Mononucleosis

If you are a teen or young adult, you are more likely to experience many of the signs and symptoms of mono. Young children may become infected and not show any signs and symptoms or such slight symptoms that the virus goes undiagnosed. The symptoms of infectious mononucleosis include:

• Extreme fatigue
• Feeling unwell
• Rash
• Headache
• Sore throat (often thought to be strep)
• Swelling of the tonsils
• High fever
• Swollen lymph nodes (especially in the neck and armpits)
• Head and body aches
• Tender swollen spleen

Mononucleosis can mimic many other illnesses. If you were diagnosed with strep or any other illness with these symptoms and they do not go away within two weeks, see your doctor to be tested for mono. In some cases, people with mono may develop an enlarged spleen and a swollen liver after the fatigue symptom goes away. Be sure to tell your doctor if any new tenderness shows up after you feel you have recovered.

Infectious mononucleosis can be caused by several viruses, but the most often caused by the Epstein-Barr virus (EBV). The Epstein-Barr virus replicates in the skin cells of the mouth and throat where it is released into the saliva and infects the immune-fighting cells known as B-cells found in the lymphoid tissue. These infected cells travel through the lymph system and incubate for a long time, anywhere from 30 to 50 days. EBV is a herpes-type virus, which typically causes a life-time infection that exists in a latent state unless reactivated. If the virus reactivates, it will again shed into the saliva secretions from the mouth and throat. Other viruses that cause infectious mononucleosis are:

• Adenovirus
• HIV
• German measles (rubella)
• Hepatitis A, B, or C
• Toxoplasmosis

Mononucleosis that is caused by EBV is usually spread by contact with saliva. Any contact with the saliva, bodily fluids, or blood of someone infected with the EBV virus increases your risk of developing infectious mononucleosis. If you have a compromised immune system then you have a higher risk of developing symptoms with a first-time exposure to the Epstein-Barr virus and of a relapse of symptoms caused by a reactivation of the virus. Other risk factors include:

• Sexual contact
• Organ transplant
• Blood transfusion
• Sharing drinks
• Sharing a toothbrush
• Kissing

If you have the symptoms above see your doctor. Mono can be a severe infection and requires rest, fluids, and restrictions until you recover. Getting diagnosed early can prevent complications. The doctor will perform a few tests to confirm if you have mono including:

The monospot test. If you have symptoms of mono, your doctor can perform this preliminary test right away. It isn’t very accurate but can confirm a case of general infectious mono. Testing for the Epstein-Barr virus needs more sensitive testing. With these tests, the doctor can tell what stage of mono you are at; Acute phase, recovery phase, and antibodies that last for life after the infection clears. These include:

Acute Mono and Recovery Phase

Early antigen (EA). This is elevated during acute mono and goes away 3 to 6 months after recovery. This tells your doctor you are in the middle of an active mono-infection.

Anti-VCA IgM. This antibody will show up during the acute mono phase and go away 4 to 6 weeks after infection.

Anti-VCA IgG. This antibody shows up during acute mono and is at its highest 2 to 4 weeks into the infection, but stays in the body for life.

These tests usually peak during the acute phase of a mono-infection and decline over the recovery phase. Doctors can usually tell what phase you are at in the infection by how the numbers on these tests look. For example; you may have some Early Antigen (EA) present in your blood, but also beginning to decline on the Anti-VCA IgG. With this information, the doctor can tell you if you have had mono for about 3 to 4 weeks and you should be feeling better soon.

Post-Infection Antibodies

EBV nuclear antigen (EBNA). This test will not be positive during the acute mono phase but will show antibodies around 2 to 4 months after your recovery from mono. These antibodies stay in your body for life. This test is useful to show the doctor if you have had mono in the past.

Imaging studies. Your doctor may check your lymph nodes and spleen with either a CT scan or an ultrasound. The virus can cause severe inflammation and secondary infections in the lymph nodes. A CT scan can check the spleen for enlargement and check for rupture.

Mono is a virus. Antibiotics will not work. Often the diagnosis of mono is made after antibiotics have been prescribed for strep throat fail to clear the infection. The following are the treatments for mono:

Bed rest. The infection is sometimes so severe, you are too fatigued and weak to get out of bed. This usually goes away after about two weeks. Do not do any heavy lifting or contact sports for 8 weeks. The spleen may become inflamed and can rupture.

Fluids. As with any infection, it is important to get plenty of fluids. Warm drinks can help your sore throat and electrolyte replacements can help prevent dehydration.

