Mononucleosis: Symptoms, Causes, Treatments, and Natural Approaches

Although mono is not a serious disease per se, in rare cases, it can lead to some dangerous complications.

Mononucleosis is most common among teenagers and young adults. Illustrations by The Epoch Times, Shutterstock

Infectious mononucleosis, also known as glandular fever or “mono,” is an infectious disease affecting certain blood cells.

Sometimes called the “kissing disease,” mononucleosis is quite prevalent in teenagers and young adults, particularly college students, and is most often caused by the Epstein-Barr virus (EBV). It is estimated that at least 25 percent of individuals in this age group who contract EBV will go on to develop infectious mononucleosis.

Most college students have acquired immunity against mono before entering college, and having mono once usually provides lasting protection against future infections. After recovery, the virus only rarely reactivates. However, in adults, mono can return after remission, so it’s crucial to maintain long-term follow-up and monitor the condition.

Sporadic cases are the most common, with outbreaks being a rare occurrence. Although mono is not a serious disease per se, in rare cases, it can lead to some dangerous complications.

What Are the Types of Mononucleosis?

Mono doesn’t necessarily have different types, but since different viruses can cause it, it may present with differing symptoms depending on which virus caused it.

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Infectious mononucleosis (IM) caused by EBV, a member of the herpesvirus family, is the most common, accounting for 80 percent to 90 percent of the total cases.

In the United States, most people have been infected by the EBV virus by their 30s or 40s, and approximately half of all children have been infected before age 5. After infection, the virus remains in the body for life. While mono often arises during the initial infection, not everyone exposed to the EBV virus develops mononucleosis, and many experience only mild symptoms or remain asymptomatic.

What Are the Symptoms and Early Signs of Mononucleosis?

Although the precise duration between infection and the onset of symptoms remains uncertain, the observed incubation period ranges from 32 to 49 days. The symptoms of mono differ based on the patient’s age group, and their intensity can vary widely from person to person. Individuals over 40 years old are particularly susceptible to severe illness. In comparison with young adults, older adults are less prone to experiencing a sore throat and swollen lymph nodes, but they have a higher chance of having an enlarged liver and jaundice.

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Most people recover completely in two to four weeks, but fatigue may persist for several additional weeks. In rare cases, symptoms can extend for six months or more.

The following are the most common signs and symptoms of mono:

• Fever: This is one of the classic symptoms of IM. It ranges from 100 to 103 F (37.8 to 39.4 C), often most intense during the initial week and potentially worsening at night.
• Headache: Half of IM patients suffer from headaches.
• Muscle aches.
• Extreme fatigue: This symptom manifests in 70 percent of IM patients.
• Sore throat: The throat may appear red with white spots or pus on the tonsils, resembling strep throat at first. A vast majority of patients will have this symptom. Many describe this as the worst sore throat they’ve ever had.
• Enlarged lymph nodes, especially in the neck: This is another classic sign. Containing white blood cells called lymphocytes, lymph nodes play a crucial role in the immune system by helping filter and trap harmful substances. Around 80 percent of mono patients suffer from this symptom.
• Nausea and sometimes vomiting (less common).
• Swollen spleen, liver, or both.
• Abdominal pain.
• Chills.
• Joint pain.
• Poor appetite and mild weight loss.
• Rash: This red rash often appears on the chest, mainly if the individual has recently used antibiotics.
• Malaise or a general feeling of being unwell.
• Palatal petechiae: These are small red or purple spots on the roof of the mouth.

Several rare symptoms and signs may include:

• Jaundice: Slight liver injury from IM may result in temporary jaundice of the skin and eyes.
• Breathing difficulties.
• Anemia.
• Irregular heartbeat.

What Causes Mononucleosis?

EBV enters through the throat and causes mono symptoms, including sore throat, swollen lymph nodes, an enlarged spleen, and other symptoms similar to those of the flu. Illustrations by The Epoch Times, Shutterstock

EBV is the primary cause of IM, transmitted via saliva (hence the name “kissing disease”) or coughing and sneezing. It may also be transmitted by sharing food, drinks, toothbrushes, or any other items that may come into contact with saliva. Another herpes virus, cytomegalovirus (CMV), is the second most common cause of mono. Several other viruses can also cause mono, listed below.

