MONONUCLEOSIS

WHAT IS MONONUCLEOSIS?

The classic syndrome of mononucleosis – fever, pharyngitis (sore throat), and lymphadenopathy (swollen lymph glands) was described in the 1880s as “glandular fever”. The term “infectious mononucleosis” was first used for this syndrome in the 1920s to describe a group of students who presented with a similar pharyngeal illness and blood laboratory findings.  It was only later in 1968, that the Epstein-Barr virus (EBV) was established as the cause of mononucleosis after an exposed healthcare worker developed a positive heterophile test (this test detects the heterophile antibodies produced by the human immune system in response to EBV infection).

Mononucleosis is a contagious disease. EBV is the most common cause, but other viruses like cytomegalovirus (CMV), hepatitis virus, and adenovirus can also cause mononucleosis. The EBV is a herpesvirus transmitted commonly through saliva and peak incidence of mononucleosis is in adolescents. Therefore, mononucleosis is sometimes also called “kissing disease” (1,2,3).  The incubation period of the virus (i.e. the time between contracting the infection, until the onset of symptoms) is four to six weeks. In young children, this period may be shorter.

RISK FACTORS OF MONONUCLEOSIS

• Age: Mononucleosis is common among teenagers and young adults. Although the virus can cause infection at any age, mononucleosis is uncommon in adults (4).
• Exposure through cough or sneeze of an infected individual
• Exposure to other bodily fluids like the blood or semen of an individual having mono.
• Bone marrow transplantation from an infected individual (5).
• Immunocompromised states: A weakened immune system is a predisposing factor for the development of mononucleosis, secondary to EBV infection. Patients receiving immunosuppressants are at a greater risk. Patients having diabetes, HIV (Human Immunodeficiency Virus) and chemotherapy might also be at risk.

SYMPTOMS OF MONONUCLEOSIS

• Enlargement of the lymph nodes, particularly in the neck and armpits
• Fever
• Extreme fatigue
• Tonsillitis and sore throat
• Chills
• Headache
• Enlarged spleen and liver
• Abdominal pain
• Nausea and vomiting
• Rash (2,6,7)

RECENT FACTS OR STATISTICS ON MONONUCLEOSIS

• EBV infections are common in early childhood with peak incidence noted at ages 15 to 24 years (6).
• In the United States, more than 90% of the adult population have developed antibodies to the EBV, because of previous exposure. Therefore, mononucleosis is uncommon in adults, with approximately 2% of all pharyngeal disease in adults attributable to this disease (3).
• In areas with higher standards of hygiene, infection with EBV is often delayed and mononucleosis is more common in adults.
• In the United States, clinically evident infection occurs at rates estimated at 30 times higher in whites than in blacks. This suggests earlier EBV exposures in the African American population and a higher frequency of asymptomatic infection in young children (5).

MEDICAL TREATMENT OF MONONUCLEOSIS

There are no specific drugs available to treat infectious mononucleosis. Since it is a viral infection, antibiotics which normally act against bacterial infections, are not useful for treating mono. The treatment is generally supportive (9).

Below listed measures may be taken to manage the symptoms of mononucleosis.

• Antipyretics and anti-inflammatory medications like acetaminophen, ibuprofen, naproxen:  These may be used to treat fever, sore throat, and general fatigue.
• Hydration, bed rest, and good nutritional intake, especially in the first two weeks are extremely important (10).
• In some instances, where mono is accompanied by secondary bacterial infections like strep throat, antibiotics like amoxicillin and other penicillin derivatives may be administered (2,8).

NATURAL WAYS TO SUPPORT A HEALTHY IMMUNE SYSTEM

Practices that Help Support a Healthy Immune System:

• Avoid any contact with oral secretions of an infected individual. Kissing or sharing drinks, food, or personal items with people who have infectious mononucleosis should be avoided (7).
• Stay hydrated
• Get plenty of rest

Natural Supplements that Help Support a Healthy Immune System:

• Reduning (11)
• Qinchai Kangdu (12)
• Glycyrrhizin (13)

REFERENCES

1. Godshall S, Kirchner J. Infectious Mononucleosis. Complexities of a common syndrome. Postgrad Med. 2000;107(7):175-179, 183-184, 186. doi:10.3810/pgm.2000.06.1130
2. Roberts JR. Infectious Mononucleosis. Emerg Med News. 2001;23(5):6-10. doi:10.1097/01.EEM.0000288653.35375.62
3. Mohseni M, Boniface MP. Mononucleosis. StatPearls Publishing; 2018. http://www.ncbi.nlm.nih.gov/pubmed/29261868. Accessed August 15, 2018.
4. Suzuki J, Komada T, Hirai K, et al. An adult case of fulminant Epstein-Barr virus infection with acute tubulointerstitial nephritis. Intern Med. 2012;51(6):629-634.
5. Cohen IJ. Epstein-Barr Virus Infections, Including Infectious Mononucleosis. In: Harrison’s Principles of Internal Medicine. 19e ed. McGraw-Hill Medical; 2015:1186-1190. Accessed August 15, 2018.
6. Rezk E, Nofal YH, Hamzeh A, Aboujaib MF, AlKheder MA, Al Hammad MF. Steroids for symptom control in infectious mononucleosis. Cochrane Database Syst Rev. 2015;(11):CD004402. doi:10.1002/14651858.CD004402.pub3
7. Centers for Disease Control and Prevention (CDC). Epstein-Barr Virus and Infectious Mononucleosis. https://www.cdc.gov/epstein-barr/about-mono.html. Accessed August 15, 2018.
8. Mayo Clinic. Mononucleosis – Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/mononucleosis/diagnosis-treatment/drc-20350333. Accessed August 16, 2018.
9. Stock I. [Infectious mononucleosis–a childhood disease of great medical concern]. Med Monatsschr Pharm. 2013;36(10):364-368.
10. Mononucleosis Management and Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/13974-mononucleosis/management-and-treatment. Accessed August 17, 2018.
11. Chen J, Ji P, Zhao S, et al. Analysis on curative effect of the combined therapy of ReDuNing injection and acyclovir on children with infectious mononucleosis. J Pract Med. 2017;33(18):3103-3107.
12. Bi Y, Yan S, Jiang Z. An analysis on clinical efficacy of Qinchai Kangdu mixture for treatment of infantile EB virus infectious mononucleosis with flaring heat in Qifen and Yingfen. Chinese J Integr Tradit West Med Intensive Crit Care. 2015;1:18-22.
13. Cao Z, Zhao Z, Zhao X. Effect of compound glycyrrhizin injection on liver function and cellular immunity of children with infectious mononucleosis complicated liver impairment. Chin J Integr Med. 2006;12(4):268-272.