Mononucleosis

By Dr. Loretta Lanphier, ND, CN, HHP, CH

The next time you come down with what you assume is a cold or the flu, you will probably be right. However, if the symptoms persist for longer than usual, and are accompanied by a nagging fatigue that just won’t quit, think again. You just may have a case of mononucleosis.

What is Mononucleosis?

Mononucleosis, also known as Mono, Infectious Mononucleosis or Glandular Fever, is an infectious disease caused by the Epstein-Barr virus. It is sometimes called “The Kissing Disease” because it is often spread through contact with the saliva of an infected person. When a person has contracted mono, a certain type of white blood cell called the B Lymphocyte is affected, and the presence of these altered cells can be used to help diagnose the illness. The main symptoms of a mononucleosis infection are fatigue and a lack of energy, which can last for up to several months.

Mono is most commonly found in teens and young adults between the ages of 15-35, but may occur in people of all ages. If you are otherwise healthy, mono is not usually serious, and will run its course in 4-6 weeks. However, in folks with compromised immune systems, such as AIDS patients for example, the effects can be more dangerous and lead to further complications.

What Causes Mononucleosis?

The Epstein-Barr virus is one of the most common viruses in the world. Almost everyone has been exposed to it by the time they reach 35 years of age, and the virus will remain in their body for life. Once a person has had mono, or even been exposed to Epstein-Barr without recognizable mono symptoms, they develop an immunity to it and cannot contract a mono infection again.

Epstein-Barr virus (EBV) is in the herpes virus family, and is a close relative of the viruses that cause chicken pox, shingles, and cold sores. EBV is spread through saliva and mucus, and can be caught when an infected person coughs or sneezes and the virus is expelled into the air and then breathed in by someone else. It can also be spread through kissing or sharing dining utensils or drinking glasses. Mono is not considered highly contagious, so living in the same house with a mono patient or spending a lot of time around them does not mean that you will come down with the infection. You must have direct contact with infected saliva in order to become infected yourself. To put it in perspective, mono is not nearly as contagious as the common cold.

Symptoms normally do not appear until four to seven weeks after the patient has been exposed to EBV. During this entire time, and for up to five months after the symptoms have disappeared, the person may be contagious. You may have mono and pass it on to someone else before you are even aware you have contracted it.

What Are the Symptoms of Mononucleosis?

The most common signs or symptoms of mono are:

  • Fatigue
  • Listlessness
  • Sore throat or a strep throat that will not improve with antibiotic treatment
  • Swollen tonsils
  • White patches on the back of the throat
  • Fever and chills
  • Sore muscles
  • Decreased appetite
  • Nausea and vomiting
  • Swollen lymph nodes in the neck and armpits
  • Headaches
  • Joint pain
  • Enlarged spleen
  • Soft, swollen spleen (pain and tenderness on the left side of the abdomen)
  • Skin rash
  • Night sweats

The illness generally takes about 4-6 weeks to run its course. In young children, between the ages of four and fifteen, mono may produce very mild symptoms that often seem no worse than a common respiratory infection, like a cold. They may also disappear sooner. The older a person is when they contract mono, the more severe the symptoms tend to be, and they are more likely to last longer. The fever and sore throat generally appear first in most mono patients, and typically last for a few weeks. Other signs such as fatigue, swollen lymph nodes, and a swollen spleen are usually the last to go. It is not uncommon for a school-aged child to miss six weeks of classes due to mononucleosis. Even after most of the symptoms have left, it is recommended that patients slowly return to their previous activity levels.

How Can I Know if I Have Mononucleosis?

The symptoms of mono can be misleading, and are not unique to this disease. Many times they can be mistaken for a common cold or other similar infection. One clue that may help is if the symptoms do not go away on their own after approximately two weeks. If they stick around longer than that, the chances are you have something more than a cold. There are several tests that can be run to help pin down the diagnosis, although none of them can make a positive identification of mono. The most common ones are:

  • Monospot Test:  This is a blood test that measures levels of certain proteins or antibodies that are associated with the presence of EBV. A positive test does not mean you have active mono. You may have been exposed to EBV years ago, and the test may just be showing that you are EBV positive, not that you have mono. Also, in some cases, this test may not be able to detect the presence of any indicators until you have had the symptoms for several weeks.
  • Other blood tests can take a look for elevated white blood cell counts or abnormal appearing white blood cells. Neither of these confirms mono, but these results can be clues to help solve the puzzle.