Infectious Mononucleosis

After a person is exposed to EBV, the virus enters the salivary glands and the cells lining the throat. When EBV gets into the throat, it starts reproducing. Then, lymphocytes in the tonsils come into contact with the virus and enter the bloodstream. This often leads to the swelling of lymph nodes, tonsillitis, and an enlarged liver and spleen. It tends to infect B cells in the immune system’s lymphoid tissue. This infection then spreads through the body’s lymphatic system, and the body’s defense system responds by creating antibodies to fight the virus.

It’s uncertain how long the virus can be found in a person’s saliva, but it can be present in significant amounts for about six months after the onset of symptoms. Fortunately, EBV is not considered highly contagious.

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Many individuals are infected with EBV without displaying mono symptoms or experience mild symptoms resembling common illnesses such as the flu. Most do not become ill after viral exposure but instead develop antibodies. Most people have these antibodies by their late teens. Healthy individuals do not need to be kept away from someone with mono. In fact, the roommates of someone who has mono are not at a higher risk of getting mono than anyone else.

CMV Mononucleosis

The symptoms of CMV mono are milder than those of IM. Like EBV mono, CMV mono can also result in fever, fatigue, and enlarged lymph nodes, but it doesn’t cause intense sore throat.

CMV mono accounts for 5 percent to 16 percent of all mono cases. CMV mono shares many similarities with IM but lacks the characteristic antibody response. It can occur either spontaneously (possibly transmitted through oral or sexual contact) or following a blood transfusion.

CMV is found in various white blood cells rather than predominantly B cells. Subclinical and mild forms of CMV infection affecting the respiratory, gastrointestinal, and liver may be common among young children.

CMV that causes mono can be transmitted through:

• Airborne droplets.
• Blood transfusions.
• Sexual contact.
• Organ transplants.
• Bodily fluids, such as saliva, urine, and tears.

Toxoplasmic Mononucleosis

Toxoplasma gondii is a parasite that lives in various warm-blooded animals. Consuming undercooked or raw meat—especially pork, lamb, beef, and venison—can result in ingesting toxoplasma cysts. Domestic cats are a significant source of human infection, with infectious oocysts in their feces remaining viable for extended periods. Transmission can also occur through accidental lab exposure, organ transplantation, and blood transfusion.

Asymptomatic lymph node enlargement is the most prevalent sign of acquired toxoplasmosis, primarily affecting head and neck nodes but occasionally involving lymph nodes throughout the body.

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Infection with the protozoan parasite can often be asymptomatic or lead to various symptoms. Like CMV mono, toxoplasmic mononucleosis is a heterophile (HA)-negative mono, meaning the antibodies that arise from fighting certain viruses like EBV are absent.

This condition is relatively rare compared to IM.

Other Causes

The following are other potential causes of mono:

• Adenovirus.
• HIV.
• Rubella.
• Hepatitis A, B, and C.

Who Is at Risk of Mononucleosis?

Although anyone who hasn’t had a previous infection is susceptible to contracting mono, certain groups are more likely than others to develop the condition, including the following:

• Teenagers and young adults in developed countries: The age group with the highest number of cases is individuals aged 15 to 24. In less-developed nations, individuals are often exposed to the virus in early childhood and may not show noticeable symptoms. In developed countries such as the United States, first exposure to the virus may occur later in childhood or during young adulthood, increasing the likelihood of experiencing symptoms. This is why the condition is more frequently observed among high school and college students.
• Individuals with weakened immune systems: People with weak immunity may be more susceptible to developing mono. They may also experience mono recurrence, although this is considered rare.
• Whites: In the United States, compared to blacks, the clinical infection rates of white people are estimated to be 30 times higher. One possible reason for this difference is that EBV infections acquired at a young age are often symptomless. This implies that black individuals may have earlier EBV exposures and a higher likelihood of asymptomatic infections during childhood.
• People who share utensils, cups, and cutlery: Examples of these groups include students or roommates.
• People living in warm and moist regions: The prevalence of toxoplasma exposure is relatively high in warm, humid regions rather than cold and dry.

How Is Mononucleosis Diagnosed?

For individuals aged 10 to 30 with symptoms such as a sore throat, extreme fatigue, palatal petechiae, and noticeable swollen glands, infectious mono should be suspected.

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Your doctor will conduct a physical examination, checking your temperature, examining your neck, underarms, and groin glands, and inquiring about your medical history and current symptoms.

In most cases, diagnostic lab tests are not required for IM. Nevertheless, specific lab tests may be necessary to determine the underlying cause of illness in individuals with atypical symptoms.

