Mononucleosis

Introduction

What should I know about Infectious Mononucleosis?

Infectious mononucleosis (Mono) is often referred to as the “kissing disease" due to it’s manner of spreading from one individual to another. Actually, Mono is caused by a type of Epstein-Barr virus (EBV), a virus that is thought to be responsible for other conditions such as Chronic Fatigue Syndrome. EBV occurs in two forms that are widely prevalent in nature and are not distinguished by conventional tests.

EBV is transmitted by salivary secretions, usually from an asymptomatic person shedding the virus. Transmission often occurs from adults to infants or among young adults by transfer of saliva during kissing. The virus infects the cells of the oropharynx and salivary glands and is shed from these cells. Infectious mononucleosis is characterized by fever, sore throat, and swollen or infected lymph glands. EBV is also associated with several human tumors, including nasopharyngeal carcinoma, Burkitt’s lymphoma, Hodgkin’s disease, and in patients with immunodeficiencies (including AIDS), B-cell lymphoma. (1) The virus was originally discovered in association with Burkitt’s lymphoma cells, and is a member of the family Herpesviridae.

Epstein-Barr virus infections occur worldwide. In fact, by adulthood, over 90 percent of individuals have been infected and have antibodies to the virus. Infections occur with greatest frequency in early childhood, with another peak during late adolescence. In areas with lower standards of hygiene, such as those observed in lower socioeconomic classes and developing nations, the infection is seen mostly in young childhood, while in areas of higher standards of hygiene, the infection occurs primarily in young adulthood. Most EBV infections in infants and young children are either asymptomatic, or present as a mild pharyngitis with or without tonsillitis. In contrast, when seen in late adolescence, it very frequently presents as infectious mononucleosis.

With mononucleosis, there is a lengthy incubation period of around 30 to 50 days. After that there is a period of three to five days when the individual experiences symptoms such as sore throat, fever, and asthenia. When the individual is examined, the examining physician will check all of the presenting symptoms and determine if a test for mononucleosis is warranted. The physician will also want to check the size of the spleen and liver to make sure they are not enlarged. Problems with the liver are sometimes found in cases of mononucleosis. (2)

In some cases, the fatigue, myalgia, and malaise may be present for one to two weeks prior to onset of fever, sore throat, and swollen glands. Most patients have symptoms for two to four weeks, but malaise and difficulty concentrating can persist for months. Complications from mononucleosis are uncommon and in most cases, the condition is self-limiting.

Statistic

Children’s Hospital & Regional Medical Center, Washington, 2005.

  • The Epstein-Barr Virus (EBV) causes approximately 90% of cases of infectious mononucleosis.
  • EBV is found throughout the world and infects more than 98% of the world's population.

National Center for Infectious Diseases , Epstein-Barr Virus and Infectious Mononucleosis, 2002

  • In the United States, as many as 95% of adults between 35 and 40 years of age have been infected.
  • When infection with EBV occurs during adolescence or young adulthood, it causes infectious mononucleosis 35% to 50% of the time.

Signs and Symptoms

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Symptoms most frequently associated with infectious mononucleosis are a sore throat and general feeling of fatigue and weakness. Other complaints include stomach pains, nausea, vomiting, fever, enlarged tonsils, enlarged lymph glands on the neck, and possibly an enlarged spleen. Other symptoms that occur much less often include jaundice (yellowing of skin due to liver involvement), enlargement of liver, swelling around the eyes, a rash, and chills.

General

  • Sore throat
  • General feeling of fatigue and weakness
  • Stomach pains, nausea, or vomiting
  • Fever
  • Enlarged tonsils
  • Enlarged lymph glands on the neck
  • Enlarged spleen

Treatment Options

Conventional

Treatment consists of supportive measures, primarily with rest and pain relievers. Excessive physical activity should be avoided during the first month to avoid injuring the spleen. Sometimes a drug called Glucocorticoid is recommended if there is a chance that the swelling of the tonsils is severe enough to cause an obstruction in the airways. Prednisone may also be recommended for one to two weeks.

Nutritional Suplementation


Vitamin C

Vitamin C is a known natural antiviral agent and numerous studies have been published reporting vitamin C’s effectiveness in the prevention and treatment of various viral conditions. Apparently vitamin C is able to enhance the manufacture of interferon, which is the body’s endogenous antiviral agent. (3) , (4) , (5) Also, in cell culture studies, ascorbic acid has been found to be capable of inactivating the human immunodeficiency virus (HIV). (6)

Because vitamin C has established antiviral activity, there is a logical scientific rational to use vitamin C in the treatment of mononucleosis.


Vitamin A, Beta-Carotene

Low levels of vitamin A and beta-carotene are associated with weaker immune systems in humans. Conversely, it is probable that individuals with adequate intakes of these nutrients will have better immune defenses compared to individuals whose diets and life styles do not provide enough of these nutrients. (7) , (8)


Selenium

Selenium plays important roles as an antioxidant and an anti-viral agent and it is also part of the antioxidant enzyme known as glutathione peroxidase. These functions make selenium a vital component in a healthy functioning immune system. (9)


Vitamin E

Vitamin E is another antioxidant nutrient that is critical to a healthy functioning immune system. In a study of healthy elderly adults, it was revealed that supplementation with vitamin E at doses of 200 mg/day and 800 mg/day provided substantial improvements in several immune system parameters. (10) These results were remarkable because the test subjects did not have vitamin deficiencies or weakened immune systems at the outset.


