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Mono or mononucleosis, also called the kissing disease, is named after its transmission via infected saliva. However, this disease is not as funny as the name implies. The virus that causes it is Epstein-Barr, or EBV virus.

It is possible to transmit the virus by less exciting routes, such as sneezing and coughing. Moreover, the consequences can be less than amusing. Besides the standard swollen glands and sore throat, which can be severe, the long-lasting weakness and fatigue that follow can be a trying experience. What is even neater is that there is no cure for mononucleosis by the hallowed halls of modern medicine. Doctors just tell patients to go home, get plenty of rest, drink plenty of liquid, and wait as the only treatment, but could this be true?

What is mono?

Infectious mononucleosis, mono, kissing disease, and glandular fever are all popular terms for the very common illness caused by the Epstein-Barr virus or EBV. This is a member of the herpes-virus family. By the time most people reach adulthood, an antibody against EBV is commonly present in their blood. In the U.S., up to 95% of adults aged 35-40 have antibodies directed against EBV in their blood. This means that most people have, at some point in their lives, had infection with EBV.
The designation mononucleosis refers to an increase in a special type of white blood cells called lymphocytes in the bloodstream, relative to the other blood components, because of the EBV infection. Mono is common in adolescents and young adults, with a peak incidence at ages 15-17. However, it is a common infection in children as well. Generally, the illness is less severe in young children and may mimic the symptoms of other common childhood illnesses. This may explain why it is not so easy to diagnose or recognize it in the younger age group. While there are other illnesses falling under the broad classification of “mononucleosis” that cause similar symptoms and an increase in blood lymphocytes, the form caused by the EBV is by far the most common in the world.

How is mononucleosis spread?

Mono is easy to spread by person-to-person contact, where saliva is the primary method of transmission. Infectious mononucleosis developed its common name of “kissing disease” from this prevalent form of transmission among teenagers. A person with mononucleosis can also pass the disease by coughing or sneezing, suspending small droplets of infected saliva and mucus in the air to be inhaled by others. Sharing food or beverages from the same container or utensil can also transfer the virus from one person to another, since contact with infected saliva may result. Most people are exposed to the virus as children, and developed immunity. In fact, those who expose themselves to the EBV usually do not ever develop mononucleosis.
The incubation period for mononucleosis refers to the time from the initial viral infection until the appearance of symptoms. This period is between four and six weeks. During an infection, a person is likely able to transmit the virus to others for a few weeks. Researches have shown that anywhere from 20 to 80 percent of people who have had mononucleosis and have recovered continue to secrete the EBV in their saliva. This goes on for years due to periodic reactivations of the viral infection. Since healthy people without symptoms also secrete the virus during reactivation episodes throughout their lifetime, isolation of infected mono patients is not necessary. Moreover, some doctors believe that some healthy people who nevertheless secrete EBV particles are the primary reservoirs for transmission of EBV among humans.

What are the symptoms of infectious mononucleosis?

The initial symptoms of mono are general lack of energy (malaise), loss of appetite, and chills. These initial symptoms can last from one to three days before more intense symptoms of the illness begin. The more common intense symptoms include severe sore throat, fever, and swollen glands or lymph nodes in the neck area. Generally, the severe sore throat prompts people to contact their doctor. In addition, a fever from 102 to 104 degrees Fahrenheit is the most common sign of mono.
The tonsils have a whitish coating in at least one third of the cases of mononucleosis. The spleen, which is the body’s biggest lymph node, is an organ found in the left upper abdomen underneath the ribcage. It swells and enlarges in about 50% of patients with infectious mononucleosis. An enlarged liver may also occur, and about 5% of patients have a splotchy red rash over the body, similar in appearance to the measles rash.

How to diagnose mononucleosis

The diagnosis of mono is based on these symptoms and signs. It is possible to confirm mono by blood tests while testing to exclude other possible causes of the symptoms. Early in the course of the illness, blood tests show an increase in a type of white blood cells. Some of these increased lymphocytes are unusual lymphocytes, which suggest infectious mononucleosis. More specific testing, such as the monospot and heterophile antibody tests, can confirm the diagnosis. These tests rely on the body’s immune system to make measurable antibodies against the EBV that provoke this infection. Unfortunately, the antibodies may not become detectable until the second or third week of this illness. A blood chemistry test can reveal abnormalities in liver function. Your doctor should also consider testing to exclude the possibility of a strep throat.

Treatment of the kissing disease

In most cases of infectious mononucleosis, no specific treatment is necessary. The illness is usually self-limited and passes much the way other common viral illnesses resolve; available antiviral drugs have no significant effect on the overall outcome and may actually prolong the course of the illness. Occasionally a strep throat occurs in conjunction with mono, and is best treated with penicillin or erythromycin. Ampicillin and amoxicillin should be avoided, since up to 90% of patients with kissing disease develop a rash when taking these medications. Acetaminophen could also help with fever and any aching of the body or head.
A sufficient amount of sleep and rest is also an important aspect of treatment for the kissing disease. The throat soreness is worst during the first five to seven days of the illness, and then subsides over the next seven to ten days; the swollen tender glands generally subside by the third week. A feeling of fatigue or tiredness may persist for months following the acute phase of the kissing disease.

It would be good to avoid participation in any contact sports during the first six to eight weeks following the onset to prevent trauma to the enlarged spleen. The spleen is susceptible to rupture, which can be life-threatening condition. Cortisone medication helps treat severely swollen tonsils or throat tissues which threaten to obstruct breathing. Patients can continue to show virus particles present in their saliva for as long as 18 months after the initial infection with Epstein-Barr virus. When symptoms persist for more than six months, the condition is designated a chronic EBV infection. However, laboratory tests generally cannot confirm continued active EBV infection in people with a chronic mono infection. You could try injections of vitamin B-12, which showed improvement in infectious mononucleosis therapy. You could also ask your doctor to use B-12 supplements under the tongue, which are SL, or sub-lingual form.

During infectious mononucleosis, the appetite can be down, and absorption may worsen, so highly nutrient dense food is important. The easiest way to get that done is using the green foods such as spirulina, Chlorella, barley green, or other similar products. Vitamin C is something you must take during mono infection. To strengthen the body as fast as possible, a complete B-complex supplement makes sense. These nutrients are intimately involved in energy production in the body and work together in their biochemical reactions. If you want to cover all the bases alpha lipoic acid (ALA), can be very helpful. It is the only antioxidant that is both water- and fat-soluble. It is also considered an anti-aging nutrient. That is why many doctors would recommend you not just lie in bed if mono strikes. You must know that you are not helpless in this situation, so get proactive and head this pest off as soon as possible.

Complications of the kissing disease

A common, but usually not serious, complication of mononucleosis is a mild inflammation of the liver, called hepatitis. This form of hepatitis is rarely serious or requires any treatment. Also, enlargement of the spleen that occurs with mono makes traumatic rupture of the spleen a possible complication and a serious consequence.

Fortunately, the more severe complications of infectious mononucleosis are quite rare. These include inflammation of the sac surrounding the heart (pericarditis), the heart muscle (myocarditis), and the brain (encephalitis). It could also lead to the destruction of red blood cells, a condition famous as hemolytic anemia. However, mono tends to be more aggressive in patients with abnormal immune systems, such as AIDS patients or patients who have had organ transplants.