Infectious Mononucleosis

Mononucleosis, often called “Mono”, is a usually mild self-limiting illness and, in most cases, does not deserve its bad reputation. Caused by the Epstein-Barr virus (EBV), it usually runs its course quickly and rarely produces any serious complications. There are, however, other viruses that may produce a mono-like illness.

Mononucleosis is an illness that affects teenagers and young adults, mainly ages 14 to 30, but can occur in children and older adults. It has been estimated that approximately 50% of students have had mono by the time they enroll in college. Many times the symptoms are so mild that it is not recognized for what it is.

The symptoms of mononucleosis may be the same as many other illnesses, such as “colds” or strep throat. For this reason, it is particularly difficult to diagnose in the early stages of the illness, although the diagnosis is usually based on symptoms and a physical exam. Symptoms usually disappear within 2-4 weeks, with fatigue sometimes lingering longer. Confirmation, if necessary, can be accomplished by either of two blood tests:

1. EBV causes an increase in a specific type of white blood cell, the atypical lymphocyte. A white blood cell count, WBC, will reflect this change commonly seen in people who have mononucleosis.

2. The mono spot test identifies an antibody which is present in mononucleosis. This test may not become positive until one has had symptoms for 5-14 days and may remain positive for months to years. It is important to remember the mono test merely helps to make the diagnosis; it does not indicate the severity of the disease and does not predict how long symptoms will last.

There are no conventional medical treatments to cure mononucleosis, only those that help manage the symptoms. In approximately 20-30% of people with mononucleosis there is a concurrent bacterial throat infection. Any antibiotics prescribed may help with the sore throat, but not the EBV infection.

Acetaminophen is preferable to aspirin for pain and fever relief because of the association of the EBV and Reye’s syndrome in children. In most cases of mononucleosis, hospitalization is not indicated. It has been shown that those who remain active to the limit of personal comfort get well more rapidly than those who remain in bed.

EBV is found in moist, exhaled air, and in nose or mouth secretions. It is not as contagious as many other viruses but may be transmitted through direct contact. This explains its nickname of the “kissing disease”. Isolation of the patient is not indicated; one can not catch mononucleosis by sitting in the same room with someone who has it, although persons who have had mononucleosis can shed the virus periodically in their saliva for the rest of their lives.


Signs, symptoms & indicators of Infectious Mononucleosis

Symptoms - Cardiovascular  

(Possibly) enlarged spleen

About 50-75 % of people with mononucleosis have some spleen enlargement.

Symptoms - Food - General  

Recent loss/regaining/recent loss of appetite

Symptoms - General  

Fatigue of recent onset

Intermittent and moderate fatigue is one of the early and main symptoms of mononucleosis. It almost always disappears within 2-4 weeks and lasts for months in only 1-2% of cases. Prospective studies among University populations have established that 20% of patients returned to work or school within 1 week and 50% within 2 weeks.

Symptoms - Glandular  

Postauricular node problems


Painful cervical nodes

Counter Indicators
Symptoms - Glandular  

Frequent/no painful cervical nodes


(No) postauricular node problems

Symptoms - Head - Eyes/Ocular  

(High) sensitivity to bright light

Symptoms - Head - Mouth/Oral  

(Frequent) raw throat

The sore throat usually seen in mononucleosis typically clears in 7-19 days or fewer.

Symptoms - Metabolic  

Resolved/current atypical recent headaches


Having a moderate/having a slight/having a high fever

A low grade fever occurs at first, and then rises to above 100 degrees F after the third or fourth day.

Symptoms - Skin - Conditions  

Current rash

Conditions that suggest Infectious Mononucleosis


Epstein-Barr virus (EBV)

When infection with EBV occurs during adolescence or young adulthood, it causes infectious mononucleosis 35- 50% of the time.

Lab Values  


Recommendations for Infectious Mononucleosis


Alcohol Avoidance

Since the virus can affect the liver, it is recommended that you abstain from alcohol for 3 months after diagnosis. Jaundice occurs in only about 5% of mono sufferers.


Increased Water Consumption

To help relieve symptoms, make sure you are getting plenty of fluids – mainly water.

Oxygen / Oxidative Therapies  

Ozone / Oxidative Therapy

According to doctors who have used ozone in mononucleosis, resolution of symptoms is accomplished more quickly.

Physical Medicine  


To help relieve symptoms, you should get plenty of rest.


Weak or unproven link
Strong or generally accepted link
Strongly counter-indicative
Likely to help
Highly recommended



An acute, infectious disease caused by the herpes virus, Epstein-Barr virus, with fever and inflamed swelling of the lymph nodes around the neck, under the arms, and in the groin.


Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.

Epstein Barr virus

(EBV): A virus that causes infectious mononucleosis and that is possibly capable of causing other diseases in immunocompromised hosts.

White Blood Cell

(WBC): A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. Also known as a leukocyte.


A type of white blood cell found in lymph, blood, and other specialized tissue such as bone marrow and tonsils, constituting between 22 and 28 percent of all white blood cells in the blood of a normal adult human being. B- and T-lymphocytes are crucial components of the immune system. The B-lymphocytes are primarily responsible for antibody production. The T-lymphocytes are involved in the direct attack against living organisms. The helper T-lymphocyte, a subtype, is the main cell infected and destroyed by the AIDS virus.


A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.

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