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Epstein barr virus mononucleosis

Infectious mononucleosis (also known as mono, the kissing disease, Pfeiffer's disease, and glandular fever) is a disease seen most commonly in adolescents and young adults, characterized by fever, sore throat and fatigue. It is caused by the Epstein-Barr virus (EBV) or the cytomegalovirus (CMV). It is typically transmitted through saliva or blood, often through kissing, or by sharing a drinking glass, eating utensil or needle. Contrary to common belief, the disease is relatively non-contagious. The causative virus is also found in the mucus of the infected person, so it is also easily spread through coughing or sneezing. more...

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It is estimated that 95% of adults in the world have EBV-antibodies, having been infected with the Epstein-Barr virus at some point in their lives. The virus infects B cells (B-lymphocytes), producing a reactive lymphocytosis and the atypical T cells (T-lymphocytes) which give the disease its name.

Symptoms and physical signs

A person can be infected with the virus for weeks or months before any symptoms begin to appear. Symptoms usually begin to appear 4-7 weeks after infection and may resemble strep throat or other bacterial or viral respiratory infections. These first signs of the disease are commonly confused with cold and flu symptoms. The typical symptoms and signs of mononucleosis are:

  • Fever - this varies from mild to severe, but is seen in nearly all cases.
  • Enlarged and tender lymph nodes - particularly the posterior cervical lymph nodes, on both sides of the neck.
  • Sore throat (throat infection) - nearly all patients with EBV-mononucleosis have symptoms similar to tonsillitis.
  • Fatigue (sometimes extreme fatigue)

Some patients may also display:

  • Enlarged spleen (splenomegaly) or liver (hepatomegaly), which may later rupture
  • Abdominal pain
  • Aching muscles
  • Headache
  • Loss of appetite
  • Jaundice
  • Sinus infection
  • Depression
  • Weakness
  • Skin rash

The symptoms of infectious mononucleosis usually last 1-2 months, but the virus can remain dormant in the B cells indefinitely after symptoms have disappeared, and resurface at a later date. Many people exposed to the Epstein-Barr virus do not show symptoms of the disease, but carry the virus and can transmit it to others. This is especially true in children, in whom infection seldom causes more than a very mild illness which often goes undiagnosed. This feature, along with mono's long incubation period, makes epidemiological control of the disease impractical. About 6% of people who have had mono will relapse.

Since mononucleosis can cause the spleen to swell, it may in rare cases lead to a ruptured spleen. Rupture may occur without trauma, but impact to the spleen is usually a factor. Other complications include hepatitis (inflammation of the liver) causing jaundice, and anaemia (a deficiency of red blood cells). In rare cases, death may result from severe hepatitis or splenic rupture.

Usually, the longer the infected person experiences the symptoms the more the infection weakens the person's immune system and the longer he/she will need to recover. Cyclical reactivation of the virus, although rare in healthy people, is often a sign of immunological abnormalities in the small subset of organic disease patients in which the virus is active or reactivated.


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From Gale Encyclopedia of Alternative Medicine, 4/6/01 by Belinda Rowland


Mononucleosis is a contagious illness caused by the Epstein-Barr virus that can affect the liver, lymph nodes, and mouth. The mononucleosis symptoms of fatigue and lack of energy can linger for several months.


Mononucleosis ("mono" or the "kissing disease") is caused by the Epstein-Barr virus (EBV) found in saliva and mucus. The virus affects a type of white blood cell called the B lymphocyte.

While anyone can develop mononucleosis, it occurs primarily in young adults between the ages of 15 and 35 and is especially common in teenagers. The mononucleosis infection rate among college students who have not previously been exposed to EBV has been estimated to be about 15%.

The disease typically runs its course in four to six weeks in people with normally functioning immune systems. People with weakened or suppressed immune systems, such as AIDS patients or those who have had organ transplants, are particularly vulnerable to potentially serious complications.

Causes & symptoms

EBV is related to one of a family of DNA viruses such as herpes viruses, including those that cause cold sores, chickenpox, and shingles . Most people are exposed to EBV at some point during their lives. Mononucleosis is most commonly spread by contact with virus-infected saliva through coughing, sneezing, kissing, or sharing drinking glasses or eating utensils.

In addition to general weakness and fatigue, symptoms of mononucleosis may include any or all of the following:

  • sore throat and/or swollen tonsils
  • fever and chills
  • nausea and vomiting, or decreased appetite
  • swollen lymph nodes in the neck and armpits
  • headaches or joint pain
  • enlarged spleen
  • jaundice
  • skin rash

Complications that can occur with mononucleosis include a temporarily enlarged spleen or inflamed liver. In rare instances, the spleen may rupture, producing sharp pain on the left side of the abdomen, a symptom that warrants immediate medical attention. Additional symptoms of a ruptured spleen include light headedness, rapidly beating heart, and difficulty breathing. Other rare, but potentially life-threatening, complications may involve the heart or brain. The infection may also cause significant destruction of the body's red blood cells or platelets.

Symptoms do not usually appear until four to seven weeks after exposure to EBV. An infected person can be contagious during this period and for as many as five months after symptoms disappear. Also, the virus will be excreted in the saliva intermittently for the rest of their lives. Contrary to popular belief, the EBV is not highly contagious. Persons living with someone who has mononucleosis have a very small risk of being infected unless they have direct contact with the person's saliva.


