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 of 100,000 people.

The following signs and symptoms may 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 - 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 - 6 weeks.

The Epstein-Barr virus (EBV) causes the vast majority of mono cases. Ninety percent 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 - 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.
• Blood transfusion.
• Diminished or suppressed immune function.

Your health care 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.

Prevention

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.

Treatment Plan

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.

Drug Therapies

Your health care 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.

Surgical and Other Procedures

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

Complementary and Alternative Therapies

Several studies report 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.

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.

Always tell your health care provider about the herbs and supplements you are using or considering using.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Try to eliminate all suspected food allergens, including dairy, wheat (gluten), soy, chocolate, corn, preservatives, and food additives. Your health care provider may want to test you for food allergies.
• Eat more antioxidant-rich foods (such as green, leafy vegetables and peppers) and fruits (such as blueberries, tomatoes, and cherries).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise moderately, if tolerated, at least 30 minutes daily, 5 days a week.

You may be able to address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil two to three times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
• N-acetyl cysteine, 200 mg daily, for antioxidant effects.
• Acetyl-L-carnitine, 500 mg daily, for antioxidant and muscle protective activity.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• Resveratrol (from red wine), 50-200 mg daily, for antioxidant and antiviral effects.
• L-theanine, 200 mg one to three times daily, for nervous system support.
• Melatonin, 2 - 5 mg one hour before bedtime, for sleep and immune protection.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory, and immune effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
• Rhodiola (Rhodiola rosea) standardized extract, 100 - 600 mg daily, for antioxidant, anti-stress, and immune activity.
• Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
• Elderberry (Sambucus nigra) extract, 1 tablespoonful two times daily, for antiviral and immune activity. Ask your health care provider about doses of elderberry extract for your children.
• Reishi mushroom (Ganoderma lucidum), 150 - 300 mg two to three times daily, for inflammation and immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation and antiviral activity.

Homeopathy

Few studies have examined 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 -- your 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 may be effective for fever related to EBV:

• Belladonna -- for early stages of mononucleosis with sudden onset of fever.
• Ferrum phosphoricum -- for individuals with the early stages of a fever accompanied by a painful cough and sore chest.
• 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.

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.

Acupuncture

Although no scientific studies have reviewed the use of acupuncture for mono, 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 reported 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.

Massage

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.

Auwaerter PG. Infectious mononucleosis in middle age. JAMA. 1999; 281(5):454-459.

Beers MH, Berkow R, eds. The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck & Co.; 1999:2336-2339.

Bhat KPL, Kosmeder JW 2nd, Pezzuto JM. Biological effects of resveratrol. Antioxid Redox Signal. 2001;3(6):1041-64.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr. 2006;25(2):79-99.

Carillo-Vico A, Reiter RJ, Lardone PJ, et al., The modulatory role of melatonin on immune responsiveness. Curr Opin Investig Drugs. 2006;7(5):423-31.

Chiang LC, Ng LT, Cheng PW, Chiang W, Lin CC. Antiviral activities of extracts and selected pure constituents of Ocimum basilicum. Clin Exp Pharmacol Physiol. 2005;32(10):811-6.

Clancy RL, Gleeson M, Cox A, et al. Reversal in fatigued athletes of a defect in interferon gamma secretion after administration of Lactobacillus acidophilus. Br J Sports Med. 2006;40(4):351-4.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-75.

Eo SK, Kim YS, Lee CK, Han SS. Antiviral activities of various water and methanol soluble substances isolated from Ganoderma lucidum. J Ethnopharmacol. 1999;68(1-3):129-36.

Gaby AR. The role of coenzyme Q10 in clinical medicine: Part 1. Alt Med Rev. 1996; 1(1):11-17.

Hunton M. The homoeopathic treatment of glandular fever. Br Homeopath J. 1986; 75(2):66-68.

Jacobson W, Wreghitt TG, Saich T, Nagington J. Serum folate in viral and mycoplasmal infections. J Infect. 1987; 14(2):103-111.

Mayer KE, Myers RP, Lee SS. Silymarin treatment of viral hepatitis: a systematic review. J Viral Hepat. 2005;12(6):559-67.

Omori M. Mononucleosis. In: Adler J, Brenner B, Dronen S, et al., eds. Emergency Medicine: An On-line Medical Reference. Accessed on January 19, 2000.

Reiche EM, Morimoto HK, Nunes SM. Stress and depression-induced immune dysfunction: implications for the development and progression of cancer. Int Rev Psychiatry. 2005;17(6):515-27.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Schooley RT. Epstein-Barr virus (infectious mononucleosis). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practices of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone Inc; 1995:1364-1377.

Van Benschoten MM. Clinical cases of Epstein Barr Virus infection treated with homeopathic and Chinese herbal therapeutics. Am J Acupunct. 1988; 16(1):19-25.

Van Rood YR, Bogaards M, Goulmy E, van Houwelingen HC. The effects of stress and relaxation on the in vitro immune response in man: a meta-analytic study. J Behav Med. 1993; 16(2):163-181.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-19.

Williams JE. Review of antiviral and immunomodulating properties of plants of the Peruvian rainforest with a particular emphasis on Una de Gato and Sangre de Grado. Altern Med Rev. 2001;6(6):567-79.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.

Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. 2004;32(2):132-40.