Pain and fever medications. Your doctor may instruct you to take acetaminophen or ibuprofen for pain and fever. Do not give aspirin to children and teenagers due to the risk of Reye syndrome, which is a severe reaction.

Acyclovir. This antiviral medication inhibits the genetic component of EBV that replicates the virus. However, clinical trials have not shown a clinical benefit in the treatment of infectious mononucleosis so your doctor will not prescribe this medication for active mono symptoms, but may prescribe it to you if you have tested positive for Epstein-Barr virus.

Corticosteroids. These oral steroids may help reduce inflammation in the oral airway and prevent airway obstruction. They may also help shorten the duration of fever and sore throat. However, the long-term effects of corticosteroid use may outweigh the benefits in treating symptoms. Your doctor will tell you to use over the counter medications to treat your sore throat and fever symptoms.

Practice self-care and get plenty of rest while you are in recovery. Be sure to drink plenty of fluids and fruit juices (no added sugar). Staying hydrated will prevent dehydration and relieve the sore throat and fever that often accompanies the viral infection. You may have less of an appetite. None the less, eat nutritious foods to help your body recover from the virus.

There are a few supplements that may help shorten the course of mono and relieve symptoms. Check with your doctor before using any alternative remedy. Some helpful remedies are:

Probiotics. Probiotics can help boost the immune system and bring back the proper balance to your body. Make sure you use Lactobacillus acidophilus At least 5 to 10 billion units every day.

Green tea. Green tea is full of natural antioxidants that can help cleanse the body of toxins. It may also help relieve inflammation and have some natural anti-viral effects.

Echinacea. Echinacea is an herb that can help improve immune system function. Use caution if you have an autoimmune disorder or need to keep your immune system lower for any reason.

Cranberry. Cranberry may have virus-fighting capabilities, but studies have not shown effectiveness for EBV. Use with caution if you take blood thinners.

• Never share objects that come into contact with the mouth or saliva
• Avoid people who have suspected symptoms of mono until they have fully recovered
• Wash your hands after using the bathroom
• Wash your hands before you eat
• Cough or sneeze into a tissue, dispose of tissue, and immediately wash your hands
• If you have symptoms of mono, stay at home until they have gone away 

A few easy lifestyle changes can help you recover faster and relieve symptoms. These include:

• Avoid any heavy lifting
• Gargle with warm salt water
• Rest when you feel tired
• Eat a diet rich in antioxidants (like green vegetables and peppers, blueberries, tomatoes, and cherries)
• Stay away from processed and fast foods
• Try not to drink caffeine, alcohol, or smoke tobacco
• Do not eat or drink after anyone that is suffering from mono
• Wash your hands after using the restroom or visiting public areas

Mono can affect all areas of the body, especially the nervous system, the brain, and spine. Some nervous system conditions it can cause are:

• Bell’s Palsy (facial nerve paralysis)
• Encephalitis (brain swelling)
• Meningitis (inflammation of the spinal cord)
• Mental disturbances
• Optic neuritis (eye nerve swelling)
• Sleep disturbances
• Paralysis

Other complications include:

• Pneumonia
• Swelling of the heart
• Pancreatitis
• Lung scarring
• Lymphoma
• Sinusitis
• Infection of the lymph nodes

Blockage of the air passages

There are currently several clinical studies that are actively researching infectious mononucleosis, including an acupuncture research trial to help treat symptoms and shorten the duration of fatigue. The link for these trials can be found here.

Berry, J. (2020, November 25). All about mononucleosis (mono). Retrieved from: https://www.medicalnewstoday.com/articles/311932

Centers for Disease Control and Prevention. About infectious mononucleosis. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/epstein-barr/about-mono.html

Hellwig, T., Jude, K., & Meyer, B. (2013, May 21). Management options for infectious mononucleosis. U.S. Pharmacist, 38(5), 38-41. Retrieved from: https://www.uspharmacist.com/article/management-options-for-infectious-mononucleosis

Mayo Clinic Staff. (2020, December 22). Mononucleosis. Retrieved from Mayo Clinic:  https://www.mayoclinic.org/diseases-conditions/mononucleosis/symptoms-causes/syc-20350328

National Institute of Allergy and Infectious Diseases. (2021). Infectious mononucleosis. Retrieved from National Institute of Allergy and Infectious Diseases: https://medlineplus.gov/infectiousmononucleosis.html

Womack, J. & Jimenez, M. (2015), Common questions about infectious mononucleosis. American Family Physician, 91(6), 372-376. Retrieved from: https://www.aafp.org/afp/2015/0315/afp20150315p372.pdf