Mononucleosis
Mononucleosis is a highly contagious disease that strikes mostly adolescents and young adults. It is sometimes called the kissing disease, because it is transmitted by direct contact with saliva or nasal secretions infected with the causative organism -- the Epstein-Barr virus (EBV). However, kissing an infected person is not necessary; mononucleosis is easily transmitted by sharing personal items such as a drinking glass eating utensils, or a toothbrush.
In most cases, exposure to Epstein-Barr virus does not cause symptoms. By the age of five, about half of all children have already contracted the virus and developed immunity to it, even though most do not get sick. Studies among Peace Corps volunteers and military recruits have similarly shown that 90 percent of those who are infected do not develop symptoms.
When symptoms do occur, they begin 30 to 60 days after exposure with fatigue, headache, and chills, followed a day or two later by fever, sore throat, and swollen glands, especially in the neck. Some people also complain of weakness, loss of appetite, and muscle and joint pain. In severe cases, the spleen becomes swollen, and jaundice may develop if the liver is involved. Symptoms typically persist for one to four weeks, but full recovery may take two or three months.
Mononucleosis itself is generally not serious, but sometimes life-threatening complications develop, especially among people with AIDS or other conditions that lower immunity. Complications include hepatitis; obstructed breathing from throat swelling; meningitis, seizures, and psychosis, if the brain and nervous system are infected; blood disorders such as hemolytic anemia; and a ruptured spleen.
Diagnostic Tests and Procedures
A complete blood count usually shows abnormal white blood cells. Antibodies to Epstein-Barr antigens may also be present. An initial negative blood test does not necessarily rule out mononucleosis; when tests are repeated later, they are often positive.
Medical Treatments
In most cases, mononucleosis is self-limiting. Because it is a viral illness, antibiotics are not effective. In some cases, however, a corticosteroid drug is prescribed if there is a severe sore throat and swelling that threatens breathing. AIDS patients and others with lowered immunity may be given oral or intravenous acyclovir (Zovirax). Otherwise, acetaminophen is recommended, if needed, for headaches, fever, or achiness.
In rare cases, hospitalization is necessary. For example, a ruptured spleen is a medical emergency that demands immediate blood transfusions and surgery to prevent death.
Alternative Therapies
Aromatherapy. Inhaling vapors of lavender, eucalyptus, peppermint, or bergamot are said to alleviate fatigue and other symptoms.
Herbal Medicine. Tea or capsules made from echinacea and marigold are often recommended to fight the Epstein-Barr infection. Some herbalists also suggest taking teas or capsules of pau d'arco, dandelion, or goldenseal.
Homeopathy. Homeopaths advocate carcinosin as the remedy of first choice for the infection itself, and Phytolacca for swollen glands.
Nutrition Therapy. Some nutritionists recommend taking extra vitamin C plus bioflavonoids -- substances believed to enhance the effectiveness of the vitamin -- to help speed recovery. Mononucleosis can lower resistance to other infections. A high-protein diet that includes lean meat, poultry, fish, or a combination of grains and legumes is said to help boost immunity. Some therapists prescribe oral spleen extracts, but their value is doubtful.
Self-Treatment
Staying in bed is usually advised as long as there is fever; after that, normal activities can be resumed, but frequent rest periods are needed to counter fatigue Because the spleen remains vulnerable even after symptoms subside, contact sports should be avoided for at least two months following recovery.
Care should be taken to avoid the spreading of the disease to others. A person is considered contagious until all symptoms have disappeared. Even after that, the virus remains in the body and can be detected in saliva and nasal secretions of about one-fourth of otherwise healthy adults.
Even after recovery, a patient should be alert for symptoms of late complications, especially hepatitis. Jaundice -- a yellowing of the skin and white portion of the eyes -- warrants calling a doctor.
Other Causes of Mononucleosis Symptoms
Flu produces many of the same symptoms as mononucleosis. Cytomegalovirus, related to the herpes virus that commonly infects newborns, and toxoplasmosis, a parasite, also cause symptoms similar to those of mononucleosis. Mononucleosis can also resemble lymphoma, cancer of the lymph system.