Can Mononucleosis Lead to Any Complications?

Yes, there are possible complications that you should be aware of:

  • Enlargement of the spleen is one of the more serious possible complications. Problems with the spleen is one of the reasons that folks are told to give themselves or their children plenty of time to recover from mono. Becoming too active too soon can aggravate the spleen before it has returned to normal. In severe cases of mono or sometimes in situations where folks have not given ample time for healing, the spleen may even burst. This is a true medical emergency that requires immediate medical attention and may possibly warrant surgery. If your spleen does rupture, you will most likely experience a sudden, sharp pain in the upper left quadrant of your abdomen, difficulty breathing, a rapid heart beat, and light headedness. This usually happens in adults who typically have more severe symptoms associated with mono, however it is possible to have spleen complications from mono at any age.
  • Liver inflammation may occur in some individuals in the form of hepatitis. If the hepatitis is serious enough, you may experience jaundice, which is the yellowing of the skin and the whites of your eyes. As with spleen complications, this most often is found in folks who have contracted mono after the age of thirty-five.
  • Approximately 50% of mono patients will exhibit a decrease in the number of platelets, which are specialized blood cells that are involved in clotting, and/or in the number of red blood cells, which are responsible for transporting oxygen throughout the body. The loss of red blood cells is a form of anemia.
  • While rare, there are some serious potential complications from mono that can adversely affect the nervous system:
    • Meningitis:  This bacterial or viral infection affects the meninges, or membranes, or the brain and spinal chord. Beware of a high fever, stiff neck, intense headache, or vomiting. This is also a true emergency that can lead to coma or death if not treated promptly.
    • Encephalitis:  This involves an infection, usually of viral origin, that affects the actual brain tissues themselves. The symptoms are very similar to meningitis, and must be treated just as seriously. Immediate medical care is a must.
    • Bell’s Palsy:A type of facial paralysis often caused (in the case of mono patients) by infection in a facial nerve. While not a dangerous condition, Bell’s Palsy can cause facial distortion.
    • Guillain-Barre Syndrome:  This condition causes temporary inflammation of the nerves in the extremities, causing pain and weakness. It also can progress into the chest and face. Incidentally, the incidence of Guillain-Barre has been reported in some people after receiving an influenza vaccine. You might want to keep that in mind the next time you’re tempted to get a flu shot.
    • Inflammation of the Heart:  This is a rare but potentially dangerous complication.
    • Seizures:  Mononucleosis can also rarely produce seizures in some people.
    • Certain individuals with mono may experience swollen tonsils that are so bad that they can obstruct and interfere with normal breathing. Most of the time, this is considered an emergency, and medications can be given to reduce the swelling.

What Can I Do to Treat or Prevent Mononucleosis?

Occasionally, bacterial infections may accompany mono, and if these are severe enough to warrant it, antibiotics can be used to treat them. These may include sinus infections such as sinusitis, or inflammation of the tonsils known as tonsillitis.

Other than that, there is not much that can be done once a person has mono. The best treatment is a whole lot of bed rest along with ample fluids (water is best, maybe with some secondary fruit juice). Sometimes gargling with warm salt water can help alleviate your sore throat.  The viral infection must just go through its cycle. Remember to never give aspirin as a pain reliever to children to avoid the possibility of Reye’s Syndrome. This disorder can be brought on by aspirin, and can lead to deadly swelling of the liver.

Prevention begins before contracting the illness. A lifestyle that is focused on health through natural means such as a nutritious diet and consistent exercise will go a long ways to preventing infections of all kinds. Taking care of yourself like this on an ongoing basis will keep your immune system strong and prevent many infections. If you do get sick, as we all do from time to time, a strong immune system will fight the bugs off much faster than if you do not make persistently healthy choices.

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