Your doctor may request several types of tests, including the following:

• Complete blood count (CBC): This test measures the levels of white blood cells, red blood cells, and platelets in the blood. It assesses the severity of an illness by examining blood cell levels, where a high white blood cell count may signal an infection.
• Differential white blood cell count: This test typically shows a significant increase in lymphocytes, a type of white blood cell, during the early stages of mono. Additionally, atypical lymphocytes are also present in large numbers. In IM, blood tests may reveal increased lymphocyte counts, atypical lymphocytes, lower than usual neutrophils (i.e., another type of white blood cell) or platelets, and abnormal liver function.
• EBV antibody test: This checks for EBV-specific antibodies, providing early mono detection. This test can identify both recent and past infections.
• Monospot test: Since mononucleosis triggers the production of an unusual type of antibody known as the heterophil antibody, the monospot test measures the levels of this specific antibody. The peak antibody levels typically appear two to five weeks into the mono infection, so it is often negative in the earlier part of the illness. Once heterophil antibodies are detected, the test may remain positive for up to a year.

Because false-negative heterophile antibody (or monospot) test results are common in the early stages of IM, and some patients don’t produce heterophile antibodies. Your health care provider may request an EBV antibody test for further evaluation.

In rare cases, a false-positive result can indicate mono when it’s not present. This may happen in individuals with hepatitis, leukemia, lymphoma, rubella, lupus, toxoplasmosis, cytomegalovirus infection, or other viral infections.

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Other tests may be requested to help exclude potential mono-related complications. For instance, liver tests can assess potential liver impact from the virus. In addition, if the mono test is negative, your doctor may evaluate you for human immunodeficiency virus (HIV) or other infections.

What Are the Complications of Mononucleosis?

Patients will usually fully recover from mono, but there may still be some complications.

Common mono complications may include the following:

• Spleen enlargement: The EBV virus can enlarge the spleen, making it prone to rupture if a patient is injured or experiences significant abdominal pressure. Around 50 percent of mono patients experience spleen enlargement. To safeguard the spleen, the patient should avoid overexertion or physically demanding activities until fully healed.
• Liver enlargement.
• Granulocytopenia: This condition takes place when there aren’t enough white blood cells called granulocytes in the peripheral blood. Approximately half of patients experience a mild form of this.
• Thrombocytopenia: Thrombocytopenia is when a person has too few platelets in the blood. About 50 percent of patients who experience this have only a mild case.
• Hemolytic anemia: This occurs rarely in mononucleosis and is due to the destruction of red blood cells. It is thought to be due to a transient autoimmune process.
• Prolonged fatigue: Over 10 percent of individuals with mono experience extended fatigue lasting six months or more. The reason for this prolonged fatigue is unclear, but it could be related to chronic fatigue syndrome (CFS), a condition causing persistent fatigue and various symptoms. Gradual exercise implementation may help prevent and alleviate this complication.
• Liver complications: Liver issues with some elevation of liver enzymes take place in around 95 percent of IM patients. Since mono rarely causes jaundice or significant elevations of liver enzymes, other causes should be sought besides mono.

Certain complications are rare but potentially fatal, including the following:

• Splenic rupture: Splenic rupture is a severe condition that can occur when the spleen enlarges and its outer covering swells, typically within 10 to 21 days. It occurs in 0.1 percent to 0.5 percent of IM patients and is the most feared complication. Rupture often leads to severe abdominal pain, but sometimes, it causes low blood pressure without pain.
• Encephalitis: Encephalitis is brain inflammation due to infection or an autoimmune response, causing symptoms such as headache, light sensitivity, confusion, and seizures. Encephalitis can have various forms, from cerebellar dysfunction to rapid global progression, but it often resolves on its own.
• Seizures.
• Guillain-Barré syndrome (GBS): GBS is a condition where the immune system targets the body’s peripheral nerves, affecting movement and the ability to breathe.
• Peripheral neuropathy: Peripheral neuropathy covers various conditions that harm the peripheral nervous system.
• Viral meningitis: This is the most prevalent form of meningitis, inflammation of the brain and spinal cord membranes.
• Meningoencephalitis: This condition resembles both encephalitis and meningitis.
• Myelitis: This condition is the inflammation of the spinal cord.
• Cranial nerve palsies: These are conditions where there is a weakness or paralysis of the cranial nerves, possibly causing a partial weakness or complete paralysis of the areas served by the affected nerves.
• Psychosis: Central nervous system complications may include psychosis.
• Bell’s palsy: This condition results in temporary weakness or paralysis of the facial muscles on one side of the face.
• Upper airway obstruction: This can be due to the enlargement or inflammation of lymph nodes located in the throat or pharynx.

