Epstein barr virus mononucleosis

Definition

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.

Description

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.

Diagnosis

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.

Treatment

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.

Herbals

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.

Prevention

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

Antibody

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

Therapy	Description	Target symptom
Aromatherapy	Add lavender or eucalyptus to a warm bath.	Fatigue
Herbal medicine	Echinacea; yarrow or edler flower tea	Fight infection and fever
Home remedies	Rest; drink fluids; gargle with salt water; and massage lower back.	Fatigue, dehydration, and sore throat
Mind/body	Meditation, biofeedback, and guided imagery.	Stress-induced fatigue
Diet	Eat fresh fruits and vegetables. Avoid caffeine, sugars, and animal proteins.	Strengthen immune system and increase energy.
Yoga	Cobra pose	Fatigue

Further Reading

For Your Information

Books

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

Periodicals

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

Organizations

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

Other

• "Communicable Disease Fact Sheet." New York State Department of Health. http://www.nyhealth@health.state.ny.us (Revised December 1996).
• "Mononucleosis: A Tiresome Disease." Mayo Health Oasis. http://www.mayo.ivi.com/mayo/9701/htm/mono.htm.

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.