Epstein-Barr Virus (EBV) Infection/Infectious Mononucleosis
What is Epstein-Barr Virus (EBV) Infection/Infectious Mononucleosis?
Epstein-Barr virus is a common virus that spreads through saliva and other body fluids. It belongs to the herpes virus family and infects most people at some point in their lives. When EBV infection happens during adolescence or young adulthood, it often causes infectious mononucleosis, commonly called mono or the kissing disease.
Mono typically causes fever, sore throat, swollen lymph nodes, and extreme fatigue that can last for weeks or months. The virus affects white blood cells and can also impact the liver and spleen. Most people recover fully, but the virus remains dormant in the body for life. In rare cases, EBV can cause serious complications or reactivate when the immune system is weakened.
About 90 percent of adults worldwide have been infected with EBV by age 35. Many children who get infected have mild symptoms or none at all. Understanding your EBV status and monitoring liver function during active infection helps ensure proper recovery and identifies any complications early.
Symptoms
- Severe fatigue that can last weeks or months
- High fever, often reaching 101 to 104 degrees
- Severe sore throat with white patches on tonsils
- Swollen lymph nodes in the neck and armpits
- Enlarged spleen, sometimes causing left side pain
- Liver inflammation causing elevated liver enzymes
- Headache and body aches
- Loss of appetite
- Skin rash, especially if treated with certain antibiotics
- Jaundice or yellowing of skin and eyes in rare cases
Some people infected with EBV have no symptoms at all, especially young children. Others may experience mild cold-like symptoms that resolve quickly. The fatigue from mono can persist long after other symptoms disappear.
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Causes and risk factors
EBV spreads primarily through saliva, which is why mono is called the kissing disease. You can get infected by sharing drinks, utensils, toothbrushes, or through kissing someone who has the virus. The virus can also spread through blood transfusions, organ transplants, and sexual contact. People can spread EBV for weeks after symptoms start, and the virus may be present in saliva intermittently for life.
Risk factors include being a teenager or young adult, close contact with infected individuals, sharing personal items, and having a weakened immune system. College students, healthcare workers, and people in close living quarters face higher exposure risk. Once you have EBV, stress, illness, or immune suppression can cause the virus to reactivate, though this usually does not cause symptoms in healthy people.
How it's diagnosed
Doctors diagnose EBV infection through a combination of physical examination, symptom history, and blood tests. The physical exam looks for swollen lymph nodes, enlarged spleen, and throat inflammation. Blood tests check for specific antibodies to EBV that indicate recent or past infection. A complete blood count may show increased white blood cells called lymphocytes, which is typical of mono.
Liver function tests are important because 80 to 90 percent of people with EBV infection develop elevated liver enzymes. Alanine aminotransferase, or ALT, often rises to 2 to 5 times the normal level due to viral inflammation of the liver. Monitoring ALT helps track disease progression and identify severe liver involvement. Rite Aid offers blood testing that includes ALT measurement at over 2,000 Quest Diagnostics locations nationwide, making it easy to monitor your liver health during and after infection.
Treatment options
- Rest and sleep to help your body fight the infection
- Drink plenty of water and fluids to prevent dehydration
- Gargle with warm salt water to soothe throat pain
- Take over-the-counter pain relievers like acetaminophen or ibuprofen for fever and pain
- Avoid contact sports and heavy lifting for at least 4 weeks to prevent spleen rupture
- Eat nutritious foods rich in vitamins and minerals to support immune function
- Avoid alcohol while liver enzymes are elevated
- Gradually return to normal activities as energy improves
- Manage stress through gentle activities like walking or meditation
There is no specific antiviral medication for EBV infection in most cases. Antibiotics do not work against viruses and may cause a rash if you have mono. Corticosteroids may be prescribed for severe throat swelling or complications. See a doctor if you have difficulty breathing or swallowing, severe abdominal pain, persistent high fever, or worsening symptoms. Most people recover fully within 2 to 4 weeks, though fatigue may linger longer.
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Frequently asked questions
Most people with mono feel better within 2 to 4 weeks, though some symptoms may persist longer. Fatigue can last for several months in some cases. Fever and sore throat typically resolve within 2 weeks, while swollen lymph nodes may take longer. You should avoid contact sports for at least 4 weeks to prevent spleen complications.
It is rare to get mono twice because your body develops immunity after the first infection. The virus stays in your body for life but usually remains dormant. In people with weakened immune systems, EBV can reactivate, but this typically does not cause the same mono symptoms. Very rarely, reinfection with a different EBV strain may occur.
EBV causes more severe and longer-lasting symptoms than a typical sore throat. The fatigue with mono is extreme and can last for weeks or months. You may also have very swollen lymph nodes, an enlarged spleen, and elevated liver enzymes. A regular bacterial sore throat usually responds to antibiotics, while mono does not.
EBV directly infects liver cells, causing inflammation known as viral hepatitis. This inflammation damages liver cells, which release enzymes like ALT into the bloodstream. About 80 to 90 percent of people with mono develop elevated ALT levels. Monitoring ALT helps doctors track liver health and identify severe cases that need closer attention.
Yes, mono is very contagious and spreads through saliva and close contact. Avoid kissing, sharing drinks, utensils, or personal items while you are sick. Wash your hands frequently and cover your mouth when coughing. You can spread the virus for weeks after symptoms start, and it may appear in your saliva intermittently even after recovery.
Focus on nutrient-dense foods that support immune function and liver health. Eat plenty of fruits, vegetables, lean proteins, and whole grains. Include foods rich in vitamin C, zinc, and B vitamins. Avoid alcohol completely while your liver enzymes are elevated. Stay hydrated with water, herbal teas, and broth-based soups.
See a doctor if you have severe sore throat, extreme fatigue lasting more than a week, high fever, or swollen lymph nodes. Seek immediate care for difficulty breathing or swallowing, sharp pain in the upper left abdomen, severe headache, or jaundice. Blood tests can confirm EBV infection and check for liver involvement or other complications.
Most people recover fully from EBV infection with no lasting effects. The virus remains dormant in your body but usually causes no problems. In rare cases, EBV has been linked to chronic fatigue, autoimmune conditions, and certain cancers, especially in people with weakened immune systems. These complications are uncommon in otherwise healthy individuals.
Mono earned this nickname because it spreads easily through saliva during kissing. The virus is most common in teenagers and young adults who are more likely to have close contact with others. However, you can also get EBV by sharing drinks, eating utensils, or being exposed to an infected person's cough or sneeze.
The incubation period for EBV is typically 4 to 6 weeks after exposure. This means you can be infected and contagious before you feel sick. Children often have a shorter incubation period and milder symptoms. The long delay between infection and symptoms makes it difficult to identify exactly when and how you were exposed.