If symptoms associated with a cold persist longer than two weeks, mononucleosis is a possibility; however, a variety of other conditions can produce similar symptoms. If mononucleosis is suspected, a physician will typically conduct a physical examination, including a "Monospot" antibody blood test that can indicate the presence of antibodies to EBV. Antibodies may not be detectable until the second or third weeks of illness. If this test is inconclusive, other blood tests may be conducted.


The most effective treatment for infectious mononucleosis is rest and a gradual return to regular activities. Because excessive activity may cause the spleen to rupture, any strenuous activity should be avoided until the symptoms disappear.

There are no cures for mononucleosis but alternative remedies may help the body fight infection and relieve symptoms. In general, the patient should drink plenty of water and eat unprocessed foods, fresh fruits, and vegetables. Meat, sugars, saturated fats, and caffeinated and decaffeinated drinks should be avoided. Alternative medicine practitioners recommend eating four to six small meals daily. Gargling with salt water (one half teaspoon in one cup of warm water) or taking throat lozenges may also relieve sore throat.

Vitamins A, C, and B-complex, magnesium, calcium, and potassium supplements may boost the immune system and increase energy levels.


The following herbal remedies may help treat mononucleosis, but they have not been clearly shown to improve mononucleosis in clinical trials:

  • Astragalus (Astragalus membranaceus): physical weakness.
  • Echinacea (Echinacea augustifolia): boosts the immune system.
  • Garlic: fights viral infections.
  • Goldenseal (Hydrastis canadensis): relieves sinus congestion.
  • Elder (Sambucus nigra) flower: reduces fever.
  • Yarrow (Achillea millefolium): reduces fever.
  • Cleavers (Galium species): cleans the lymphatic system.
  • Wild indigo (Baptisia tinctoria): cleans the lymphatic system.
  • St. John's wort (Hypericum perforatum): relieves anxiety and depression.
  • Vervain (Verbena officinales): relieves anxiety and depression and treats jaundice.
  • Slippery elm bark and licorice: soothes a sore throat when gargled.

Other remedies

The following treatments may help relieve the symptoms of mononucleosis:

  • Acupressure point Lung 6 may boost lung function and the immune system.
  • Aromatherapy with bergamot, eucalyptus, and lavender essential oils to relieve fatigue and other symptoms.
  • Chinese medicine uses acupuncture and the herbal Xiao Chai Hu Wan (Minor Bupleurum pills) in combination with other herbs for mononucleosis symptoms.
  • Homeopathic physicians choose remedies based on the patients specific symptoms.
  • Relaxation techniques such as biofeedback, visualization, meditation, and yoga can reduce fatigue by relieving stress.

Allopathic treatment

Acetaminophen (Tylenol) or ibuprofen (Motrin), may relieve symptoms, but aspirin should be avoided because mononucleosis has been associated with Reye's syndrome, a serious illness aggravated by aspirin.

Although antibiotics are ineffective in treating EBV, the sore throat accompanying mononucleosis can be complicated by a streptococcal infection, which can be treated with antibiotics. Cortisone steriod anti-inflammatory medications are also occasionally prescribed for the treatment of severe complications such as spleenic rupture, swollen tonsils that obstruct the airway, etc. tissues.

Expected results

Most persons diagnosed with mononucleosis will be able to return to their normal daily routines within two to three weeks. It may take up to six months before a person's usual energy levels return.


Although there is no way to avoid becoming infected with EBV, paying general attention to good hygiene and avoiding sharing beverage glasses or having close contact with people who have mononucleosis or cold symptoms can help prevent infection.

Key Terms

A specific protein produced by the immune system in response to a specific foreign protein or particle called an antigen.
Herpes viruses
A group of viruses that can cause cold sores, shingles, chicken pox, and congenital abnormalities. The Epstein-Barr virus that causes mononucleosis belongs to this group of viruses.
Reye's syndrome
A very serious, rare disease, primarily in children, that involves an upper respiratory tract infection followed by brain and liver damage.

Remedies for Mononucleosis
TherapyDescriptionTarget symptom
AromatherapyAdd lavender or eucalyptus to a warm bath.Fatigue
Herbal medicineEchinacea; yarrow or edler flower teaFight infection and fever
Home remediesRest; drink fluids; gargle with salt water; and massage lower back.Fatigue, dehydration, and sore throat
Mind/bodyMeditation, biofeedback, and guided imagery.Stress-induced fatigue
DietEat fresh fruits and vegetables. Avoid caffeine, sugars, and animal proteins.Strengthen immune system and increase energy.
YogaCobra poseFatigue

Further Reading

For Your Information


  • "Mononucleosis." In The Alternate Advisor: The Complete Guide to Natural Therapies and Alternative Treatments. edited by Robert Somerville. Alexandria, VA: Time-Life Books, 1997.


  • Baily, Eugene R. "Diagnosis and Treatment of Infectious Mononucleosis." American Family Physician. (March 1994): 879-887.


  • National Institute of Allergy and Infectious Diseases, National Institutes of Health Bethesda, MD 20892.


  • "Communicable Disease Fact Sheet." New York State Department of Health. (Revised December 1996).
  • "Mononucleosis: A Tiresome Disease." Mayo Health Oasis.

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.

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