Mono has also been linked to a few long-term complications, such as the following:

• Hodgkin lymphoma.
• Multiple sclerosis.
• Prostate cancer.

Complications in CMV mononucleosis specifically may include the following:

• Pneumonitis/pneumonia: Pneumonitis is a broad term for lung tissue inflammation, but it’s called pneumonia when it’s due to an infection.
• Colitis: This is colon inflammation.
• Neurological complications, including GBS.
• Pericarditis or myocarditis.

What Are the Treatments for Mononucleosis?

There is no specific medical cure for mono, as it typically resolves on its own. Treatment is generally supportive and aims to provide comfort and manage symptoms while the immune system contains the virus. Rarely, a hospital trip might be warranted if experiencing breathing problems, difficulty swallowing, or severe abdominal pain. Hospital treatment may involve IV fluids, corticosteroid injections, and pain relief.

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Preventing the spleen from rupturing is crucial and involves avoiding strenuous activities, including heavy lifting and particularly contact sports, for at least four weeks or until the spleen is no longer enlarged. In rare cases, emergency spleen removal might be necessary if it ruptures.

In addition to spleen protection, the following are typical treatment modalities for mono.

Medications

• Antipyretics and anti-inflammatory medications: These can address symptoms such as fever, sore throat, and fatigue. One type is ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) with anti-inflammatory properties and fever-reducing effects. However, aspirin should not be given to individuals under 18 due to the risk of Reye syndrome, a severe medical condition.
• Acetaminophen: This drug treats fever and body aches.
• Prednisone: This corticosteroid can be used in cases of severely swollen tonsils that impede breathing to reduce their size. However, corticosteroids are not typically recommended for routine mono treatment due to immune suppression concerns. Before using them in cases of airway obstruction, consultation with an ear, nose, and throat specialist may be necessary. Corticosteroids may help if severe anemia is present, heart issues such as pericarditis occur, and brain or nerve problems develop.

Self-Care

• Bedrest: A patient should receive plenty of rest, and bedrest is often recommended. However, it shouldn’t be enforced, as it may slow recovery. Instead, the patient’s energy level should determine their activity.
• Lots of fluids: Individuals should stay hydrated with high-quality fluids, like filtered water and herbal tea. Adding raw honey to soothe a sore throat is another good option.
• Salt water: Gargling with salt water can help heal a sore throat. Mix 1 level teaspoon of salt in 8 ounces of warm water to make salt water.
• Balanced diet: A mono patient should consume antioxidant-rich foods like leafy greens, peppers, and blueberries while avoiding processed foods.
• Alcohol avoidance: Refrain from alcohol, which can further damage the already weakened liver.

How Does Mindset Affect Mononucleosis?

Having a positive mindset can play a role in the recovery from mono, as it does with many illnesses. A positive attitude and mental outlook can contribute to your overall well-being and may help with recovery by reducing stress and improving mental health. If you find it challenging to maintain a positive mindset while experiencing mono symptoms, consider seeking support from loved ones, mental health professionals, or support groups.

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What Are the Natural Approaches to Mononucleosis?

In addition to the aforementioned self-care methods, some natural remedies may help alleviate mono symptoms, including the following:

