A shortcoming of these newer tests, though, is that antibodies may not show up for several weeks after infection and symptoms have occurred, making definitive diagnosis slow, and extending treatment time. High levels of a liver enzyme called transaminase can also indicate mononucleosis in 50% of patients.

Effects of Mono

Since the symptoms of mononucleosis can be vague and resemble the symptoms of many other diseases, diagnosis is often difficult. Many people who go to a doctor complaining of a sore throat are misdiagnosed with strep throat and given antibiotics. Antibiotics are ineffective against viruses and have no effect on the symptoms of mononucleosis.

Cytomegalovirus is another member of the herpes family of viruses and is closely related to the Epstein-Barr virus. It may also produce similar symptoms to mononucleosis, but the symptoms may be milder. Like Epstein-Barr virus, cytomegalovirus remains in the body for the duration of a person’s life.

Risk Factors

Mononucleosis can strike anybody at any age. The symptoms and the duration of the disease usually get worse as a person ages, meaning that infected children often may not even know they are infected, while adolescents and adults may develop serious complications and have fatigue that lasts for months. There are several factors that may increase the risk of a person contracting mononucleosis. These include:

Being Between Ages 10 and 24

These individuals are more likely to be unaware of the causes of mononucleosis and how to prevent infection. Persons in this age may also engage in riskier behavior, which increases the chances that they can become infected with the Epstein-Barr virus.

In Large Groups

Individuals like nurses, doctors, military personnel, and students, who come into contact with a large number of people daily, have an increased risk of being infected with mononucleosis. This is because Epstein-Barr virus is so common in the general population that increasing the number of people a person comes into contact with increases the chance that they will come into contact with someone who carries the virus and may be contagious.

Intimate Relationships

Intimate relations with someone who has Epstein-Barr virus or mononucleosis increases the chances that they will become infected as well. Kissing can expose a person to infected saliva, which can spread the virus. Also, even though a person may not have symptoms of mononucleosis at the present moment, does not mean that they are not contagious. Contagiousness may extend for up to a year and a half after symptoms disappear.

Oral Contact

Kissing is not the only way to spread mononucleosis. Any exchange or exposure to saliva can transmit the Epstein-Barr virus. Sharing food or a drink with an infected person can lead to infection. Also sharing toothbrushes or coming into contact with anything that a person may have put into their mouth may lead to an increased risk of being infected with the Epstein-Barr virus.

Immune Compromised Individuals

People with compromised immune systems are at greater risk of developing mononucleosis than individuals with normal immune systems. With a lowered immune response, these individuals may not be able to fight off the Epstein-Barr virus before it develops into mononucleosis. People who are on immunosuppressants, like those who have undergone organ transplantation are especially susceptible.

Also, individuals who have HIV/AIDS also have compromised immune systems which may increase their risk of contracting the Epstein-Barr virus. Finally, the extremely young and the extremely old often have compromised immune systems which can make them more likely to become infected with the Epstein-Bar virus. In the case of the elderly, because of their age and exposure over a lifetime, it’s much less of a problem since most have already been infected year earlier.

Conventional Treatment

Viruses do not respond to antibiotic treatment. In fact, there is still no effective way known that can target the Epstein-Barr virus specifically and kill it. Treatment of mononucleosis, then therefore, relies on treating the symptoms of the disease in order to make the patient comfortable till the disease runs its course over the period of a couple of months.

To treat fever, a doctor may recommend acetaminophen or a non-steroidal anti-inflammatory drug (NSAID). Patients should follow manufacturer dosing instructions and be aware of the long term consequences of taking these drugs. For patients who have inflammation of the liver, alcohol consumption should be prohibited.

The liver is responsible for metabolizing and filtering alcohol from the blood, so when it is not functioning correctly, it may not be able to handle the extra stress of alcohol in the system. Corticosteroids may be taken to reduce inflammation of the liver, spleen and throat. These may have some side effects like weight gain, fluid retention, and nervousness. Physicians may recommend a person eat cold items like ice cream or milk to sooth a sore throat. Also, it may help to gurgle salt water.

When symptoms manifest, it is important to get plenty of rest. As symptoms wane, regular activities can be continued. It is also important not to do any strenuous activity in order to avoid rupturing the spleen. Also, to prevent the infection of anyone else that may come into contact with a person suffering from mononucleosis, it is imperative to avoid sharing drinks, food, and toothbrushes. It is also important to cover the mouth when coughing to prevent aerosol droplets of saliva from entering the air.

As of now, there is no vaccine for Epstein-Barr virus, although much research is being done to develop and effective vaccine that can either destroy the virus or prevent the symptoms of mononucleosis from manifesting.

Alternative and Natural Treatments

Many alternative therapies for the treatment of mononucleosis exist. Some of these treatments focus on boosting the effectiveness of the body’s immune system.

One way to maintain a healthy immune system is to eat a diet that is full of nutrients but low in fat. Consumption of vegetables that contain antioxidants can help the functioning of the immune system. Also, supplementing with vitamins such as vitamin A and vitamin C has been shown to boost the immune system. These can be bought online and in local health food stores at very affordable prices.

Often they are sold in pills by the hundreds which should last several months. Pricing depends on the quantity and quality of the vitamin supplements. For vitamin A, the maximum recommended dose per day is less than 3000 micrograms in order to avoid toxicity. Vitamin C can be taken in higher doses because it is water soluble and easily eliminated from the body. As always, it is important to follow manufacturer provided dosages when beginning vitamin supplementation.

Coconut Oil & Herbal Tea

Coconut oil supplements may also be able to help treat mononucleosis. Coconut oil contains lauric acid, which is converted in the body to monolauric acid. This molecule is purported to be an effective antiviral agent, which may help to kill the Epstein-Barr virus. Coconut oil pills are available in soft gel capsules in health food and nutritional stores. Coconut oil is also sold in liquid form that can be taken in doses of 2 tablespoons per day to treat mononucleosis.

Herbal teas may also help combat mononucleosis. Teas made by brewing burdock, ginseng, cayenne pepper, and goldenseal root in water can be helpful in treating mononucleosis. A tea is made by boiling one teaspoon of each ingredient in 2 cups of water. The mixture should be reduced over high heat until evaporation leaves one cup of liquid. The tea can be taken once a day.

Finally, it is important to drink enough fluids to guard against dehydration and to sooth sore throats.

As always it is important to consult with a doctor before beginning any alternative treatments in order to prevent drug interactions or complications from taking supplements.

Conclusion

Mononucleosis is a very common disease that can have long lasting effects and ramifications for the patient and everyone that he or she comes into contact. Mononucleosis can be passed for a long time after the virus has caused symptoms, so caution must be taken to prevent its spread. Although the symptoms are mot typically life threatening, they can affect a person’s quality of life for several months. Mononucleosis is caused by the Epstein-Barr virus. Like all viruses, there is no effective cure that can target and kill the virus. Instead, treatment consists of providing support and comfort till the symptoms subside.


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  1. Adrienne Faye 4 January 2012 at 8:05 am permalink

    Hi – I’ve been just diagnosed with Epstein Barr disease. I don’t know how long I have had it. However, if it is transmitted by saliva when will I be able to kiss a man, or have intimate relations with him?
    thanks in advance


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