B Complex Vitamin

The various B-vitamins are involved in many biological activities that affect the production of energy and the overall functioning of the entire body. Thus, adequate B-vitamins are required in order to have a well functioning immune system. (11) B-vitamins can be taken individually, together in a B-complex formula, or as part of a multivitamin/mineral supplement.


Zinc

Zinc is an important immune system-regulating mineral. Zinc deficiency causes a decrease in both antibody and cell-mediated immune responses in both humans and animals. Many studies on a variety of disease states have demonstrated that immune system function and integrity is tightly linked to zinc status. Conversely, zinc supplementation often provides substantial enhancement of immune defenses in individuals with various diseases. (12)


Omega-3 Fatty Acids

Imbalances in dietary fatty acids are now known to impact the immune system. In general, Americans ingest far too much of the omega-6 fatty acids, and not nearly enough of the omega-3 series fatty acids. (13) Since proper amounts and ratios of these fatty acids control the production of prostaglandins and immune function, this is a critical issue related to health. In many cases, supplementation with flaxseed oil, which provides alpha lenolenic acid, and fish oils, which provide eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) enhance immunity. Individuals who are consuming these fatty acid supplements should always take adequate vitamin E.

Herbal Suplementation


Cat's Claw

Cat’s claw reportedly affects the immune system and acts as a potent free radical scavenger. (14) Cat’s claw has glycosides which may reduce inflammation and edema. (15) The anti-inflammatory effects of cat’s claw are considered to be due to the sum total of the plant’s constituents, but the sterols have demonstrated anti-inflammatory activity in animal studies. The glycosides are also reported to enhance and stimulate immune function activity. (16) Other chemicals in Cat’s claw have properties that are antiviral and have immuno-stimulatory properties. (17) , (18)


Olive Leaf

Olive leaf extract has reported antiviral activity, reportedly caused by the constituent calcium elenolate, a derivative of elenolic acid. (19) , (20) Olive leaf extract has been reported to be an effective antimicrobial agent against a wide variety of pathogens, including Salmonella typhi, Vibrio parahaemolyticus and Staphylococcus aureus (including penicillin-resistant strains), Klebsiella pneumonia and Escherichia coli, causal agents of intestinal or respiratory tract infections in man. (21) The component usually associated with olive leaf’s antimicrobial properties is oleuropein. (22) , (23)


Grapefruit Seed

Grapefruit seed extract has been reported to be a broad-spectrum antimicrobial both in vitro and in vivo. Studies indicate that the antimicrobial activity of grapefruit seed extract exists in the membrane of the invading bacteria, where the uptake of amino acids is prevented. (24)


Reishi Mushroom

Reishi mushroom is called the “mushroom of immortality" in China and has been used as a tonic and strengthening medicine for thousands of years. Uses in traditional healing include increasing intellectual capacity and memory, promoting agility, and lengthening the life span. (25) Reishi is reported to have some of the most active polysaccharides in the plant kingdom. Polysaccharides are claimed to have immunomodulating activity. Reishi is also reported beneficial as an antioxidant, antihypertensive, hypoglycemic, antiviral, and hepatoprotective agent.


Arabinoxylane

Arabinoxylane is a polysaccharide dietary fiber formula from the outer shell of rice bran (hemicellulose B) that has been enzymatically modified with hyphomycetes mycelia from three different medicinal mushrooms: Shiitake, Kawaratake, and Suehirotake. (26) Arabinoxylane shows great promise not only in immune support, but also in diseases of the immune system such as cancer and HIV. (27)


Shiitake Mushroom

Shiitake mushroom grows on the trunks or stumps of trees, with the medicinal part used being the mycelia or immature growing stage of the mushroom. Shiitake has been used in Traditional Chinese Medicine for thousands of years as a medicinal agent. Shiitake mycelia have been reported to be immunomodulating in several ways. (28) , (29)


Astragalus

Astragalus has been valued by the Chinese for centuries for its immune-enhancing and adaptogenic properties. As an adaptogen, it may modify and improve the body’s response to stress through action on the adrenal cortex. (30) , (31) Experiments have reported that astragalus promotes regeneration of cells in the bronchi after viral infection. The polysaccharides contained in astragalus relate to the improvement in natural killer (NK) cells and T-cell function, as well as interferon production by the immune system. (32)

References

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  2. Richer M, Deschenes M. Upper Respiratory Tract Infections. In: DiPiro JT et al. eds. Pharmacotherapy, A Pathophysiologic Approach. 4th ed. Stamford CT; 1999:1677.
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  9. View Abstract: Rayman MP. The importance of selenium to human health. Lancet. Jul2000;356(9225):233-41.
  10. View Abstract: Meydani SN, Meydani M, Blumberg JB, et al. Vitamin E supplementation and in vivo immune response in healthy elderly subjects. A randomized controlled trial. JAMA. May1997;277(17):1380-6.
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  13. View Abstract: Holman RT. The slow discovery of the importance of omega 3 essential fatty acids in human health. J Nutr. Feb1998;128(2 Suppl):427S-433S
  14. View Abstract: Aquino R, et al. Plant Metabolites. Structure and in Vitro Antiviral Activity of Quinovic Acid Glycosides from Uncaria tomentosa and Guettarda platypoda. J Nat Prod. 1989;52(4):679-85.
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