1. Herbs

• King of bitters (Andrographis paniculata): The herb Andrographis paniculata is an antiviral and immune stimulant, lowering the viral load of mono. Traditionally used for various viral ailments, especially common colds and upper respiratory infections, it’s proven to lessen the severity and duration of viral conditions. Research has found that andrographolide, the main principal bioactive chemical constituent of Andrographis paniculata, fights various viruses, including EBV, by preventing this virus’s lytic reactivation, the process when a virus becomes active and starts reproducing in the body after being dormant or inactive for a while.
• Green tea (Camellia sinensis): Green tea and its primary components, called polyphenols or green tea catechins (GTCs), are widely recognized for their ability to fight cancer, provide antioxidant benefits, and combat microbial infections. In one lab culture study, EGCG, a type of green tea catechin and polyphenol, was observed to effectively prevent EBV from undergoing spontaneous lytic infection, a kind of viral infection where the virus enters a host cell, replicates, and causes the host cell to burst, releasing new virus particles and often leading to symptoms of the infection. EGCG’s inhibition occurred at various levels, including DNA, gene transcription, and protein production. Therefore, decaffeinated green tea is often recommended for mono patients.
• Echinacea (Echinacea purpurea): Echinacea’s compounds stimulate the immune system and have antiviral properties, which can help prevent recurrent infections and relieve symptoms such as headaches, sore throats, and body aches. However, you should consult a doctor before giving echinacea to children; avoid echinacea if you have autoimmune diseases or if you have ragweed allergies, as it may trigger allergic reactions.
• Astragalus (Astragalus membranaceus): Astragalus, a key herb in traditional Chinese medicine (TCM), treats various ailments. Astragalus polysaccharide (APS), a crucial natural compound in Astragalus, boasts numerous pharmacological benefits. According to one study, APS shows promise as an anti-EBV medication.
• Moringa (Moringa oleifera): Moringa is a tree known for its significant nutritional and medicinal value. Its seed pods and leaves are used as vegetables and herbal medicines. Abundant in essential nutrients and bioactive compounds, moringa leaves play a crucial role in supporting bodily functions and controlling specific diseases, including high blood pressure and diabetes. Moringa offers over seven times the vitamin C of oranges, 10 times the vitamin A of carrots, and 17 times the calcium of milk. Extracts from moringa have demonstrated strong inhibitory effects against numerous viral infections, including those of EBV.
• Chinese herbal medicine: Simiao Qingwen Baidu decoction, a TCM prescription, has been found to inhibit EBV DNA replication in animal serum by suppressing the expression of DNA replication-related genes, offering valuable insights and an experimental foundation for preventing and treating EBV infection.
• Licorice: Licorice root extracts have been used worldwide to treat various illnesses and symptoms, including sore throats. The compounds in licorice have been shown to have antiviral, anti-inflammatory, and antioxidant properties and may help relieve a sore throat caused by mono.

2. Supplements

• Vitamin C: Vitamin C offers various health benefits, including immune support and antioxidant protection. In one study, researchers observed a negative relationship between EBV VCA IgM (immunoglobulin M antibodies against the viral capsid antigen of EBV) and plasma vitamin C levels in individuals with mono and CFS. This suggests higher vitamin C levels were associated with lower antigen levels during the disease’s acute phase.
• B vitamins: B vitamins can combat fatigue, enhance energy levels, uplift mood, and support cognitive function. You can take a B vitamin complex supplement or include foods rich in vitamins B6 and B12 in your diet to help your recovery from mono. These foods include organ meats, salmon, eggs, and dairy.
• Zinc: Zinc, a trace mineral, is essential for nearly 100 enzymes, playing a crucial role in DNA formation, cell growth, protein building, tissue healing, and immune system support.
• Omega-3 fatty acids: You can incorporate omega-3 fatty acids, found in fish oil, in your diet to curb inflammation and enhance immunity. Choose cold-water fish such as salmon or halibut. Note that fish oil might increase the risk of bleeding, especially when taken alongside blood thinners such as warfarin.

3. Acupuncture

While there’s no specific research on acupuncture for mono, it could potentially alleviate symptoms, boost immune function, and address congestion (i.e., qi blockage) in the liver, spleen, and lymphatic system.

4. Essential Oils

Certain essential oils may help alleviate mono symptoms, including sore throat, body aches, fatigue, and inflammation. The following oils have some evidence of efficacy, though not directly applied to mono:

• Oregano: Oregano essential oil possesses antioxidant, antibacterial, antiviral, and anti-inflammatory properties. It has been shown to inhibit both human and animal viruses, including herpesviruses, in cell culture studies. A small 2013 study found that oregano oil also reduced tail pain in rats, so it may help with sore throat, but human studies are needed.
• Lavender: Lavender essential oil is recognized for its medicinal properties, including antimicrobial, anti-inflammatory, sedative, and general antioxidant effects. Some evidence suggests its aroma may help induce relaxation and promote sleep, which is essential to recovering from illness.

How Can I Prevent Mononucleosis?

Currently, there is no vaccine or way to prevent mono.

The things you can do to help reduce the risk of contracting mono include the following:

• Avoid contact with the saliva of someone who has had mono for a few months after their symptoms have cleared.
• Practice good hand hygiene by washing your hands with soap and running water, especially after sneezing, coughing, and before touching others. Sneeze or cough into a tissue or your elbow, not your hands.
• Clean items contaminated with saliva, such as toys, dishes, and utensils, in hot, soapy water or the dishwasher.
• Don’t share drinks and utensils.
• Before blood transfusions or organ transplants, the donor’s CMV status can be screened to prevent transmission of CMV to a recipient who has not been exposed to the virus.